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<BillSummaries>
<item congress="113" measure-type="hr" measure-number="5732" measure-id="id113hr5732" originChamber="HOUSE" orig-publish-date="2014-11-18" update-date="2014-12-16">
<title>Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act</title>
<summary summary-id="id113hr5732v00" currentChamber="HOUSE" update-date="2014-12-16">
<action-date>2014-11-18</action-date>
<action-desc>Introduced in House</action-desc>
<summary-text><![CDATA[<p>Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act - Amends title XI of the Social Security Act with respect to standards for financial and administrative transactions and their data elements to enable the electronic exchange of health information.</p> <p>Requires the Secretary of Health and Human Services (HHS) to adopt standards that: (1) ensure that any entity producing and transmitting valid transactions that include code sets for appropriate data elements is subject to a consistent, industry-wide framework that supports a seamless transition to new and modified code sets; and (2) establish an end-to-end testing procedure for new and modified code sets that shall require the participation of any entity producing and transmitting valid transactions that use the new or modified code set.</p> <p>Prohibits the Secretary from adopting a new or modified code set unless the Secretary: (1) assesses its impact on fraud prevention and pre-payment review, determines that anti-fraud edits work as intended, and confirms that a plan is in place to ensure continuing effective detection of fraud following the adoption of the code set; (2) ensures that the end-to-end testing procedure established has been completed; and (3) completes end-to-end testing with any federal government entity that produces and transmits valid transactions that include the code set with private sector tracking partners. Exempts routine, regularly scheduled updates to existing code sets from such prohibition.</p> <p>Directs the Secretary, with respect to information supplied to it by a disclosing entity about those with an ownership or control interest in the entity, to verify such information in a specified manner and confirm the accuracy of any Social Security account number or employer identification number.</p> <p>Holds immune from civil liability (in a safe harbor) any non-governmental entity participating in a Healthcare Fraud Prevention Partnership, including private insurers, for sharing information about potentially fraudulent providers with each other, HHS, the Department of Justice (DOJ), any other federal or state law enforcement agency, any federal or state agency contractor, and another Partnership participant.</p> <p>Directs the Medicare Payment Advisory Commission (MEDPAC) to study administrative efforts to strengthen program integrity in the Medicare program.</p> <p>Amends the Small Business Jobs Act of 2010, with respect to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program, to require predictive analytics technologies to capture outcome information on civil recoveries, administrative actions, and criminal convictions for fraud. </p>]]></summary-text>
</summary>
</item>
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<dc:language>EN</dc:language>
<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>
<dc:description>This file contains bill summaries 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.</dc:description>
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