,i  #aaith ,,congress  #ast ,session    
,h4 ,r4 #fhfc  ,,in ,,the ,,house ,,of  
,,representatives  ,december #ah1       
#bjbe,mr4 ,harder of ,california 7for   
himself and ,mrs4 ,kim7 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 ,,xviii of   
the ,social ,security ,act to improve   
transparency with respect to the        
suspension of ,medicare payments pending
 an investigation into a credible       
allegation of fraud4  #a4 ,short title  
,this ,act may be cited as the ,centers 
for ,medicare  ,medicaid ,services      
,auditor ,transparency ,act of #bjbe or 
the ,,cat ,act of #bjbe4  #b4 ,findings 
,congress finds the following3 7#a7 ,in 
#bjbj1 #aci1jjj1jjj individuals received

 health care coverage through the       
,medicare or ,medicaid programs1 costing
 the ,federal ,government approximately 
#a1ejj1jjj1jjj1jjj4 ,of these funds paid
 by ,united ,states taxpayers1          
#c1ajj1jjj1jjj were discovered to have  
been fraudulent claims4  7#b7 ,ensuring 
the integrity of the ,medicare and      
,medicaid programs is crucial to        
preventing fraud1 waste1 and abuse and  
safeguarding the financial              
sustainability of these important       
programs4  7#c7 ,even though the        
,centers for ,medicare  ,medicaid       
,services 7,,cms7 utilization of        
,unified ,program ,integrity            
,contractors 7,u,p,i,cs7 has shown to be
 effective at identifying bad actors    
defrauding the ,federal ,government     
through the ,medicare and ,medicaid     
programs1 current ,federal law and      
regulations have shown to be harmful to 
most providers who are submitting       
,medicare and ,medicaid claims in good  
faith4  7#d7 ,existing law provides     

,,cms and ,u,p,i,cs broad authority and 
discretion to suspend ,medicare payments
 for up to a year pending the           
investigation of credible allegations of
 fraud4  7#e7 ,however1 current law does
 not require adequate transparency from 
,,cms or ,u,p,i,cs into the nature of   
the alleged fraud before ,medicare      
payments are suspended4 ,current law    
also does not require ,,cms or ,u,p,i,cs
 to provide adequate due process to     
providers whose payments have been      
suspended to challenge or cure the      
allegations of fraud prior to the       
suspension of ,medicare payments4  7#f7 
,in addition1 anecdotal reports have    
shown that some ,u,p,i,cs extend the    
suspension of ,medicare payments on a   
routine basis so that they may have     
additional time to finish their audit   
despite not providing evidence that the 
continuation of a payment suspension is 
necessary to protect the integrity of   
the ,medicare program4  7#g7 ,the broad 
authority to suspend ,medicare payments 

pending the investigation of a credible 
allegation of fraud without adequate due
 process or transparency places the     
financial viability of many ,medicare   
providers acting in good faith at risk4 
7#h7 ,if ,medicare providers acting in  
good faith close their doors as a result
 of the unnecessary suspension of       
payments by ,,cms or ,u,p,i,cs1         
,medicare beneficiaries and the         
,american public could face additional  
barriers to access to necessary health  
care services as a direct result of     
unfair ,federal law and regulations4    
#c4 ,improving transparency in          
suspension of payments pending          
investigation of credible allegations of
 fraud under ,medicare  7a7 ,in general 
,section #ahfb7o7 of the ,social        
,security ,act 7#db ,u4,s4,c4 #aciey7o77
 is amended-- 7#a7 in paragraph 7#a7--  
7,a7 by striking ,the ,secretary may    
suspend and inserting ,subject to       
paragraph 7#e71 the ,secretary may      
suspend2 and  7,b7 by inserting ,an     

investigation of a credible allegation  
of fraud1 and the suspension of payment 
pending such investigation under the    
preceding sentence1 may only exceed #ahj
 days if the ,secretary determines there
 is good cause to extend such           
investigation and suspension4 at the    
end2  7#b7 in paragraph 7#d7-- 7,a7 by  
striking a fraud hotline tip 7as defined
 by the ,secretary7 and inserting the   
following items2 and  7,b7 by striking  
credible allegation of fraud4 and       
inserting credible allegation of fraud3 
7,a7 ,a fraud hotline tip 7as defined by
 the ,secretary74  7,b7 ,mere error 7as 
defined by the ,secretary74  7,c7 ,a    
billing error found during the course of
 an audit that is attributable to human 
error4  4  7#c7 by adding at the end the
 following new paragraphs3  7#e7        
,transparency in suspension of payments 
7,a7 ,in general ,the ,secretary may    
only suspend payments to a provider of  
services or supplier under this title   
pursuant to paragraph 7#a7 if-- 7i7     

