,i  #aadth ,,congress  #b;d ,session    
,h4 ,r4 #dhja  ,,in ,,the ,,house ,,of  
,,representatives  ,march #ag1 #bjaf    
,ms4 ,michelle ,lujan ,grisham of ,new  
,mexico 7for herself and ,ms4           
,schakowsky7 introduced the following   
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on ,ways 
and ,means1 for a period to be          
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to amend title ,,xxvii of   
the ,public ,health ,service ,act1 and  
title ,,xviii of the ,social ,security  
,act1 to direct the ,secretary of       
,health and ,human ,services to conduct 
audits of medical loss ratio reports    
submitted by health insurance issuers1  
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,medical ,loss ,ratio ,accountability   
,act of #bjaf4  #b4 ,audits of medical  

loss ratio reports submitted with       
respect to group or individual health   
insurance coverage ,section #bgah of the
 ,public ,health ,service ,act 7#db     
,u4,s4,c4 #cjj;gg-#ah7 is amended--     
7#a7 in subsection 7b77#c71 by inserting
 1 including with respect to the        
submission of any information that1     
pursuant to an audit conducted under    
subsection 7f71 is found to be          
untruthful or inaccurate after          
penalties2 and  7#b7 by adding at the   
end the following new subsection3  7f7  
,audits  7#a7 ,in general ,beginning    
with the first plan year that begins    
after the date of the enactment of the  
,medical ,loss ,ratio ,accountability   
,act of #bjaf1 the ,secretary shall1    
with respect to a statistically         
significant percentage of the reports   
submitted under this section by health  
insurance issuers offering group or     
individual health insurance coverage    
7including grandfathered health plans71 
conduct audits of the books and records 

7or such other information as may be    
necessary7 of such health insurance     
issuers to verify that the information  
contained in each such report is        
truthful and accurate4  7#b7 ,selection 
of reports for audits ,in selecting     
reports to be audited under paragraph   
7#a71 the ,secretary shall ensure that1 
for a plan year1 the health insurance   
issuers whose reports are selected for  
such audits are representative of the   
health insurance issuers that submitted 
such reports for such plan year4  7#c7  
,authority to enter into contracts or   
cooperative agreements ,the ,secretary  
may1 for purposes of conducting audits  
under paragraph 7#a71 enter into a      
contract or cooperative agreement with a
 private entity4  7#d7 ,report to       
,congress ,beginning #ah months after   
the date of the enactment of the        
,medical ,loss ,ratio ,accountability   
,act of #bjaf and each year thereafter1 
the ,secretary shall submit to ,congress
 a report on the results of audits      

conducted under this section with       
respect to the previous plan year4  4   
#c4 ,application to parts ,c and ,d of  
the ,medicare program ,section          
#aheg7;e77#d7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#bg7;e77#d77 
is amended by adding at the end the     
following new flush sentence3  ,in the  
case that audits have been conducted by 
the ,secretary 7such as the audits      
conducted under section #bgah7;f7 of the
 ,public ,health ,service ,act7 of the  
books and records 7or of such other     
information as may be necessary7 of an  
,,ma plan for a contract year that      
begins on or after the date of the      
enactment of the ,medical ,loss ,ratio  
,accountability ,act of #bjaf1 a        
determination that is made under this   
paragraph for such ,,ma plan for such   
contract year shall be based upon one or
 more reports 7or other submissions of  
information7 by the ,,ma plan with      
respect to which the ,secretary has     
verified1 through such audits of such   

,,ma plan1 that the information         
contained in such reports 7or other     
submissions7 is truthful and accurate4 4