[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1761 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 1761

 To provide for improved coordination, communication, and enforcement 
 related to health care fraud, waste, and abuse, to create a point of 
   order against legislation which diverts savings achieved through 
 Medicare waste, fraud, and abuse enforcement activities for purposes 
  other than improving the solvency of the Federal Hospital Insurance 
Trust Fund under title XVIII of the Social Security Act, to ensure the 
         integrity of such trust fund, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 3, 1997

Mr. Davis of Florida introduced the following bill; which was referred 
 to the Committee on Ways and Means, and in addition to the Committees 
    on Commerce, and the Judiciary, 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

_______________________________________________________________________

                                 A BILL


 
 To provide for improved coordination, communication, and enforcement 
 related to health care fraud, waste, and abuse, to create a point of 
   order against legislation which diverts savings achieved through 
 Medicare waste, fraud, and abuse enforcement activities for purposes 
  other than improving the solvency of the Federal Hospital Insurance 
Trust Fund under title XVIII of the Social Security Act, to ensure the 
         integrity of such trust fund, and for other purposes.

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

SECTION 1. SHORT TITLE; REFERENCES IN ACT; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Antifraud 
Act of 1997''.
    (b) Amendments to Social Security Act.--Except as otherwise 
specifically provided, whenever in this Act an amendment is expressed 
in terms of an amendment to, or repeal of, a section or other 
provision, the reference shall be considered to be made to that section 
or other provision of the Social Security Act.
    (c) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; references in act; table of contents.
                 TITLE I--PROTECTING PROGRAM INTEGRITY

Sec. 101. Disclosure of information and surety bond requirements.
Sec. 102. Requirements to disclose employer identification numbers and 
                            social security numbers.
Sec. 103. Requirement to furnish diagnostic information.
Sec. 104. Replacement of reasonable charge methodology by fee 
                            schedules.
Sec. 105. Application of inherent reasonableness.
Sec. 106. Exclusion of entity controlled by family member of a 
                            sanctioned individual.
Sec. 107. Liability of medicare carriers and fiscal intermediaries and 
                            States for claims submitted by excluded 
                            providers.
Sec. 108. Authority to refuse to enter into medicare or medicaid 
                            agreements with individuals or entities 
                            convicted of felonies.
Sec. 109. Application of certain provisions of the bankruptcy code.
Sec. 110. Inspector general access to national practitioner data bank.
Sec. 111. State health care fraud control units.
Sec. 112. Ensuring the integrity of the Federal hospital insurance 
                            trust fund.
Sec. 113. Requirement for annual GAO report.
Sec. 114. Prohibition on consideration of legislation that diverts 
                            savings achieved through medicare waste, 
                            fraud, and abuse enforcement activities for 
                            purposes other than improving the solvency 
                            of the Federal hospital insurance trust 
                            fund.
                TITLE II--SANCTIONS FOR FRAUD AND ABUSE

Sec. 201. Civil monetary penalties for kickbacks.
Sec. 202. Civil monetary penalties for persons that contract with 
                            excluded individuals.
Sec. 203. Civil monetary penalties for services ordered or prescribed 
                            by an excluded individual or entity.
          TITLE III--TECHNICAL CLARIFICATIONS AND CORRECTIONS

Sec. 301. Definition of the term conviction.
Sec. 302. Proper reference in advisory opinions.
Sec. 303. Ensuring proper implementation of Federal health care program 
                            exclusions.
                   TITLE IV--COORDINATION OF BENEFITS

Sec. 401. Permanent extension of certain secondary payer provisions.
Sec. 402. Technical changes concerning minimum sizes of group health 
                            plans.
Sec. 403. Information requirements.
Sec. 404. Clarification of time and filing limitations.
Sec. 405. Clarification of liability of third party administrators.
Sec. 406. Clarification of payment amounts to medicare.

                 TITLE I--PROTECTING PROGRAM INTEGRITY

SEC. 101. DISCLOSURE OF INFORMATION AND SURETY BOND REQUIREMENTS.

    (a) Disclosure of Information and Surety Bond Requirement for 
Suppliers of Durable Medical Equipment.--Section 1834(a) (42 U.S.C. 
1395m(a)) is amended by inserting after paragraph (15) the following:
    ``(16) Disclosure of information.--
            ``(A) In general.--The Secretary shall not provide for the 
        issuance (or renewal) of a provider number for a supplier of 
        durable medical equipment, for purposes of payment under this 
        part for durable medical equipment furnished by the supplier, 
        unless the supplier provides the Secretary on a continuing 
        basis with--
                    ``(i)(I) full and complete information as to the 
                identity of each person with an ownership or control 
                interest (as defined in section 1124(a)(3)) in the 
                supplier or in any subcontractor (as defined by the 
                Secretary in regulations) in which the supplier 
                directly or indirectly has a 5 percent or more 
                ownership interest, and
                    ``(II) to the extent determined to be feasible 
                under regulations of the Secretary, the name of any 
                disclosing entity (as defined in section 1124(a)(2)) 
                with respect to which a person with such an ownership 
                or control interest in the supplier is a person with 
                such an ownership or control interest in the disclosing 
                entity; and
                    ``(ii) a surety bond in a form specified by the 
                Secretary and in an amount that is not less than 
                $50,000.''.
    (b) Surety Bond Requirement for Home Health Agencies.--
            (1) In general.--Section 1861(o)(7) (42 U.S.C. 1395x(o)(7)) 
        is amended by inserting ``and including providing the Secretary 
        on a continuing basis with a surety bond in a form specified by 
the Secretary and in an amount that is not less than $50,000'' after 
``financial security of the program''.
            (2) Conforming amendments.--Section 1861(v)(1)(H) (42 
        U.S.C. 1395x(v)(1)(H)) is amended by striking ``the financial 
        security requirement'' and inserting ``the financial security 
        and surety bond requirements'' each place it appears in clauses 
        (i) and (ii).
    (c) Authorizing Application of Disclosure and Surety Bond 
Requirements to Ambulance Services and Certain Clinics.--Section 
1834(a)(16) (42 U.S.C. 1395m(a)(16)) (as added by subsection (a) of 
this section) is amended by adding at the end the following:
            ``(B) Application to ambulance services and certain 
        clinics.--The Secretary, in the Secretary's discretion, may 
        impose the requirements of the previous sentence with respect 
        to some or all classes of suppliers of ambulance services 
        described in section 1861(s)(7) and clinics that furnish 
        medical and other health services (other than physicians' 
        services) under this part.''.
    (d) Effective Dates.--
            (1) Subsection (a).--The amendment made by subsection (a) 
        shall apply to suppliers of durable medical equipment with 
        respect to such equipment furnished on or after January 1, 
        1998.
            (2) Subsection (b).--
                    (A) In general.--The amendments made by subsection 
                (b) shall apply to home health agencies with respect to 
                services furnished on or after January 1, 1998.
                    (B) Participation agreements.--The Secretary of 
                Health and Human Services shall modify participation 
                agreements under section 1866(a)(1) of the Social 
                Security Act with respect to home health agencies to 
                provide for implementation of such amendments on a 
                timely basis.
            (3) Subsection (c).--The amendment made by subsection (c) 
        shall take effect on the date of enactment of this Act and may 
        be applied with respect to items and services furnished on or 
        after the date specified in paragraph (1).

