3.0.0 3474 2022-02-03T05:56:59Z 2022-02-03T05:56:59Z House H HR 2011-11-18 112 From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]By Mr. STEARNS:H.R. 3474.Congress has the power to enact this legislation pursuantto the following:Article I, Section 8, Clause 1[Page H7891]]]> hswm00 Ways and Means Committee House Standing hswm02 Health Subcommittee Referred to 2011-11-25T22:28:30Z Referred to 2011-11-18T14:01:15Z hsif00 Energy and Commerce Committee House Standing hsif14 Health Subcommittee Referred to 2011-11-18T18:58:42Z Referred to 2011-11-18T14:01:10Z 2011-11-25 hswm02 Health Subcommittee 1 House committee actions Referred to the Subcommittee on Health. Committee 2011-11-18 hsif14 Health Subcommittee 1 House committee actions Referred to the Subcommittee on Health. Committee 2011-11-18 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 2 House floor actions hswm00 Ways and Means Committee 2011-11-18 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 2 House floor actions hsif00 Energy and Commerce Committee 2011-11-18 Introduced in House IntroReferral Intro-H 9 Library of Congress 2011-11-18 Introduced in House IntroReferral 1000 9 Library of Congress S000822 Rep. Stearns, Cliff [R-FL-6] CLIFF STEARNS R FL 6 N D000533 Rep. Duncan, John J., Jr. [R-TN-2] JOHN DUNCAN R TN J. 2 2011-12-07 False G000569 Rep. Grimm, Michael G. [R-NY-13] Michael Grimm R NY G. 13 2011-12-08 False M001151 Rep. Murphy, Tim [R-PA-18] Tim Murphy R PA 18 2012-01-18 False R000580 Rep. Roskam, Peter J. [R-IL-6] Peter Roskam R IL J. 6 2012-06-07 False Health Business records Child health Computer security and identity theft Computers and information technology Congressional oversight Crime prevention Department of Health and Human Services Fraud offenses and financial crimes Freedom of information Government employee pay, benefits, personnel management Government ethics and transparency, public corruption Government information and archives Government studies and investigations Health care costs and insurance Health information and medical records Medicaid Medicare Poverty and welfare assistance Prescription drugs Health 00 2011-11-18 Introduced in House 2012-01-25T22:29:08Z Promoting Responsibility in Medical Expenditures Act of 2011 - Amends title XI of the Social Security Act (SSA) to increase civil money penalties, criminal fines, and prison sentences for fraud and abuse under the SSA title XVIII (Medicare) program.

Directs the Secretary of Health and Human Services to submit to Congress annual fraud reports with respect to Medicare, SSA title XIX (Medicaid), and SSA title XXI (Children's Health Insurance) (CHIP).

Amends the Small Business Jobs Act to exempt from disclosure under the Freedom of Information Act the algorithms used in predictive modeling and other analytics technology to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program.

Requires valid National Provider Identifiers for prescribers on pharmacy claims for covered Medicare part D prescription drugs.

Requires a prescription drug plan (PDP) sponsor identifying a claim for reimbursement for a drug prescribed by an individual without a valid National Provider Identifier to report to the HHS Inspector General any relevant information on such a prescriber, including any invalid national provider identifiers being used to submit such claims and related records. Requires the Inspector General of HHS to provide such information to appropriate law enforcement agencies.

Directs the Secretary of HHS to establish procedures and rules to restrict access to the National Provider Identifier Registry in order to deter the fraudulent use of National Provider Identifiers.

Decreases by 10% per quarter the federal medical assistance percentage (FMAP) for a state if: (1) it is receiving a grant for a state controlled substance monitoring program through which it identifies fraud, waste, or abuse in connection with the provision of prescription drug coverage under the state Medicaid plan; and (2) the state or a political subdivision is reimbursed by a third party for expenditures related to such fraud, waste, or abuse, or for a recovered amount.

Directs the Secretary of HHS to establish procedures to eliminate the unnecessary collection, use, and display of Social Security account numbers of Medicare beneficiaries.

Requires the Secretary of HHS to ensure that each newly issued Medicare identification card does not display or electronically store, in an unencrypted format, a Medicare beneficiary's Social Security account number, unless the beneficiary's health insurance claim number is the beneficiary's or spouse's Social Security number, and the risk of fraudulent use of such numbers is not unacceptably high.

Requires the Secretary of HHS to prohibit the display of a Medicare beneficiary's Social Security account number in any written or electronic communication to the beneficiary unless its inclusion is essential for the operation of the Medicare program.

Directs the Secretary of HHS to establish a pilot program to evaluate the applicability of smart card technology to the Medicare program, and whether such cards would be effective in preventing Medicare fraud.

Prohibits payment for an item or service under Medicaid or CHIP unless the claim contains: (1) a valid beneficiary identification number corresponding to an individual enrolled under the state plan or an applicable waiver; and (2) a valid provider identifier corresponding to a provider eligible to receive payment for furnishing such item or service.

Directs the Comptroller General to recommend methods to make Medicare claims data available to the public to improve Medicare transparency while protecting the privacy of individual Medicare beneficiaries, service providers, and suppliers.

]]> PRIME Act of 2011 Short Titles as Introduced PRIME Act of 2011 Short Titles as Introduced Promoting Responsibility in Medical Expenditures Act of 2011 Official Title as Introduced To amend titles XI and XVIII of the Social Security Act to prevent fraud and abuse under the Medicare program and to require National Provider Identifiers for reimbursement of prescriptions under part D of the Medicare program, and for other purposes. Display Title PRIME Act of 2011 Introduced in House 2011-11-18T05:00:00Z https://www.govinfo.gov/content/pkg/BILLS-112hr3474ih/xml/BILLS-112hr3474ih.xml 2011-11-25 Referred to the Subcommittee on Health. 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.