,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #egcb  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,novemb] #ah1 #bjad   
,mr4 ,deut* 7= himself & ,mr4 ,roskam7  
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to crack d[n on  
fraud 9 ! ,m$ic>e program to protect    
s5iors1 p ) disabilities1 & taxpay]s4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,/op ,s*emes & ,crimes ,aga9/ ,m$ic>e 
& ,s5iors 7,/op ,,scams7 ,act4  #b4     
,ensur+ t new m$ical cod+ sy/ems d n    
compromise fraud prev5tion ef=ts  7a7 ,9
 g5]al ,section #aagc7;c7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acbj;d-#b7;c77 is am5d$--  7#a7 9      
p>agraph 7#a7--  7,a7 9 subp>agraph     
7,a71 by /rik+ 2 or & ins]t+ or1 if no  

code sets = su* data elem5ts h be5      
develop$1 e/abli% code sets = ! data    
elem5ts22 &  7,b7 by /rik+ subp>agraph  
7,b7 & add+ ! foll[+ new subp>agraphs3  
7,b7 ensure t any entity produc+ &      
transmitt+ valid transactions t include 
code sets are subject to a consi/5t1    
indu/ry-wide framework t supports a     
seamless transition to new & modifi$    
code sets2 &  7,c7 e/abli%1 by a rule   
promulgat$ aft] notice & an opportunity 
= a he>+ on ! record1 an end-to-end te/+
 proc$ure = new & modifi$ code sets t   
%all require ! p>ticipation ( any entity
 produc+ & transmitt+ valid transactions
 t use su* new or modifi$ code set4  2 &
  7#b7 by add+ at ! end ! foll[+        
p>agraphs3  7#c7 ,adopt+ new & modifi$  
code sets ,! ,secret>y %all n adopt a   
new or modifi$ code set unless !        
,secret>y--  7,a7 assesses ! impact ( ! 
code set on fraud prev5tion & pre-paym5t
 review1 det]m9es t anti-fraud edits "w 
z int5d$1 & confirms t a plan is 9 place
 to ensure cont9u+ effective detection (

 fraud foll[+ ! adoption ( ! code set2  
7,b7 ensures t ! end-to-end te/+        
proc$ure e/abli%$ by ! ,secret>y "u     
p>agraph 7#a7 has be5 complet$2 &  7,c7 
completes end-to-end te/+ ) any ,f$]al  
,gov]nm5t entity t produces & transmits 
valid transactions t include ! code set 
) private sector track+ p>tn]s4  7#d7   
,r\t9e updates to exi/+ code sets       
,p>agraph 7#c7 %all n apply to r\t9e1   
regul>ly s*$ul$ updates to exi/+ code   
sets4  4  7b7 ,effective date ,!        
am5dm5ts made by ?is section %all be    
effective z ( ,octob] #a1 #bjae4  #c4   
,v]ification ( provid] own]%ip int]e/s  
7a7 ,9 g5]al ,section #aabd7;c7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#c7;c77 is am5d$--  7#a7 by     
r$esignat+ p>agraph 7#e7 z p>agraph     
7#f72 &  7#b7 by ins]t+ aft] p>agraph   
7#d7 ! foll[+ p>agraph3  7#e7           
,v]ification ( ,in=mation  7,a7 ,9 g5]al
 ,) respect to in=mation suppli$ by a   
disclos+ entity "u subsections 7a7 &    
7b71 ! ,secret>y %all--  7i7 v]ify su*  

in=mation by comp>+ x to available data 
on ! provid] collect$ ?r\gh disclosures 
made to ! ,secret>y "u section          
#aabh;,g7a77#b71 or1 9 ! case ( a       
disclos+ entity to :i* section          
#aabh;,g7a77#b7 does n apply1 v]ify su* 
in=mation ?r\gh comp>ison ) at lea/ "o  
o!r public or private database :i*      
conta9s in=mation z to ! id5tity ( ea*  
p]son ) an own]%ip or control int]e/ 9 !
 entity2 &  7ii7 confirm ! accuracy (   
any social security acc\nt numb] or     
employ] id5tification numb] suppli$ "u  
subsection 7a7 by v]ify+--  7,i7 ea*    
social security acc\nt numb] ) !        
,commission] ( ,social ,security2 &     
7,,ii7 ea* employ] id5tification numb] )
 ! ,secret>y ( ! ,treasury4  7,b7       
,discrepancies ,if ! comp>ison describ$ 
9 subp>agraph 7,a77i7 reveals a         
discrepancy betwe5 in=mation suppli$ by 
a disclos+ entity "u subsections 7a7 &  
7b7 & available data on ! provid]       
collect$ ?r\gh disclosures made to !    
,secret>y "u section #aabh;,g7a77#b71 ! 