SEC. 102. REQUIREMENTS TO DISCLOSE EMPLOYER IDENTIFICATION NUMBERS AND 
              SOCIAL SECURITY NUMBERS.

    (a) Disclosing Entities, Owners, and Controlling Interests.--
Section 1124 (42 U.S.C. 1320a-3) is amended by adding at the end the 
following:
    ``(c) Requirement To Furnish Social Security Numbers and Employer 
Identification Numbers.--A payment shall not be made to a disclosing 
entity under title V, XVIII, or XIX unless the disclosing entity 
furnishes to the Secretary the employer identification number and 
social security number of--
            ``(1) the disclosing entity;
            ``(2) each person with an ownership or control interest; 
        and
            ``(3) any subcontractor in which the entity directly or 
        indirectly has a 5 percent or more ownership interest.''.
    (b) Other Medicare Providers.--Section 1124A (42 U.S.C. 1320a-3a) 
is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(3) including the employer identification number and 
        social security number of the disclosing part B provider and 
        any person, managing employee, or other entity identified under 
        paragraph (1) or (2).''; and
            (2) in subsection (c)(1) by inserting ``(or, for purposes 
        of subsection (a)(3), any entity receiving payment)'' after 
        ``on an assignment-related basis''.
    (c) Verification by Social Security Administration.--Section 1124A 
(42 U.S.C. 1320a-3a) is amended--
            (1) by redesignating subsection (c) as subsection (d); and
            (2) by inserting after subsection (b) the following:
    ``(c) Verification by Social Security Administration.--
            ``(1) Transmittal by hhs.--The Secretary shall transmit to 
        the Social Security Administration information concerning each 
        social security number and employer identification number 
        supplied to the Secretary under to subsection (a)(3) or section 
        1124(c) as necessary for verification of the information 
        required under paragraph (2).
            ``(2) Verification by ssa.--The Social Security 
        Administration shall verify the accuracy of and correct, if 
        necessary, the information supplied by the Secretary under 
        paragraph (1) and shall report the verification to the 
        Secretary.
            ``(3) Fees for ssa verification.--The Secretary shall 
        reimburse the Commissioner of Social Security, at a rate 
        negotiated between the Secretary and the Commissioner, for the 
        costs incurred by the Commissioner in performing the 
        verification and correction services described in this 
        subsection.''.

SEC. 103. REQUIREMENT TO FURNISH DIAGNOSTIC INFORMATION.

    (a) Inclusion of Non-Physician Practitioners in Requirement To 
Provide Diagnostic Codes for Physician Services.--Paragraphs (1) and 
(2) of section 1842(p) (42 U.S.C. 1395u(p)) are each amended by 
inserting ``or practitioner described in subsection (b)(18)(C)'' after 
`` by a physician''.
    (b) Requirement To Provide Diagnostic Information When Ordering 
Certain Items or Services Furnished by Another Entity.--Section 1842(p) 
(42 U.S.C. 1395u(p)), as amended by subsection (a), is amended by 
adding at the end the following:
    ``(4) In the case of an item of service (as described in paragraph 
(3), (6), (8), or (9) of subsection 1861(s)) ordered by a physician or 
a practitioner described in subsection (b)(18)(C), but furnished by 
another entity, if the Secretary (or fiscal agent of the Secretary) 
requires the entity furnishing the item or service to provide 
diagnostic or other medical information for payment to be made to the 
entity, the physician or practitioner shall provide that information to 
the entity at the time that the item or service is ordered by the 
physician or practitioner.''.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
apply to items and services furnished on or after January 1, 1998.

SEC. 104. REPLACEMENT OF REASONABLE CHARGE METHODOLOGY BY FEE 
              SCHEDULES.

