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  <version>3.0.0</version>
  <bill>
    <number>6575</number>
    <updateDate>2019-11-15T21:46:58Z</updateDate>
    <updateDateIncludingText>2019-11-15T21:46:58Z</updateDateIncludingText>
    <originChamber>House</originChamber>
    <originChamberCode>H</originChamberCode>
    <type>HR</type>
    <introducedDate>2012-10-16</introducedDate>
    <congress>112</congress>
    <constitutionalAuthorityStatementText><![CDATA[<pre>From the Congressional Record Online through the Government Publishing Office [<a href='http://www.gpo.gov'>www.gpo.gov</a>]By Mr. GRAVES of Missouri:H.R. 6575.Congress has the power to enact this legislation pursuantto the following:Article 1, Section 8, Clause 1 (General Welfare) and Clause3 (Commerce)`Congress shall have the power to . . . provide for the . .. general welfare'`Congress shall have the power . . . to regulate Commerce'The Medicare Audit Improvement Act makes several changes tothe way hospital audits are conducted which involves at leastthree parties: a hospital, a private Medicare contractor whoconducts audits and the Center for Medicare and MedicaidServices. During the auditing process, transactions takeplace between these parties which is what constitutes thisbill as regulating commerce. Further, Medicare is consideredto be constitutional as part of providing for the generalwelfare and therefore any changes to Medicare would fallunder this provision as well.[Page H6310]</pre>]]></constitutionalAuthorityStatementText>
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        <fullName>Rep. Graves, Sam [R-MO-6]</fullName>
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        <fullName>Rep. Schiff, Adam B. [D-CA-29]</fullName>
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        <party>D</party>
        <state>CA</state>
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        <fullName>Rep. Long, Billy [R-MO-7]</fullName>
        <firstName>Billy</firstName>
        <lastName>Long</lastName>
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        <state>MO</state>
        <district>7</district>
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        <fullName>Rep. Akin, W. Todd [R-MO-2]</fullName>
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        <party>R</party>
        <state>MO</state>
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        <isOriginalCosponsor>True</isOriginalCosponsor>
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        <fullName>Rep. Hanna, Richard L. [R-NY-24]</fullName>
        <firstName>Richard</firstName>
        <lastName>Hanna</lastName>
        <party>R</party>
        <state>NY</state>
        <middleName>L.</middleName>
        <district>24</district>
        <sponsorshipDate>2012-10-23</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <fullName>Rep. McCollum, Betty [D-MN-4]</fullName>
        <firstName>BETTY</firstName>
        <lastName>MCCOLLUM</lastName>
        <party>D</party>
        <state>MN</state>
        <district>4</district>
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        <fullName>Rep. Owens, William L. [D-NY-23]</fullName>
        <firstName>William</firstName>
        <lastName>Owens</lastName>
        <party>D</party>
        <state>NY</state>
        <middleName>L.</middleName>
        <district>23</district>
        <sponsorshipDate>2012-11-06</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>S000480</bioguideId>
        <fullName>Rep. Slaughter, Louise McIntosh [D-NY-28]</fullName>
        <firstName>LOUISE</firstName>
        <lastName>SLAUGHTER</lastName>
        <party>D</party>
        <state>NY</state>
        <middleName>M.</middleName>
        <district>28</district>
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        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>E000172</bioguideId>
        <fullName>Rep. Emerson, Jo Ann [R-MO-8]</fullName>
        <firstName>JO</firstName>
        <lastName>EMERSON</lastName>
        <party>R</party>
        <state>MO</state>
        <middleName>ANN</middleName>
        <district>8</district>
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        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>B001254</bioguideId>
        <fullName>Rep. Boren, Dan [D-OK-2]</fullName>
        <firstName>Dan</firstName>
        <lastName>Boren</lastName>
        <party>D</party>
        <state>OK</state>
        <district>2</district>
        <sponsorshipDate>2012-11-06</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>P000602</bioguideId>
        <fullName>Rep. Pompeo, Mike [R-KS-4]</fullName>
        <firstName>Mike</firstName>
        <lastName>Pompeo</lastName>
        <party>R</party>
        <state>KS</state>
        <district>4</district>
        <sponsorshipDate>2012-11-06</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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      <item>
        <bioguideId>G000289</bioguideId>
        <fullName>Rep. Goodlatte, Bob [R-VA-6]</fullName>
        <firstName>ROBERT</firstName>
        <lastName>GOODLATTE</lastName>
        <party>R</party>
        <state>VA</state>
        <middleName>W.</middleName>
        <district>6</district>
        <sponsorshipDate>2012-11-13</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
      </item>
      <item>