subject to subparagraph 7,b71 not later 
than #cj days before the date on which  
the payment suspension begins1 the      
,secretary provides such provider of    
services or supplier with information   
about each credible allegation of fraud 
that is the basis for the payment       
suspension1 including-- 7,i7 the        
specific nature of each credible        
allegation of fraud2  7,,ii7 the date of
 the alleged fraud2 and  7,,iii7 the    
basis of the credible allegation of     
fraud1 such as whether the allegation is
 based upon-- 7aa7 a fraud hotline      
complaint2  7bb7 data mining of data    
with respect to claims for payment under
 this title1 title ,,xix1 or title      
,,xxi2 or  7cc7 a pattern identified    
through audits of providers of services 
or suppliers2 and  7ii7 not less        
frequently than once every #cj days     
during such payment suspension1 the     
,secretary provides such provider of    
services or supplier with-- 7,i7 a      
detailed1 up-to-date list of the        

findings of the investigation2  7,,ii7  
an anticipated timeline for the         
completion of the investigation2 and    
7,,iii7 an opportunity to ask the       
,centers for ,medicare  ,medicaid       
,services questions regarding the       
payment suspension and the              
investigation4  7,b7 ,exception ,the    
,secretary may elect not to provide a   
provider of services or supplier with   
the information described in            
subparagraph 7,a77i7 if the provision of
 such information would compromise the  
integrity of the investigation1 as      
determined by the ,secretary in         
consultation with the ,inspector        
,general of the ,department of ,health  
and ,human ,services and ,state auditors
 7as appropriate74  7,c7 ,failure to    
provide information ,if the requirements
 described in subparagraph 7,a7 are not 
met with respect to the suspension of   
payment to a provider of services or a  
supplier under this title1 the          
,secretary shall immediately resume such

 payment1 and shall pay to the provider 
of services or supplier the amounts not 
paid due to such suspension and any     
interest accrued with respect to such   
amounts4  7,d7 ,annual report ,not later
 than #ahj days after the end of each   
fiscal year 7beginning with fiscal year 
#bjbe71 the ,secretary shall submit to  
,congress a report that includes the    
following information with respect to   
such fiscal year3 7i7 ,the number of    
payment suspensions issued as the result
 of a pending investigation of a        
credible allegation of fraud under this 
subsection1 section #ahfj;,d-#ab7;b77#g7
 7including as applied pursuant to      
section #aheg7;f77#c77;,d771 or section 
#aijc7;i77#b77;,c74  7ii7 ,the basis of 
each such credible allegation of fraud4 
7iii7 ,the average duration of a payment
 suspension described in clause 7i74    
7iv7 ,the average duration of an        
investigation of a credible allegation  
of fraud described in clause 7i74  7v7  
,if applicable1 the average time between

 the completion of an investigation into
 a credible allegation of fraud         
described in clause 7i7 and the         
reinstatement of payments to the        
relevant provider of services or        
supplier4  7#f7 ,appeals ,not later than
 #ahj days after the date of the        
enactment of the ,,cat ,act of #bjbe1   
the ,secretary shall provide an         
independent process by which a provider 
of services or supplier under this title
 that has received notice of a payment  
suspension due to a pending             
investigation of a credible allegation  
of fraud pursuant to this subsection may
 appeal such suspension and receive a   
resolution of such appeal in a timely   
manner4  4  7b7 ,stakeholder            
consultation ,in developing the appeals 
process required under section          
#ahfb7o77#f7 of the ,social ,security   
,act1 as added by subsection 7a71 the   
,secretary of ,health and ,human        
,services shall consult with relevant   
stakeholders1 including providers of    

services and suppliers under title      
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie et seq471 title    
,,xix of such ,act 7#db ,u4,s4,c4 #acif 
et seq471 and title ,,xxi of such ,act  
7#db ,u4,s4,c4 #acig;aa et seq471 as    
determined appropriate by the           
,secretary4  7c7 ,applicability ,the    
amendments made by this section shall   
apply with respect to any investigation 
of a credible allegation of fraud under 
section #ahfb7o7 of the ,social         
,security ,act 7#db ,u4,s4,c4           
#aciey7o771 section #ahfj;,d-#ab7;b77#g7
 of such ,act 7#db ,u4,s4,c4            
#aciew-#aab7;b77#g77 7including as      
applied pursuant to section             
#aheg7;f77#c77;,d7 of such ,act 7#db    
,u4,s4,c4 #aciew-#bg7;f77#c77;,d7771 or 
section #aijc7;i77#b77;,c7 of such ,act 
7#db ,u4,s4,c4 #acif;b7i77#b77;,c77 that
 is initiated after the date of         
enactment of this ,act4