,,ii  #aaith ,,congress  #b;d ,session  
,s4 #cgbg  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,january #bi1  
#bjbf,ms4 ,ernst introduced the         
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to combat fraud in ,federal 
programs1 and for other purposes4  #a4  
,short title ,this ,act may be cited as 
the ,putting an ,n to ,learing about    
,fraud ,act4  #b4 ,preventing fraud in  
child care services  7a7 ,state plan    
,section #feh;,e of the ,child ,care and
 ,development ,block ,grant ,act of     
#aiij 7#db ,u4,s4,c4 #iheh;c7 is        
amended-- 7#a7 in subsection 7c77#b71 by
 adding by striking subparagraph 7,s7   
and inserting the following3  7,s7      
,attendance-based billing ,the plan     
shall include an assurance that the lead
 agency will provide payment under this 
subchapter to a child care provider     
based on recorded attendance1 rather    
than enrollment alone1 in the program of
 the provider4  2 and  7#b7 by adding at

 the end the following3  7e7 ,timing of 
payment ,nothing in this subchapter     
shall be construed to require a lead    
agency to make a payment to a child care
 provider prior to the provision of     
child care services4 ,the lead agency   
shall make a payment under this         
subchapter to such a provider as        
reimbursement1 in a timely manner1 and  
on the basis of the provider's provision
 of child care services4  4  7b7 ,audits
 ,section #feh,k of the ,child ,care and
 ,development ,block ,grant ,act of     
#aiij 7#db ,u4,s4,c4 #iheh;i7 is amended
 by adding at the end the following3    
7c7 ,federal audits ,each child care    
provider that receives a payment under  
this subchapter shall prepare a record  
of attendance in the provider's program 
and of the provider's provision of child
 care services1 and maintain the record 
for a period of #g years after the date 
of preparation of such record4 ,the     
provider shall make such records        
available for audits by the ,secretary1 

the ,attorney ,general1 and the         
,comptroller ,general of the ,united    
,states4  4  #c4 ,identifying fraud in  
health care services  7a7 ,medicare     
7#a7 ,in general ,the ,secretary of     
,health and ,human ,services shall1 not 
later than #fj days after making a      
determination described in paragraph    
7#b71 notify the ,inspector ,general of 
the ,department of ,health and ,human   
,services of such determination4  7#b7  
,determination ,a determination         
described in this paragraph is a        
determination that-- 7,a7 the aggregate 
amount paid under the ,medicare program 
under title ,,xviii of the ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 for an item or service or items or
 services in a zip code and county or   
county equivalent increased by more than
 #ajj percent in a single year2 or  7,b7
 the number of provider of services or  
suppliers 7as those terms are defined   
under section #ahfa of the ,social      
,security ,act 7#db ,u4,s4,c4 #aciex77  

who received payment for items or       
services furnished under the ,medicare  
program increased in a zip code and     
county or county equivalent by more than
 #ajj percent in a single year4  7b7    
,qualified health plans under the       
,american ,health ,benefit ,exchanges   
7#a7 ,in general ,the ,secretary of     
,health and ,human ,services shall1 not 
later than #fj days after making a      
determination described in paragraph    
7#b71 notify the ,inspector ,general of 
the ,department of ,health and ,human   
,services of such determination4  7#b7  
,determination ,a determination         
described in this paragraph is a        
determination that-- 7,a7 the aggregate 
amount paid under all qualified health  
plans offered through the ,american     
,health ,benefit ,exchanges established 
under sections #acaa and #acba of the   
,patient ,protection and ,affordable    
,care ,act 7#db ,u4,s4,c4 #ahjca1       
#ahjda7 for an item or service or items 
or services in a zip code and county or 

county equivalent increased by more than
 #ajj percent in a single year2 or  7,b7
 the number of providers of services who
 received payment for items or services 
under such qualified health plans       
increased in a zip code and county or   
county equivalent by more than #ajj     
percent in a single year4  7#c7         
,requirement to submit certain          
information ,annually1 each ,american   
,health ,benefit ,exchange established  
under section #acaa or #acba of the     
,patient ,protection and ,affordable    
,care ,act 7#db ,u4,s4,c4 #ahjca1       
#ahjda7 shall collect from each         
qualified health plan offered through   
such an ,exchange1 and submit to the    
,secretary of ,health and ,human        
,services1 the information necessary for
 the ,secretary to make a determination 
described in paragraph 7#b74  7c7       
,medicaid and ,,chip  7#a7 ,medicaid    
,section #aijb of the ,social ,security 
,act 7#db ,u4,s4,c4 #acif;a7 is         
amended-- 7,a7 in subsection 7a7-- 7i7  