    (a) In General.--Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is 
amended in the matter preceding subparagraph (A) by striking ``the 
reasonable charges for the services'' and inserting ``the lesser of the 
actual charges for the services and the amounts determined by the 
applicable fee schedules developed by the Secretary for the particular 
services''.
    (b) Conforming Amendments.--
            (1) Section 1833(a).--Section 1833(a) (42 U.S.C. 1395l(a)) 
        is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A), by striking 
                        ``reasonable charges for'' and inserting 
                        ``payment basis otherwise applicable to'';
                            (ii) in subparagraph (B), by striking 
                        ``reasonable charges'' and inserting ``fee 
                        schedule amounts''; and
                            (iii) by inserting after subparagraph (F) 
                        the following: ``(G) with respect to services 
                        described in clause (i) or (ii) of section 
                        1861(s)(2)(K) (relating to physician assistants 
                        and nurse practitioners), the amounts paid 
                        shall be 80 percent of the lesser of the actual 
                        charge for the services and the applicable 
                        amount determined under subclause (I) or (II) 
                        of section 1842(b)(12)(A)(ii),''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (B), in the matter 
                        preceding clause (i), by striking ``(C), (D),'' 
                        and inserting ``(D)''; and
                            (ii) by striking subparagraph (C).
            (2) Section 1833(l).--Section 1833(l) (42 U.S.C. 1395l(l)) 
        is amended--
                    (A) in paragraph (3)--
                            (i) by striking subparagraph (B); and
                            (ii) by striking ``(3)(A)'' and inserting 
                        ``(3)''; and
                    (B) by striking paragraph (6).
            (3) Section 1834.--Section 1834(g)(1)(A)(ii) (42 U.S.C. 
        1395m(g)(1)(A)(ii)) is amended in the heading by striking 
        ``Reasonable charges for professional'' and inserting 
        ``Professional''.
            (4) Section 1842(a).--Section 1842(a) (42 U.S.C. 1395u(a)) 
        is amended--
                    (A) in the matter preceding paragraph (1), by 
                striking ``reasonable charge'' and inserting ``fee 
                schedule''; and
                    (B) in paragraph (1)(A), by striking ``reasonable 
                charge'' and inserting ``other''.
            (5) Section 1842(b).--Section 1842(b) (42 U.S.C. 1395u(b)) 
        is amended--
                    (A) in paragraph (3)--
                            (i) in subparagraph (B)--
                                    (I) in the matter preceding clause 
                                (i), by striking ``assure that,'' and 
                                all that follows through ``such 
                                payment'' and inserting the following: 
                                ``where payment under this part for a 
                                service is on a basis other than a cost 
                                basis, such payment''; and
                                    (II) in clause (ii), by amending 
                                subclause (I) to read as follows: ``(I) 
                                the amount determined by the applicable 
                                payment basis under this part is the 
                                full charge for the service,''; and
                            (ii) by striking the second through the 
                        ninth sentences;
                    (B) by amending paragraph (4) to read as follows:
    ``(4) In the case of an enteral or parenteral pump that is 
furnished on a rental basis during a period of medical need--
            ``(A) monthly rental payments shall not be made under this 
        part for more than 15 months during that period, and
            ``(B) after monthly rental payments have been made for 15 
        months during that period, payment under this part shall be 
        made for maintenance and servicing of the pump in amounts that 
        the Secretary determines to be reasonable and necessary to 
        ensure the proper operation of the pump.'';
                    (C) in paragraph (7)--
                            (i) in subparagraph (D)--
                                    (I) in clause (i), in the matter 
                                preceding subclause (I), by striking 
                                ``, to the extent that such payment is 
                                otherwise allowed under this 
                                paragraph''; and
                                    (II) in clause (ii), by striking 
                                ``subparagraph'' and inserting 
                                ``paragraph'';
                            (ii) by striking subparagraphs (A), (B), 
                        and (C);
                            (iii) by striking ``(D)(i)'' and inserting 
                        ``(7)(A)''; and
                            (iv) in subparagraph (A), as redesignated 
                        by clause (iii), by--
                                    (I) redesignating clauses (ii) and 
                                (iii) as subparagraphs (B) and (C), 
                                respectively; and
                                    (II) by redesignating subclauses 
                                (I), (II), and (III) as clauses (i), 
                                (ii), and (iii), respectively;
                    (D) by striking paragraphs (9) and (10);
                    (E) in paragraph (11)--
                            (i) by striking subparagraphs (B), (C), and 
                        (D);
                            (ii) by striking ``(11)(A)'' and inserting 
                        ``(11)'', and
                            (iii) by redesignating clauses (i) and (ii) 
                        as subparagraphs (A) and (B), respectively;
                    (F) in paragraph (12)(A)(ii)--
                            (i) in the matter preceding subclause (I), 
                        by striking ``prevailing charges determined 
                        under paragraph (3)'' and inserting ``the 
                        amounts determined under section 
                        1833(a)(1)(G)''; and
                            (ii) in subclause (II), by striking 
                        ``prevailing charge rate'' and all that follows 
                        through the period and inserting ``fee schedule 
                        amount specified in section 1848 for such 
                        services performed by physicians.'';
                    (G) by striking paragraphs (14), (15), (16), and 
                (17);
                    (H) in paragraph (18)(A), by striking ``reasonable 
                charge or''; and
                    (I) by redesignating paragraph (18) as paragraph 
                (14).
            (6) Elimination of redundant language.--Section 6112(b) of 
        the Omnibus Reconciliation Act of 1989 (42 U.S.C. 1395m note; 
        Public Law 101-239) is repealed.
            (7) Section 1842(j).--Section 1842(j) (42 U.S.C. 1395u(j)) 
        is amended--
                    (A) by amending paragraph (1) to read as follows:
    ``(j)(1) Sanctions may be applied under paragraph (2) as provided 
in subsections (k), (l), (m), (n), and (p).''; and
                    (B) in paragraph (4), by striking ``under paragraph 
                (1)''.
            (8) Section 1842(n).--Section 1842(n)(1)(A) (42 U.S.C. 
        1395u(n)(1)(A)) is amended by striking ``reasonable charge (or 
        other applicable limit)'' and inserting ``other applicable 
        limit''.
            (9) Section 1842(q).--Section 1842(q) (42 U.S.C. 1395u(q)) 
        is amended--
                    (A) by striking paragraph (1)(B); and
                    (B) by striking ``(q)(1)(A)'' and inserting 
                ``(q)(1)''.
            (10) Section 1845.--Section 1845(b)(1) (42 U.S.C. 1395w-
        1(b)(1)) is amended by striking ``adjustments to the reasonable 
        charge levels for physicians' services recognized under section 
        1842(b) and''.
            (11) Section 1848.--Section 1848(i)(3) (42 U.S.C. 1395w-
        4(i)(3)) is repealed.
            (12) Section 1866.--Section 1866(a)(2)(A)(ii) (42 U.S.C. 
        1395cc(a)(2)(A)(ii)) is amended by striking ``reasonable 
        charges'' through ``provider)'' and inserting ``amount 
        customarily charged for the items and services by the 
        provider''.
            (13) Section 1881.--Section 1881(b)(3)(A) (42 U.S.C. 
        1395rr(b)(3)(A)) is amended by striking ``a reasonable charge'' 
        and all that follows through ``section 1848)'' and inserting 
        ``the basis described in section 1848''.
            (14) Obra-86.--Section 9340 of the Omnibus Budget 
        Reconciliation Act of 1986 (42 U.S.C. 1395u note; Public Law 
        99-509) is repealed.
    (c) Effective Dates.--The amendments made by subsections (a) and 
(b), to the extent the amendments substitute fee schedules for 
reasonable charges, apply to particular services as of the date 
specified by the Secretary of Health and Human Services.
    (d) Initial Budget Neutrality.--The Secretary, in developing a fee 
schedule for particular services (under the amendments made by 
subsections (a) and (b)), shall set amounts for the first year period 
to which the fee schedule applies at such a level that the total 
payments under title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) for those services for that period shall be approximately 
equal to the estimated total payments for those services if the 
amendments had not been made.

