,i #aai? ,,congress #a/ ,session ,h4 ,r4 #fhfc ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,decemb] #ah1 #bjbe,mr4 ,h>d] ( ,cali=nia 7= himself & ,mrs4 ,kim7 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 improve transp>5cy ) respect to ! susp5sion ( ,m$ic>e paym5ts p5d+ an inve/igation into a cr$ible allegation ( fraud4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,auditor ,transp>5cy ,act ( #bjbe or ! ,,cat ,act ( #bjbe4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,9 #bjbj1 #aci1jjj1jjj individuals receiv$ heal? c>e cov]age ?r\gh ! ,m$ic>e or ,m$icaid programs1 co/+ ! ,f$]al ,gov]nm5t approximately #a1ejj1jjj1jjj1jjj4 ,( ^! funds paid by ,unit$ ,/ates taxpay]s1 #c1ajj1jjj1jjj 7 discov]$ to h be5 fraudul5t claims4 7#b7 ,ensur+ ! integrity ( ! ,m$ic>e & ,m$icaid programs is crucial to prev5t+ fraud1 wa/e1 & abuse & safegu>d+ ! f9ancial su/a9ability ( ^! important programs4 7#c7 ,ev5 ?\gh ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7,,cms7 utilization ( ,unifi$ ,program ,integrity ,contractors 7,u,p,i,cs7 has %[n to be effective at id5tify+ bad actors defraud+ ! ,f$]al ,gov]nm5t ?r\gh ! ,m$ic>e & ,m$icaid programs1 curr5t ,f$]al law & regulations h %[n to be h>mful to mo/ provid]s :o are submitt+ ,m$ic>e & ,m$icaid claims 9 good fai?4 7#d7 ,exi/+ law provides ,,cms & ,u,p,i,cs broad au?ority & discretion to susp5d ,m$ic>e paym5ts = up to a ye> p5d+ ! inve/igation ( cr$ible allegations ( fraud4 7#e7 ,h[ev]1 curr5t law does n require adequate transp>5cy f ,,cms or ,u,p,i,cs into ! nature ( ! alleg$ fraud be=e ,m$ic>e paym5ts are susp5d$4 ,curr5t law also does n require ,,cms or ,u,p,i,cs to provide adequate due process to provid]s ^: paym5ts h be5 susp5d$ to *all5ge or cure ! allegations ( fraud prior to ! susp5sion ( ,m$ic>e paym5ts4 7#f7 ,9 addition1 anecdotal reports h %[n t "s ,u,p,i,cs ext5d ! susp5sion ( ,m$ic>e paym5ts on a r\t9e basis s t !y may h additional "t to f9i% _! audit despite n provid+ evid5ce t ! cont9uation ( a paym5t susp5sion is necess>y to protect ! integrity ( ! ,m$ic>e program4 7#g7 ,! broad au?ority to susp5d ,m$ic>e paym5ts p5d+ ! inve/igation ( a cr$ible allegation ( fraud )\t adequate due process or transp>5cy places ! f9ancial viability ( _m ,m$ic>e provid]s act+ 9 good fai? at risk4 7#h7 ,if ,m$ic>e provid]s act+ 9 good fai? close _! doors z a result ( ! unnecess>y susp5sion ( paym5ts by ,,cms or ,u,p,i,cs1 ,m$ic>e b5efici>ies & ! ,am]ican public c\ld face additional b>ri]s to access to necess>y heal? c>e s]vices z a direct result ( unfair ,f$]al law & regulations4 #c4 ,improv+ transp>5cy 9 susp5sion ( paym5ts p5d+ inve/igation ( cr$ible allegations ( fraud "u ,m$ic>e 7a7 ,9 g5]al ,section #ahfb7o7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7o77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 by /rik+ ,! ,secret>y may susp5d & ins]t+ ,subject to p>agraph 7#e71 ! ,secret>y may susp5d2 & 7,b7 by ins]t+ ,an inve/igation ( a cr$ible allegation ( fraud1 & ! susp5sion ( paym5t p5d+ su* inve/igation "u ! prec$+ s5t5ce1 may only exce$ #ahj days if ! ,secret>y det]m9es !re is good cause to ext5d su* inve/igation & susp5sion4 at ! end2 7#b7 9 p>agraph 7#d7-- 7,a7 by /rik+ a fraud hotl9e tip 7z def9$ by ! ,secret>y7 & ins]t+ ! foll[+ items2 & 7,b7 by /rik+ cr$ible allegation ( fraud4 & ins]t+ cr$ible allegation ( fraud3 7,a7 ,a fraud hotl9e tip 7z def9$ by ! ,secret>y74 7,b7 ,m]e error 7z def9$ by ! ,secret>y74 7,c7 ,a bill+ error f\nd dur+ ! c\rse ( an audit t is attributable to human error4 4 7#c7 by add+ at ! end ! foll[+ new p>agraphs3 7#e7 ,transp>5cy 9 susp5sion ( paym5ts 7,a7 ,9 g5]al ,! ,secret>y may only susp5d paym5ts to a provid] ( s]vices or suppli] "u ?is title pursuant to p>agraph 7#a7 if-- 7i7 subject to subp>agraph 7,b71 n lat] ?an #cj days be=e ! date on :i* ! paym5t susp5sion