in paragraph 7#hh71 by striking 2 and   
and inserting a semicolon2  7ii7 in     
paragraph 7#hi71 by striking the period 
at the end and inserting 2 and2 and     
7iii7 by adding after paragraph 7#hi7   
the following new paragraph3  7#ij7     
provide that1 not later than #fj days   
after making a determination described  
in subsection 7yy71 the ,state agency   
shall notify the ,secretary and the     
,inspector ,general of the ,department  
of ,health and ,human ,services of such 
determination4  2 and  7,b7 by adding at
 the end the following new subsection3  
7yy7 ,determination of certain increased
 payments or providers in a single year 
,for purposes of subsection 7a77#ij71 a 
determination described in this         
subsection is a determination that--    
7#a7 the aggregate amount paid under the
 ,state plan under this title1 or under 
a waiver of such plan1 for an item or   
service or items or services in a zip   
code and county or county equivalent    
increased by more than #ajj percent in a

 single year2 or  7#b7 the number of    
providers of items or services who      
received payments for items or services 
furnished in a zip code and county or   
county equivalent under such ,state plan
 or waiver increased by more than #ajj  
percent in a single year4  4  7#b7      
,,chip ,section #bajg7;e77#a7 of the    
,social ,security ,act 7#db ,u4,s4,c4   
#acig;gg7e77#a77 is amended by-- 7,a7   
redesignating subparagraphs 7,i7 through
 7,w7 as subparagraphs 7,j7 through     
7,x71 respectively2 and  7,b7 inserting 
after subparagraph 7,h7 the following   
subparagraph3  7,i7 ,subsections        
7a77#ij7 and 7yy7 of section #aijb      
7relating to determination of certain   
increased payments or providers in a    
single year and notification to the     
,secretary and the ,inspector ,general  
of ,health and ,human ,services74  4    
7d7 ,audit by the ,inspector ,general of
 ,health and ,human ,services ,not later
 than #e years after the date of        
enactment of this ,act1 and annually    

thereafter1 the ,inspector ,general of  
,health and ,human ,services shall--    
7#a7 identify1 based on the results of  
any notifications received under        
subsection 7a7 or 7b71 or under section 
#aijb7;a77#ij7 of the ,social ,security 
,act 7#db ,u4,s4,c4 #acif;a7a77#ij77 or 
section #bajg7;e77#a77;,i7 of such ,act 
7#db ,u4,s4,c4 #acig;gg7e77#a77;,i771   
any program or ,state plan or waiver 7in
 the case of ,medicaid and the ,state   
,children's ,health ,insurance ,program7
 under which the aggregate amount paid  
for an item or service or items or      
services in a zip code and county or    
county equivalent or the number of      
providers of items or services or       
suppliers1 as applicable1 who received  
payments for items or services furnished
 in a zip code and county or county     
equivalent increased by at least #djj   
percent during the preceding #e-year    
period2 and  7#b7 audit any such        
program1 ,state plan1 or waiver4  7e7   
,effective date  7#a7 ,medicare         

,subsection 7a7 shall take effect on the
 date that is #ahj days after the date  
of enactment of this ,act4  7#b7        
,qualified health plans under the       
,american ,health ,benefit ,exchanges   
,subsection 7b7 shall take effect on the
 date that is #ahj days after the date  
of enactment of this ,act4  7#c7        
,medicaid and ,,chip  7,a7 ,in general  
,except as provided in subparagraph     
7,b71 the amendments made by subsection 
7c7 shall take effect on the date that  
is #ahj days after the date of enactment
 of this ,act4  7,b7 ,delay permitted if
 ,state legislation required ,in the    
case of a ,state plan approved under    
title ,,xix of the ,social ,security    
,act 7#db ,u4,s4,c4 #acif et seq47 or   
title ,,xxi of such ,act 7#db ,u4,s4,c4 
#acig;aa et seq47 which the ,secretary  
of ,health and ,human ,services         
determines requires ,state legislation  
7other than legislation appropriating   
funds7 in order for the plan to meet the
 additional requirements imposed by the 

amendments made by subsection 7c71 the  
,state plan shall not be regarded as    
failing to comply with the requirements 
of such title ,,xix or ,,xxi 7as        
applicable7 solely on the basis of the  
failure of the plan to meet such        
additional requirements before the first
 day of the first calendar quarter      
beginning after the close of the first  
regular session of the ,state           
legislature that ends after the #a-year 
period beginning with the date of the   
enactment of this section4 ,for purposes
 of the preceding sentence1 in the case 
of a ,state that has a #b-year          
legislative session1 each year of the   
session is deemed to be a separate      
regular session of the ,state           
legislature4  #d4 ,recovering improper  
payments  7a7 ,guidance ,the ,director  
of the ,office of ,management and       
,budget shall prescribe guidance to all 
agencies 7as defined in section #eea of 
title #e1 ,united ,states ,code7 to     
ensure that all improper payments 7as   

defined in section #ccea of title #ca1  
,united ,states ,code7 are recovered4   
7b7 ,annual ,inspector ,general report  
,section #ccec7;a77#a7 of title #ca1    
,united ,states ,code1 is amended-- 7#a7
 in subparagraph 7,a71 by striking and  
at the end2  7#b7 in subparagraph       
7,b77iv71 by striking the period at the 
end and inserting 2 and2 and  7#c7 by   
adding at the end the following3  7,c7  
include in each report submitted under  
subparagraph 7,b7 the amount of improper
 payments recovered by the executive    
agency in the fiscal year covered by the
 report4  4