        <bioguideId>L000569</bioguideId>
        <fullName>Rep. Luetkemeyer, Blaine [R-MO-9]</fullName>
        <firstName>Blaine</firstName>
        <lastName>Luetkemeyer</lastName>
        <party>R</party>
        <state>MO</state>
        <district>9</district>
        <sponsorshipDate>2012-11-14</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
      </item>
      <item>
        <bioguideId>N000186</bioguideId>
        <fullName>Rep. Nunnelee, Alan [R-MS-1]</fullName>
        <firstName>Alan</firstName>
        <lastName>Nunnelee</lastName>
        <party>R</party>
        <state>MS</state>
        <district>1</district>
        <sponsorshipDate>2012-11-14</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
      </item>
      <item>
        <bioguideId>M000508</bioguideId>
        <fullName>Rep. McKeon, Howard P. "Buck" [R-CA-25]</fullName>
        <firstName>HOWARD</firstName>
        <lastName>MCKEON</lastName>
        <party>R</party>
        <state>CA</state>
        <middleName>P.</middleName>
        <district>25</district>
        <sponsorshipDate>2012-11-15</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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      <item>
        <bioguideId>H001053</bioguideId>
        <fullName>Rep. Hartzler, Vicky [R-MO-4]</fullName>
        <firstName>Vicky</firstName>
        <lastName>Hartzler</lastName>
        <party>R</party>
        <state>MO</state>
        <district>4</district>
        <sponsorshipDate>2012-11-16</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>P000258</bioguideId>
        <fullName>Rep. Peterson, Collin C. [D-MN-7]</fullName>
        <firstName>COLLIN</firstName>
        <lastName>PETERSON</lastName>
        <party>D</party>
        <state>MN</state>
        <middleName>C.</middleName>
        <district>7</district>
        <sponsorshipDate>2012-11-29</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>B000490</bioguideId>
        <fullName>Rep. Bishop, Sanford D., Jr. [D-GA-2]</fullName>
        <firstName>SANFORD</firstName>
        <lastName>BISHOP</lastName>
        <party>D</party>
        <state>GA</state>
        <middleName>D.</middleName>
        <district>2</district>
        <sponsorshipDate>2012-11-29</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
      </item>
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        <bioguideId>B001259</bioguideId>
        <fullName>Rep. Braley, Bruce L. [D-IA-1]</fullName>
        <firstName>Bruce</firstName>
        <lastName>Braley</lastName>
        <party>D</party>
        <state>IA</state>
        <middleName>L.</middleName>
        <district>1</district>
        <sponsorshipDate>2012-11-30</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
      </item>
      <item>
        <bioguideId>H001057</bioguideId>
        <fullName>Rep. Huelskamp, Tim [R-KS-1]</fullName>
        <firstName>Tim</firstName>
        <lastName>Huelskamp</lastName>
        <party>R</party>
        <state>KS</state>
        <district>1</district>
        <sponsorshipDate>2012-11-30</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>B001243</bioguideId>
        <fullName>Rep. Blackburn, Marsha [R-TN-7]</fullName>
        <firstName>Marsha</firstName>
        <lastName>Blackburn</lastName>
        <party>R</party>
        <state>TN</state>
        <district>7</district>
        <sponsorshipDate>2012-11-30</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>A000055</bioguideId>
        <fullName>Rep. Aderholt, Robert B. [R-AL-4]</fullName>
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        <lastName>ADERHOLT</lastName>
        <party>R</party>
        <state>AL</state>
        <middleName>B.</middleName>
        <district>4</district>
        <sponsorshipDate>2012-11-30</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>L000111</bioguideId>
        <fullName>Rep. Latham, Tom [R-IA-4]</fullName>
        <firstName>TOM</firstName>
        <lastName>LATHAM</lastName>
        <party>R</party>
        <state>IA</state>
        <district>4</district>
        <sponsorshipDate>2012-12-04</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>B000652</bioguideId>
        <fullName>Rep. Boswell, Leonard L. [D-IA-3]</fullName>
        <firstName>LEONARD</firstName>
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        <party>D</party>
        <state>IA</state>
        <middleName>L.</middleName>
        <district>3</district>
        <sponsorshipDate>2012-12-11</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>K000362</bioguideId>
        <fullName>Rep. King, Steve [R-IA-5]</fullName>
        <firstName>Steve</firstName>
        <lastName>King</lastName>
        <party>R</party>
        <state>IA</state>
        <district>5</district>
        <sponsorshipDate>2012-12-11</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>L000565</bioguideId>
        <fullName>Rep. Loebsack, David [D-IA-2]</fullName>
        <firstName>David</firstName>
        <lastName>Loebsack</lastName>
        <party>D</party>
        <state>IA</state>
        <district>2</district>
        <sponsorshipDate>2012-12-11</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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        <bioguideId>K000210</bioguideId>
        <fullName>Rep. King, Peter T. [R-NY-3]</fullName>
        <firstName>PETER</firstName>
        <lastName>KING</lastName>