beg9s1 ! ,secret>y provides su* provid] ( s]vices or suppli] ) in=mation ab\t ea* cr$ible allegation ( fraud t is ! basis = ! paym5t susp5sion1 includ+-- 7,i7 ! specific nature ( ea* cr$ible allegation ( fraud2 7,,ii7 ! date ( ! alleg$ fraud2 & 7,,iii7 ! basis ( ! cr$ible allegation ( fraud1 su* z :e!r ! allegation is bas$ ^u-- 7aa7 a fraud hotl9e compla9t2 7bb7 data m9+ ( data ) respect to claims = paym5t "u ?is title1 title ,,xix1 or title ,,xxi2 or 7cc7 a patt]n id5tifi$ ?r\gh audits ( provid]s ( s]vices or suppli]s2 & 7ii7 n less frequ5tly ?an once e #cj days dur+ su* paym5t susp5sion1 ! ,secret>y provides su* provid] ( s]vices or suppli] )-- 7,i7 a detail$1 up-to-date li/ ( ! f9d+s ( ! inve/igation2 7,,ii7 an anticipat$ timel9e = ! completion ( ! inve/igation2 & 7,,iii7 an opportunity to ask ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices que/ions reg>d+ ! paym5t susp5sion & ! inve/igation4 7,b7 ,exception ,! ,secret>y may elect n to provide a provid] ( s]vices or suppli] ) ! in=mation describ$ 9 subp>agraph 7,a77i7 if ! provision ( su* in=mation w\ld compromise ! integrity ( ! inve/igation1 z det]m9$ by ! ,secret>y 9 consultation ) ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices & ,/ate auditors 7z appropriate74 7,c7 ,failure to provide in=mation ,if ! requirem5ts describ$ 9 subp>agraph 7,a7 are n met ) respect to ! susp5sion ( paym5t to a provid] ( s]vices or a suppli] "u ?is title1 ! ,secret>y %all imm$iately resume su* paym5t1 & %all pay to ! provid] ( s]vices or suppli] ! am\nts n paid due to su* susp5sion & any int]e/ accru$ ) respect to su* am\nts4 7,d7 ,annual report ,n lat] ?an #ahj days aft] ! end ( ea* fiscal ye> 7beg9n+ ) fiscal ye> #bjbe71 ! ,secret>y %all submit to ,congress a report t includes ! foll[+ in=mation ) respect to su* fiscal ye>3 7i7 ,! numb] ( paym5t susp5sions issu$ z ! result ( a p5d+ inve/igation ( a cr$ible allegation ( fraud "u ?is subsection1 section #ahfj;,d-#ab7;b77#g7 7includ+ z appli$ pursuant to section #aheg7;f77#c77;,d771 or section #aijc7;i77#b77;,c74 7ii7 ,! basis ( ea* su* cr$ible allegation ( fraud4 7iii7 ,! av]age duration ( a paym5t susp5sion describ$ 9 clause 7i74 7iv7 ,! av]age duration ( an inve/igation ( a cr$ible allegation ( fraud describ$ 9 clause 7i74 7v7 ,if applicable1 ! av]age "t betwe5 ! completion ( an inve/igation into a cr$ible allegation ( fraud describ$ 9 clause 7i7 & ! re9/atem5t ( paym5ts to ! relevant provid] ( s]vices or suppli]4 7#f7 ,appeals ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ! ,,cat ,act ( #bjbe1 ! ,secret>y %all provide an indep5d5t process by :i* a provid] ( s]vices or suppli] "u ?is title t has receiv$ notice ( a paym5t susp5sion due to a p5d+ inve/igation ( a cr$ible allegation ( fraud pursuant to ?is subsection may appeal su* susp5sion & receive a resolution ( su* appeal 9 a timely mann]4 4 7b7 ,/akehold] consultation ,9 develop+ ! appeals process requir$ "u section #ahfb7o77#f7 ( ! ,social ,security ,act1 z add$ by subsection 7a71 ! ,secret>y ( ,heal? & ,human ,s]vices %all consult ) relevant /akehold]s1 includ+ provid]s ( s]vices & suppli]s "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq471 & title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq471 z det]m9$ appropriate by ! ,secret>y4 7c7 ,applicability ,! am5dm5ts made by ?is section %all apply ) respect to any inve/igation ( a cr$ible allegation ( fraud "u section #ahfb7o7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7o771 section #ahfj;,d-#ab7;b77#g7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#aab7;b77#g77 7includ+ z appli$ pursuant to section #aheg7;f77#c77;,d7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#bg7;f77#c77;,d7771 or section #aijc7;i77#b77;,c7 ( su* ,act 7#db ,u4,s4,c4 #acif;b7i77#b77;,c77 t is initiat$ aft] ! date ( enactm5t ( ?is ,act4