,secret>y %all indep5d5tly v]ify !      
accuracy ( su* data collect$ "u section 
#aabh;,g7a77#b7 be=e tak+ any action    
aga9/ a provid] bas$ on su* discrepancy4
  4  7b7 ,effective date ,! am5dm5ts    
made by ?is section %all be effective z 
( ! date t is #a ye> aft] ! date (      
enactm5t ( ?is ,act4  #d4 ,support+     
public & private in=mation %>+ to prev5t
 heal? c>e fraud  7a7 ,def9itions ,9 ?is
 section3  7#a7 ,heal?c>e fraud         
prev5tion p>tn]%ip2 ,p>tn]%ip ,! t]ms   
,heal?c>e ,fraud ,prev5tion ,p>tn]%ip & 
,p>tn]%ip mean ! in=mation %>+ p>tn]%ip 
e/abli%$ betwe5 ! ,dep>tm5t ( ,heal? &  
,human ,s]vices1 ! ,dep>tm5t ( ,ju/ice1 
& o!r public & private /akehold]s1      
includ+ private insur]s1 "u ! au?ority (
 section #aabh;,c7a77#b7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;c7a77#b77 = ! purpose (      
detect+ & prev5t+ heal? c>e fraud4  7#b7
 ,private insur] ,! t]m private insur]  
has ! mean+ giv5 ! t]m heal? insurance  
issu] "u section #bgia7;b77#b7 ( !      

,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;,,gg-#ia7;b77#b774  7b7  
,safe h>bor = ! %>+ ( in=mation  7#a7   
,g5]al immunity  7,a7 ,9 g5]al ,a       
non-gov]nm5tal entity p>ticipat+ 9 !    
,p>tn]%ip 7includ+ a private insur]7 t--
  7i7 provides data or in=mation        
describ$ 9 clause 7i7 or 7ii7 (         
subp>agraph 7,b7 to ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 ! ,dep>tm5t (       
,ju/ice1 any o!r ,f$]al or ,/ate law    
en=cem5t ag5cy1 any contractor ( su*    
,dep>tm5t or ag5cy1 or ano!r entity     
p>ticipat+ 9 ! ,p>tn]%ip 7includ+ a     
private insur]72 or  7ii7 uses su* data 
or in=mation z p]mitt$ by ?is           
subsection1  %all be immune f civil     
liability ) respect to ! provision or   
au?oriz$ use ( su* data or in=mation4   
7,b7 ,data or in=mation  7i7 ,data ,!   
data describ$ 9 ?is clause is aggregat$ 
claims data or o!r in=mation describ$ 9 
clause 7ii7 t does n include            
individually id5tifiable in=mation )    
respect to any heal? c>e provid]1       

suppli]1 or b5efici>y1 :e!r or n        
analysis ( su* in=mation results 9 !    
id5tification ( a heal? c>e provid]1    
suppli]1 or o!r p]son or organization z 
hav+ committ$ fraud or hav+ committ$    
acts suspect$ ( be+ fraudul5t4  7ii7    
,in=mation ,! in=mation describ$ 9 ?is  
clause is in=mation conc]n+ fraud or    
suspect$ fraudul5t acts t id5tifies a   
specific heal? c>e provid]1 suppli]1 or 
o!r p]son or organization if ! provid]1 
suppli]1 or o!r p]son or organization s 
id5tifi$--  7,i7 is ! subject ( a bona  
fide fraud inve/igation conduct$ by !   
entity p>ticipat+ 9 ! ,p>tn]%ip1 includ+
 a private insur]1 t is provid+ !       
in=mation2  7,,ii7 is ! subject ( a     
fraud-relat$ allegation t has be5 fil$  
by or receiv$ by ! entity p>ticipat+ 9 !
 ,p>tn]%ip1 includ+ a private insur]1 t 
is provid+ ! in=mation2 or  7,,iii7 has 
be5 convict$ ( a fraud-relat$ (f5se4    
7#b7 ,limitation ,! immunity describ$ 9 
p>agraph 7#a7 %all apply only :]e--     
7,a7 ! data or in=mation involv$ 0      