SEC. 105. APPLICATION OF INHERENT REASONABLENESS.

    (a) In General.--Section 1834(a)(10)(B) (42 U.S.C. 1395m(a)(10)(B)) 
is amended--
            (1) in the first sentence, by striking ``apply the 
        provisions'' and all that follows through the period and 
        inserting ``describe by regulation the factors to be used in 
        determining the cases (or particular items) in which the 
        application of this subsection results in the determination of 
        an amount that, by reason of its being grossly excessive or 
        grossly deficient, is not inherently reasonable, and to provide 
        in such cases for the factors that will be considered 
in establishing an amount that is realistic and equitable.''; and
            (2) in the second sentence, by striking ``applying such 
        provisions'' and inserting ``applying the previous provisions 
        of this subsection''.
    (b) Conforming Amendment.--Section 1834(i) (42 U.S.C. 1395m(i)) is 
amended by adding at the end the following:
            ``(3) Adjustment for inherent reasonableness.--The 
        provisions of subsection (a)(10)(B) shall apply to payment for 
        surgical dressings under this subsection.''.

SEC. 106. EXCLUSION OF ENTITY CONTROLLED BY FAMILY MEMBER OF A 
              SANCTIONED INDIVIDUAL.

    Section 1128 (42 U.S.C. 1320a-7) is amended--
            (1) in subsection (b)(8), by inserting in the matter 
        preceding subparagraph (A) ``, an immediate family member of 
        such person (as defined in section 1128(j)), or a member of the 
        household of such person (as defined in section 1128(k))'' 
        after ``the Secretary determines that a person''; and
            (2) by adding at the end the following:
    ``(j) Definition of Immediate Family Member.--For purposes of 
subsection (b)(8), the term `immediate family member' means--
            ``(1) a spouse;
            ``(2) a biological or adoptive parent of the individual and 
        the individual's spouse;
            ``(3) a child or sibling;
            ``(4) a grandparent or grandchild; or
            ``(5) an individual that is married to any of the 
        individuals listed in paragraphs (2) through (5).
    ``(k) Definition of Member of the Household.--For purposes of 
subsection (b)(8), the term `member of the household' means a person 
sharing a common abode as part of a single family unit, including 
domestic employees and others who live together as a family unit, but 
not including a roomer or boarder.''.

SEC. 107. LIABILITY OF MEDICARE CARRIERS AND FISCAL INTERMEDIARIES AND 
              STATES FOR CLAIMS SUBMITTED BY EXCLUDED PROVIDERS.

