3.0.0 5546 2023-01-11T13:19:54Z 2023-01-11T13:19:54Z House H HR 2010-06-16 111 hswm00 Ways and Means Committee House Standing Referred to 2010-06-16T14:00:53Z hsif00 Energy and Commerce Committee House Standing Referred to 2010-06-16T14:00:51Z 2010-06-16 Referred to House Ways and Means IntroReferral H11100 2 House floor actions hswm00 Ways and Means Committee 2010-06-16 Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. IntroReferral H11100-A 9 Library of Congress 2010-06-16 Referred to House Energy and Commerce IntroReferral H11100 2 House floor actions hsif00 Energy and Commerce Committee 2010-06-16 Introduced in House IntroReferral Intro-H 9 Library of Congress 2010-06-16 Introduced in House IntroReferral 1000 9 Library of Congress R000580 Rep. Roskam, Peter J. [R-IL-6] Peter Roskam R IL J. 6 N Health Computers and information technology Crime prevention Fraud offenses and financial crimes Government information and archives Medicare Health 00 2010-06-16 Introduced in House 2010-06-22T16:34:19Z Directs the Secretary of Health and Human Services (HHS) to develop and implement a fraud, waste, and abuse comprehensive prepayment review Prevention System for reviewing claims for reimbursement under title XVIII (Medicare) of the Social Security Act. Requires the Secretary to carry out the system acting through the Center for Program Integrity of the Centers for Medicare and Medicaid Services (CMS).

Requires the Prevention System to cover all types of providers and suppliers under the Medicare program, but allows it to be limited to a subset of claim segments.

Requires the Prevention System to: (1) be a high volume, rapid, near real-time information technology solution which includes data pooling and scoring capabilities to quickly and accurately capture and evaluate data; (2) identify high-risk Medicare claims by scoring all such claims in near real-time before payment is made; (3) involve a statistically sound, empirically derived predictive modeling technology; and (4) utilize a fraud management system that presents score, reason codes, and treatment actions for high-risk scored transactions, and a feedback loop to gain access to outcome information on adjudicated Medicare claims.

Prohibits the Secretary from making a payment on a claim selected for review until it has been reviewed under the System.

]]> To provide for the establishment of a fraud, waste, and abuse detection and mitigation program for the Medicare Program under title XVIII of the Social Security Act. Display Title To provide for the establishment of a fraud, waste, and abuse detection and mitigation program for the Medicare Program under title XVIII of the Social Security Act. Official Title as Introduced To provide for the establishment of a fraud, waste, and abuse detection and mitigation program for the Medicare Program under title XVIII of the Social Security Act. Introduced in House IH Introduced in House 2010-06-16T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-111hr5546ih/xml/BILLS-111hr5546ih.xml 2010-06-16 Referred to House Ways and Means text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.