provid$ 9 good fai? & )\t malice2 &     
7,b7 ! data or in=mation provid$ is     
true1 bas$ on a reasonable belief1 to ! 
k ( ! p]son provid+ ! in=mation1 or if  
false1 ! in=mation is provid$ )\t k (1 &
 )\t reckless disreg>d =1 its falsity4  
7#c7 ,use ( ,p>tn]%ip data or in=mation 
,= purposes ( ?is subsection1 data or   
in=mation relat+ to a specific provid]  
or suppli] receiv$ by a private insur]  
solely ?r\gh ! ,p>tn]%ip %all be us$1 ) 
respect to su* provid] or suppli]1 only 
= ! purpose ( in=m+ decisionmak+ by !   
private insur] relat$ to fraud          
inve/igations1 includ+ :e!r to conduct  
su* an inve/igation4 ,no?+ 9 ! prec$+   
s5t5ce %all prev5t a private insur] or  
o!r entity p>ticipat+ 9 ! ,p>tn]%ip f   
tak+ o!r actions1 n specific to su*     
provid] or suppli]1 bas$ on su* data or 
in=mation4  7c7 ,report ,n lat] ?an     
,octob] #a ( ea* cal5d> ye> t beg9s aft]
 ! date ( enactm5t ( ?is ,act1 !        
,secret>y ( ,heal? & ,human ,s]vices    
%all submit to ! ,special ,committee on 

,ag+1 ! ,committee on ,f9ance1 & !      
,committee on ,homel& ,security &       
,gov]nm5tal ,affairs ( ! ,s5ate1 & !    
,committee on ,ways & ,means & !        
,committee on ,en]gy & ,comm]ce ( !     
,h\se ( ,repres5tatives1 a report t     
describes ! activities ( ! ,heal?c>e    
,fraud ,prev5tion ,p>tn]%ip4 ,su* report
 %all include--  7#a7 a description ( h[
 input 0 obta9$ f private insur]s reg>d+
 ! appropriate usage ( data %>$ ?r\gh ! 
,heal?c>e ,fraud ,prev5tion ,p>tn]%ip2 &
  7#b7 plans = ! ,p>tn]%ip to be exp&$  
to encompass a repres5tative sample (   
national private insur]s & to include   
heal? c>e provid] organizations4  #e4   
,med,p,a,c /udy & report  7a7 ,/udy ,!  
,m$ic>e ,paym5t ,advisory ,commission   
%all conduct a /udy on adm9i/rative     
ef=ts to /r5g!n program integrity 9 !   
,m$ic>e program4 ,su* /udy may include--
  7#a7 an evaluation ( ways to detect   
fraudul5t claims be=e paym5t is made2   
7#b7 a review ( ! effici5cy &           
effectiv5ess ( po/-paym5t recov]y       

me?ods2  7#c7 analysis by ! ,c5t]s =    
,m$ic>e  ,m$icaid ,s]vices & public     
report+ ( claims & sp5d+ patt]ns2 &     
7#d7 a review ( ! organizational        
/ructure & res\rces ( ! ,c5t]s = ,m$ic>e
  ,m$icaid ,s]vices z !y relate to      
program integrity4  7b7 ,report ,n lat] 
?an ,june #ae1 #bjaf1 ! ,m$ic>e ,paym5t 
,advisory ,commission %all submit to    
,congress a report on ! /udy conduct$ "u
 subsection 7a71 toge!r ) recomm5dations
 = su* legislative & adm9i/rative action
 z ! ,commission det]m9es appropriate4  
#f4 ,ability to measure fraud prev5tion 
ef=ts ,section #dbda ( ! ,small ,bus9ess
 ,jobs ,act ( #bjaj 7#db ,u4,s4,c4      
#acbj;a-#gm7 is am5d$--  7#a7 9         
subsection 7b77#d71 by ins]t+ & on civil
 recov]ies1 adm9i/rative actions1 &     
crim9al convictions = fraud aft]        
reimbursem5t2 &  7#b7 9 subsection 7c71 
by add+ at ! end ! foll[+ p>agraph3     
7#g7 ,implem5tation ( am5dm5ts ,!       
,secret>y %all implem5t am5dm5ts made to
 ?is subsection by ! ,/op ,s*emes &     

,crimes ,aga9/ ,m$ic>e & ,s5iors 7,/op  
,,scams7 ,act n lat] ?an #f mon?s aft] !
 date ( enactm5t ( su* ,act4 ,if !      
,secret>y det]m9es t new te*nology or   
data process+ sy/ems are requir$ to c>ry
 out su* am5dm5ts1 ! ,secret>y %all     
issue a reque/ = proposals to c>ry out  
su* am5dm5ts n lat] ?an #f mon?s aft] ! 
enactm5t ( su* ,act1 & ! contractors    
select$ "u su* reque/ = proposal %all   
implem5t su* am5dm5ts n lat] ?an #ab    
mon?s aft] ! date ( enactm5t ( su* ,act4
  4