    (a) Reimbursement to the Secretary for Amounts Paid to Excluded 
Providers.--
            (1) Requirements for fiscal intermediaries.--
                    (A) In general.--Section 1816 (42 U.S.C. 1395h) is 
                amended by adding at the end the following:
    ``(m) An agreement with an agency or organization under this 
section shall require that the agency or organization reimburse the 
Secretary for any amounts paid for a service under this title which is 
furnished, directed, or prescribed by an individual or entity during 
any period for which the individual or entity is excluded pursuant to 
section 1128, 1128A, or 1156 from participation in the program under 
this title, if the amounts are paid after the Secretary notifies the 
agency or organization of the exclusion.''.
                    (B) Conforming amendment.--Section 1816(i) (42 
                U.S.C. 1395h(i)) is amended by adding at the end the 
                following:
            ``(4) Nothing in this subsection shall be construed to 
        prohibit reimbursement by an agency or organization under 
        subsection (m).''.
            (2) Requirements for carriers.--Section 1842(b)(3) (42 
        U.S.C. 1395u(b)(3)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (I); and
                    (B) by inserting after subparagraph (I) the 
                following:
            ``(J) will reimburse the Secretary for any amounts paid for 
        an item or service under this part which is furnished, 
        directed, or prescribed by an individual or entity during any 
        period for which the individual or entity is excluded pursuant 
        to section 1128, 1128A, or 1156 from participation in the 
        program under this title, if the amounts are paid after the 
        Secretary notifies the carrier of the exclusion; and''.
            (3) Requirements for states.--Section 1902(a)(39) (42 
        U.S.C. 1396a(a)(39)) is amended by striking the semicolon at 
        the end and inserting ``, and provide further for reimbursement 
        to the Secretary of any payments made under the plan for any 
        item or service furnished, directed, or prescribed by the 
        excluded individual or entity during such period, after the 
        Secretary notifies the State of such exclusion;''.
    (b) Conforming Repeal of Mandatory Payment Rule.--Section 
1862(e)(2) (42 U.S.C. 1395y(e)(2)) is amended to read as follows:
    ``(2) No individual or entity may bill (or collect any amount from) 
any individual for any item or service for which payment is denied 
under paragraph (1). No person is liable for payment of any amounts 
billed for such an item or service in violation of the previous 
sentence.''.

SEC. 108. AUTHORITY TO REFUSE TO ENTER INTO MEDICARE OR MEDICAID 
              AGREEMENTS WITH INDIVIDUALS OR ENTITIES CONVICTED OF 
              FELONIES.

    (a) Medicare Part A.--Section 1866(b)(2) (42 U.S.C. 1395cc(b)(2)) 
is amended--
            (1) in subparagraph (B), by striking ``or'' at the end;
            (2) in subparagraph (C), by striking the period at the end 
        and inserting ``, or''; and
            (3) by adding at the end the following:
                    ``(D) has ascertained that the provider has been 
                convicted of a felony under Federal or State law for an 
                offense that the Secretary determines is inconsistent 
                with the best interests of program beneficiaries.''.
    (b) Medicare Part B.--Section 1842 (42 U.S.C. 1395u) is amended by 
adding at the end the following:
    ``(s) The Secretary may refuse to enter into an agreement with a 
physician or supplier under subsection (h) or may terminate or refuse 
to renew such agreement, in the event that such physician or supplier 
has been convicted of a felony under Federal or State law for an 
offense which the Secretary determines is inconsistent with the best 
interests of program beneficiaries.''.
    (c) Medicaid.--Section 1902(a)(23) (42 U.S.C. 1396(a)(23)) is 
amended--
            (1) by inserting a comma after ``1915''; and
            (2) by inserting after ``Guam,'' the following:
``and except that this provision does not require a State to provide 
medical assistance for such services furnished by a person or entity 
convicted of a felony under Federal or State law for an offense which 
the State agency determines is inconsistent with the best interests of 
beneficiaries under the State plan,''.

SEC. 109. APPLICATION OF CERTAIN PROVISIONS OF THE BANKRUPTCY CODE.

    (a) Restricted Applicability of Bankruptcy Stay, Discharge, and 
Preferential Transfer Provisions to Medicare and Medicaid Debts.--Part 
A of title XI (42 U.S.C. 1301 et seq.) is amended by inserting after 
section 1143 the following:

       ``application of certain provisions of the bankruptcy code

    ``Sec. 1144. (a) Medicare and Medicaid-Related Actions Not Stayed 
by Bankruptcy Proceedings.--The commencement or continuation of any 
action against a debtor under this title or title XVIII or XIX (other 
than an action with respect to health care services for the debtor 
under title XVIII), including any action or proceeding to exclude or 
suspend the debtor from program participation, assess civil money 
penalties, recoup or set off overpayments, or deny or suspend payment 
of claims shall not be subject to the provisions of section 362(a) of 
title 11, United States Code.
    ``(b) Medicare- and Medicaid-Related Debt Not Dischargeable in 
Bankruptcy.--A debt owed to the United States or to a State for an 
overpayment under title XVIII or XIX (other than an overpayment for 
health care services for the debtor under title XVIII), or for a 
penalty, fine, or assessment under this title or title XVIII or XIX, 
shall not be dischargeable under any provision of title 11, United 
States Code.
    ``(c) Repayment of Certain Debts Considered Final.--Payments made 
to repay a debt to the United States or to a State with respect to 
items or services provided, or claims for payment made, under title 
XVIII or XIX (including repayment of an overpayment (other than an 
overpayment for health care services for the debtor under title 
XVIII)), or to pay a penalty, fine, or assessment under this title or 
title XVIII or XIX, shall be considered final and not preferential 
transfers under section 547 of title 11, United States Code.''.
    (b) Medicare Rules Applicable to Bankruptcy Proceedings.--Title 
XVIII (42 U.S.C. 1395 et seq.) is amended by adding at the end the 
following:

           ``application of provisions of the bankruptcy code

    ``Sec. 1894. (a) Use of Medicare Standards and Procedures.--
Notwithstanding any provision of title 11, United States Code, or any 
other provision of law, in the case of claims by a debtor in bankruptcy 
for payment under this title, the determination of whether the claim is 
allowable and of the amount payable, shall be made in accordance with 
the provisions of this title and title XI and implementing regulations.
    ``(b) Notice to Creditor of Bankruptcy Petitioner.--In the case of 
a debt owed to the United States with respect to items or services 
provided, or claims for payment made, under this title (including a 
debt arising from an overpayment or a penalty, fine, or assessment 
under title XI or this title), the notices to the creditor of 
bankruptcy petitions, proceedings, and relief required under title 11, 
United States Code (including under section 342 of that title and 
section 2002(j) of the Federal Rules of Bankruptcy Procedure), shall be 
given to the Secretary. Provision of such notice to a fiscal agent of 
the Secretary shall not be considered to satisfy this requirement.
    ``(c) Turnover of Property to the Bankruptcy Estate.--For purposes 
of section 542(b) of title 11, United States Code, a claim for payment 
under this title shall not be considered to be a matured debt payable 
to the estate of a debtor until such claim has been allowed by the 
Secretary in accordance with procedures under this title.''.