        <party>R</party>
        <state>NY</state>
        <middleName>T.</middleName>
        <district>3</district>
        <sponsorshipDate>2012-12-13</sponsorshipDate>
        <isOriginalCosponsor>False</isOriginalCosponsor>
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    <policyArea>
      <name>Health</name>
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    <subjects>
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          <name>Accounting and auditing</name>
        </item>
        <item>
          <name>Administrative law and regulatory procedures</name>
        </item>
        <item>
          <name>Administrative remedies</name>
        </item>
        <item>
          <name>Department of Health and Human Services</name>
        </item>
        <item>
          <name>Government information and archives</name>
        </item>
        <item>
          <name>Health facilities and institutions</name>
        </item>
        <item>
          <name>Health personnel</name>
        </item>
        <item>
          <name>Home and outpatient care</name>
        </item>
        <item>
          <name>Hospital care</name>
        </item>
        <item>
          <name>Judicial review and appeals</name>
        </item>
        <item>
          <name>Legal fees and court costs</name>
        </item>
        <item>
          <name>Medicare</name>
        </item>
        <item>
          <name>Performance measurement</name>
        </item>
        <item>
          <name>Public contracts and procurement</name>
        </item>
      </legislativeSubjects>
      <policyArea>
        <name>Health</name>
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    </subjects>
    <summaries>
      <summary>
        <versionCode>00</versionCode>
        <actionDate>2012-10-16</actionDate>
        <actionDesc>Introduced in House</actionDesc>
        <updateDate>2012-11-13T16:30:51Z</updateDate>
        <text><![CDATA[ <p>Medicare Audit Improvement Act of 2012 - Directs the Secretary of Health and Human Services (HHS) to establish a process under which the number of additional documentation requests made by a Medicare contractor pursuant to a complex prepayment or postpayment audit with respect to a hospital's Medicare part A (Hospital Insurance) claims in a year may not exceed, across all such contractors with respect to the hospital's claims, the lesser of: (1) 2% of all such claims for such year, or (2) 500 additional documentation requests during any 45-day period. </p> <p>Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.</p> <p>Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.</p> <p>Directs the Secretary to publish on the Internet website of the Centers for Medicare &amp; Medicaid Services information on recovery audit contractor performance regarding: (1) audit rates, denials, and appeals outcomes; and (2) independent performance evaluations.</p> <p>Prohibits the Secretary, in conducting the Medicare Part A and Part B Rebilling Demonstration, from prohibiting any appeal by a hospital of any finding by a recovery audit contractor that an inpatient admission was not reasonably and medically necessary.</p> <p>Deems to be an original claim for Medicare part B (Supplementary Medical Insurance) payment a resubmitted hospital claim for Medicare part A payment for inpatient hospital services which a recovery audit contractor determines: (1) were not medically necessary and reasonable based on the site of service, but (2) would be medically necessary and reasonable in an outpatient setting of the hospital. Requires payment to be made for such a resubmitted claim for all furnished items and services for which payment may be made under Medicare part B.</p> <p>Deems to be a reopened claim, for purposes of a hospital's ability to resubmit a claim for Medicare payment in timely fashion, any claim that is the subject of an audit by a recovery audit contractor or a Medicare administrative contractor.</p> <p>Requires contracts for a recovery audit contractor to require that a physician review each denial of a claim for medical necessity made by an employee of the contractor who is not a physician.</p> <p><br> </p>]]></text>
      </summary>
    </summaries>
    <title>Medicare Audit Improvement Act of 2012</title>
    <titles>
      <item>
        <titleType>Short Titles as Introduced</titleType>
        <title>Medicare Audit Improvement Act of 2012</title>
      </item>
      <item>
        <titleType>Display Title</titleType>
        <title>Medicare Audit Improvement Act of 2012</title>
      </item>
      <item>
        <titleType>Official Title as Introduced</titleType>
        <title>To amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors, and for other purposes.</title>
      </item>
    </titles>
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        <type>Introduced in House</type>
        <date>2012-10-16T04:00:00Z</date>
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    <latestAction>
      <actionDate>2012-10-26</actionDate>
      <text>Referred to the Subcommittee on Health.</text>
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    <dc:rights>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.</dc:rights>
    <dc:contributor>Congressional Research Service, Library of Congress</dc:contributor>
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