[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 515 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                 S. 515

   To amend title XVIII of the Social Security Act to provide for a 
     limitation on use of claim sampling to deny claims or recover 
                      overpayments under medicare.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                March 5 (legislative day, March 3), 1993

Mr. Pryor (for himself and Mr. Mitchell) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to provide for a 
     limitation on use of claim sampling to deny claims or recover 
                      overpayments under medicare.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. LIMITATION ON USE OF CLAIM SAMPLING TO DENY CLAIMS OR 
              RECOVER OVERPAYMENTS UNDER MEDICARE.

    (a) Limitation on Use of Claim Sampling.--Section 1869(a) of the 
Social Security Act (42 U.S.C. 1395ff(a)) is amended--
            (1) by striking ``(a) The determination'' and inserting 
        ``(a)(1) Subject to paragraph (2), the determination''; and
            (2) by adding at the end thereof the following new 
        paragraph:
    ``(2) Except for purposes of assessing civil money penalties for 
fraud under section 1128A(a)--
            ``(A) the determination with respect to a claim for 
        benefits under part A or part B shall be based solely on the 
        individual's entitlement to such benefits; and
            ``(B) the Secretary may not make any determination with 
        respect to any claim for benefits described in paragraph (1) by 
        applying information obtained through a process of claim 
        sampling to such claim.''.
    (b) Conforming Amendments.--(1) Section 1862(f) of such Act (42 
U.S.C. 1395y(f)) is amended by striking ``otherwise'' and inserting 
``otherwise that meets the requirements of section 1869(a)(2)''.
    (2) Section 1869(b)(1) of such Act (42 U.S.C. 1395ff(b)(1)) is 
amended by striking ``subsection (a)'' and inserting ``subsection 
(a)(1)''.

SEC. 2. EFFECTIVE DATE.

    The amendments made by section 1 shall apply to determinations on 
claims for benefits under title XVIII of the Social Security Act issued 
on or after the date of enactment of this Act.

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