SEC. 110. INSPECTOR GENERAL ACCESS TO NATIONAL PRACTITIONER DATA BANK.

    Section 427 of the Health Care Quality Improvement Act of 1986 (42 
U.S.C. 11137) is amended--
            (1) in subsection (a), by adding at the end the following: 
        ``Information reported under this part shall also be made 
        available, upon request, to the Inspector General of the 
        Departments of Health and Human Services, Defense, and Labor, 
        the Office of Personnel Management, and the Railroad Retirement 
        Board.''; and
            (2) by amending subsection (b)(4) to read as follows:
            ``(4) Fees.--
                    ``(A) Imposition of fees.--The Secretary may impose 
                fees for the disclosure of information under this part 
                sufficient to recover the full costs of carrying out 
                the provisions of this part, including reporting, 
                disclosure, and administration, except that a fee may 
                not be imposed for requests made by the Inspector 
                General of the Department of Health and Human Services.
                    ``(B) Availability of fees.--The fees shall remain 
                available to the Secretary (or, in the Secretary's 
                discretion, to the agency designated in section 424(b)) 
                until expended.''.

SEC. 111. STATE HEALTH CARE FRAUD CONTROL UNITS.

    (a) Extension of Concurrent Authority To Investigate and Prosecute 
Fraud in Other Federal Programs.--Section 1903(q)(3) (42 U.S.C. 
1396b(q)(3)) is amended--
            (1) by striking ``in connection with any aspect'' and 
        inserting ``in connection with--
                    ``(A) any aspect'';
            (2) by striking the period at the end and inserting ``; 
        and''; and
            (3) by adding at the end the following:
                    ``(B) in cases where the entity's function is also 
                described by subparagraph (A), and upon the approval of 
                the relevant Federal agency, any aspect of the 
                provision of health care services and activities of 
                providers of such services under any Federal health 
                care program (as defined in section 1128B(f)).''.
    (b) Extension of Authority To Investigate and Prosecute Patient 
Abuse in Non-Medicaid Board and Care Facilities.--Section 1903(q)(4) 
(42 U.S.C. 1396b(q)(4)) is amended to read as follows:
            ``(4)(A) The entity has--
                    ``(i) procedures for reviewing complaints of abuse 
                or neglect of patients in health care facilities which 
                receive payments under the State plan under this title;
                    ``(ii) at the option of the entity, procedures for 
                reviewing complaints of abuse or neglect of patients 
                residing in board and care facilities; and
                    ``(iii) procedures for acting upon such complaints 
                under the criminal laws of the State or for referring 
                such complaints to other State agencies for action.
            ``(B) For purposes of this paragraph, the term `board and 
        care facility' means a residential setting which receives 
        payment from or on behalf of two or more unrelated adults who 
        reside in such facility, and for whom one or both of the 
        following is provided:
                    ``(i) Nursing care services provided by, or under 
                the supervision of, a registered nurse, licensed 
                practical nurse, or licensed nursing assistant.
                    ``(ii) Personal care services that assist residents 
                with the activities of daily living, including personal 
                hygiene, dressing, bathing, eating, toileting, 
                ambulation, transfer, positioning, self-medication, 
                body care, travel to medical services, essential 
                shopping, meal preparation, laundry, and housework.''.

SEC. 112. ENSURING THE INTEGRITY OF THE FEDERAL HOSPITAL INSURANCE 
              TRUST FUND.

    (a) Determination.--Prior to the end of each fiscal year, the 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') and the Attorney General shall jointly determine--
            (1) the portion of the costs charged during the fiscal year 
        to any account established within the Federal Hospital 
        Insurance Trust Fund (in this section referred to as ``trust 
        fund'') under title XVIII of the Social Security Act (42 U.S.C. 
        1395 et seq.) to combat health care waste, fraud, and abuse, 
        that do not relate to the administration of the medicare 
        program; and
            (2) the amount of funds deposited into such account of the 
        trust fund during a fiscal year that were attributable to 
        enforcement activities that were intended to combat health care 
        waste, fraud, and abuse, that do not relate to the 
        administration of the medicare program.
    (b) Certification.--If the portion determined under paragraph (1) 
of subsection (a) exceeds the amount determined under paragraph (2) of 
such subsection, the Secretary and the Attorney General shall certify 
to the Secretary of the Treasury the amount, which shall be equal to 
the amount of the excess, which should be transferred from the General 
Fund of the Treasury to the trust fund, in order to ensure that the 
trust fund is fully reimbursed for any expenditures made from the 
account described in subsection (a) that are not related to the 
administration of the medicare program under title XVIII of the Social 
Security Act.
    (c) Transfer of Funds.--The Secretary of the Treasury shall 
transfer to the trust fund from the General Fund of the Treasury, out 
of any funds in the General Fund that are not otherwise appropriated, 
an amount equal to the amount certified under subsection (b).

SEC. 113. REQUIREMENT FOR ANNUAL GAO REPORT.

    Section 1817(k)(6) (42 U.S.C. 1395i(k)(6)) is amended--
            (1) in the matter preceding subparagraph (A), by striking 
        ``2000, 2002, and 2004,'' and inserting ``2000 and each 
        subsequent year through 2004''; and
            (2) in subparagraph (A)--
                    (A) in clause (i), by striking ``two fiscal years'' 
                and inserting ``fiscal year''; and
                    (B) in clause (ii), by striking ``fiscal years'' 
                and inserting ``fiscal year''.

SEC. 114. PROHIBITION ON CONSIDERATION OF LEGISLATION THAT DIVERTS 
              SAVINGS ACHIEVED THROUGH MEDICARE WASTE, FRAUD, AND ABUSE 
              ENFORCEMENT ACTIVITIES FOR PURPOSES OTHER THAN IMPROVING 
              THE SOLVENCY OF THE FEDERAL HOSPITAL INSURANCE TRUST 
              FUND.

    (a) Point of Order.--It shall not be in order in the Senate to 
consider any bill, conference report, or any other legislation that 
would use savings achieved through enforcement activities that are 
intended to combat waste, fraud, and abuse under the medicare program 
under title XVIII of the Social Security Act as offsets for purposes 
other than to improve the solvency of the Federal Hospital Insurance 
Trust Fund established under section 1817 of such Act (42 U.S.C. 
1395i).
    (b) Waiver.--The point of order described in subsection (a) may be 
waived or suspended in the Senate by a \3/5\ majority vote of the 
Senators duly chosen and sworn, or by the unanimous consent of the 
Senate.
    (c) Appeals.--
            (1) In general.--Appeals in the Senate from decisions of 
        the Chair relating to this section shall be limited to 1 hour, 
        to be equally divided between and controlled by, the appellant 
        and the manager of the bill, conference report, or other 
        legislation, as the case may be.
            (2) Waiver.--An affirmative \3/5\ majority vote of the 
        Senators duly chosen and sworn, or a unanimous consent 
        agreement of the Senate shall be required to sustain an appeal 
        of the ruling of the Chair on a point of order raised under 
        this section.

                TITLE II--SANCTIONS FOR FRAUD AND ABUSE

SEC. 201. CIVIL MONETARY PENALTIES FOR KICKBACKS.

    (a) Permitting Secretary To Impose Civil Monetary Penalty.--Section 
1128A(a) (42 U.S.C. 1320a-7a(a)) is amended--
            (1) by striking ``or'' at the end of paragraph (4);
            (2) by adding ``or'' at the end of paragraph (5); and
            (3) by adding after paragraph (5) the following:
            ``(6) commits an act described in paragraph (1) or (2) of 
        section 1128B(b);''.
    (b) Description of Civil Monetary Penalty Applicable.--Section 
1128A(a) (42 U.S.C. 1320a-7a(a)) (as amended by subsection (a) of this 
section) is amended in the matter following paragraph (6)--
            (1) by striking ``occurs).'' and inserting ``occurs; in 
        cases under paragraph (6), $50,000 for each such act).''; and
            (2) by inserting after ``of such claim'' the following: 
        ``(or, in cases under paragraph (6), damages of not more than 3 
        times the total amount of remuneration offered, paid, 
        solicited, or received, without regard to whether a portion of 
        such remuneration was offered, paid, solicited, or received for 
        a lawful purpose)''.

SEC. 202. CIVIL MONETARY PENALTIES FOR PERSONS THAT CONTRACT WITH 
              EXCLUDED INDIVIDUALS.

    Section 1128A(a) (42 U.S.C. 1320a-7a(a)) (as amended by section 
201(a) of this Act) is amended--
            (1) by striking ``or'' at the end of paragraph (5);
            (2) by adding ``or'' at the end of paragraph (6); and
            (3) by adding after paragraph (6) the following:
            ``(7) arranges or contracts (by employment or otherwise) 
        with an individual or entity that the person knows or should 
        know is excluded from participation in a Federal health care 
        program (as defined in section 1128B(f)), for the provision of 
        items or services for which payment may be made under such a 
        program;''.

SEC. 203. CIVIL MONETARY PENALTIES FOR SERVICES ORDERED OR PRESCRIBED 
              BY AN EXCLUDED INDIVIDUAL OR ENTITY.

    Section 1128A(a)(1) (42 U.S.C. 1320a-7a(a)(1)) is amended--
            (1) in subparagraph (D)--
                    (A) by inserting ``, ordered, or prescribed by a 
                person'' after ``other item or service furnished'';
                    (B) by inserting ``(under this title or title 
                XVIII) after ``period in which the person was 
                excluded'';
                    (C) by striking ``pursuant to a determination by 
                the Secretary'' and all that follows through ``the 
                provisions of section 1842(j)''; and
                    (D) by striking ``or'' at the end; and
            (2) by redesignating subparagraph (E) as subparagraph (F); 
        and
            (3) by adding after subparagraph (D) the following:
                    ``(E) is for a medical or other item or service 
                ordered or prescribed by a person excluded (under this 
                title or title XVIII) from the program under which the 
                claim was made, and the person furnishing such item or 
                service knows or should know of such exclusion, or''.

          TITLE III--TECHNICAL CLARIFICATIONS AND CORRECTIONS

SEC. 301. DEFINITION OF THE TERM CONVICTION.

    Section 1128E(g)(5) (42 U.S.C. 1320a-7e(g)(5)) is amended by 
striking ``paragraph (4) of'' and inserting ``paragraphs (1) through 
(4)''.

SEC. 302. PROPER REFERENCE IN ADVISORY OPINIONS.

    Section 1128D(b)(2)(D) (42 U.S.C. 1320a-7d(b)(2)(D)) is amended by 
striking ``1128B(b)'' and inserting ``1128A(b)''.

SEC. 303. ENSURING PROPER IMPLEMENTATION OF FEDERAL HEALTH CARE PROGRAM 
              EXCLUSIONS.

    Section 1128 (42 U.S.C. 1320a-7) is amended--
            (1) in subsection (a), by striking ``program under title 
        XVIII and shall direct that the following individuals and 
        entities be excluded from participation in any State health 
        care program (as defined in subsection (h))'' and inserting 
        ``Federal health care program (as defined in section 
        1128B(f))''; and
            (2) in subsection (b), by striking ``program under title 
        XVIII and may direct that the following individuals and 
        entities be excluded from participation in any State health 
        care program'' and inserting ``Federal health care program (as 
        defined in section 1128B(f))''.

                   TITLE IV--COORDINATION OF BENEFITS

SEC. 401. PERMANENT EXTENSION OF CERTAIN SECONDARY PAYER PROVISIONS.

    (a) Working Disabled.--Section 1862(b)(1)(B) (42 U.S.C. 
1395y(b)(1)(B)) is amended by striking clause (iii).
    (b) Individuals With End Stage Renal Disease.--Section 
1862(b)(1)(C) (42 U.S.C. 1395y(b)(1)(C)) is amended--
            (1) in the first sentence, by striking ``12-month'' each 
        place it occurs and inserting ``18-month''; and
            (2) by striking the second sentence.
    (c) IRS-SSA-HCFA Data Match.--
            (1) Social security act.--Section 1862(b)(5)(C) (42 U.S.C. 
        1395y(b)(5)(C)) is amended by striking clause (iii).
            (2) Internal revenue code.--Section 6103(l)(12) of the 
        Internal Revenue Code of 1986 is amended by striking 
        subparagraph (F).

SEC. 402. TECHNICAL CHANGES CONCERNING MINIMUM SIZES OF GROUP HEALTH 
              PLANS.

    (a) Placement of ``Group Health Plan'' Definition in Social 
Security Act.--
            (1) Definition.--Section 1862(b)(1)(E) (42 U.S.C. 
        1395y(b)(1)(E)) is amended by adding at the end the following:
                            ``(iv) Group health plan defined.--The term 
                        `group health plan' means a plan (including a 
                        self-insured plan) of, or contributed to by, an 
                        employer or employee organization to provide 
                        health care (directly or otherwise) to the 
                        employees, former employees, the employer, 
                        others associated or formerly associated with 
                        the employer in a business relationship, or 
                        their families.''.
            (2) Conforming amendments.--
                    (A) Section 1862(b)(1)(a).--Section 1862(b)(1)(A) 
                (42 U.S.C. 1395y(b)(1)(A)) is amended by striking 
                clause (v).
                    (B) Section 1862(b)(1)(c).--Section 1862(b)(1)(C) 
                (42 U.S.C. 1395y(b)(1)(C)) is amended in the matter 
                preceding clause (i) by striking ``plan (as defined in 
                subparagraph (A)(v))--'' and inserting ``plan--''.
                    (C) Sections 1837 and 1839.--Subparagraph (A) of 
                the first sentence of section 1837(i)(1) (42 U.S.C. 
                1395p(i)(1)), subparagraph (B) of the first sentence of 
                section 1837(i)(2) (42 U.S.C. 1395p(i)(2)), section 
                1837(i)(3)(A) (42 U.S.C. 1395p(i)(3)(A)), and paragraph 
                (2) of the second sentence of section 1839(b) (42 
                U.S.C. 1395r(b)), are each amended by striking 
                ``1862(b)(1)(A)(v)'' and inserting 
                ``1862(b)(1)(E)(iv)''.
                    (D) Section 5000 of the internal revenue code.--
                Section 5000(b) of the Internal Revenue Code of 1986 is 
                amended to read as follows:
    ``(b) Group Health Plan.--For purposes of this section, the term 
`group health plan' has the meaning given that term in section 
1862(b)(1)(E)(iv) of the Social Security Act (42 U.S.C. 
1395y(b)(1)(E)(iv)).''.
                    (E) Section 7701(a) of the internal revenue code.--
                Section 7701(a) of the Internal Revenue Code of 1986 is 
                amended by adding at the end the following:
            ``(47) Group health plan.--The term `group health plan' 
        means a plan (including a self-insured plan) of, or contributed 
        to by, an employer (including a self-employed person) or 
        employee organization to provide health care (directly or 
        otherwise) to the employees, former employees, the employer, 
        others associated or formerly associated with the employer in a 
        business relationship, or their families.''.
                    (F) Sections 4980b, 9805, and 6103 of the internal 
                revenue code.--Sections 4980B, 9805, and 
                6103(l)(12)(E)(ii) of the Internal Revenue Code of 1986 
                are amended by striking ``5000(b)(1)'' each place it 
                occurs and inserting ``7701(a)(47)''.
    (b) Consolidation of Size Requirements.--
            (1) In general.--Section 1862(b)(1)(E) (42 U.S.C. 
        1395y(b)(1)(E)) (as amended by subsection (a)(1) of this 
        section) is amended by adding at the end the following:
                            ``(v) Exclusion of group health plans of 
                        small and medium employers.--
                                    ``(I) Subparagraph (A) does not 
                                apply to a group health plan unless the 
                                plan involves at least one employer 
                                that has 20 or more employees in each 
                                of 20 or more calendar weeks in the 
                                current or preceding calendar year.
                                    ``(II) Subparagraph (B) does not 
                                apply to a group health plan unless the 
                                plan involves at least one employer 
                                that has 100 or more employees in each 
                                of 20 or more calendar weeks in the 
                                current or preceding calendar year.''.
            (2) Conforming amendments.--
                    (A) Section 1862(b)(1)(a).--Section 1862(b)(1)(A) 
                (42 U.S.C. 1395y(b)(1)(A)) (as amended by subsection 
                (a)(2)(A) of this section) is amended--
                            (i) by striking clauses (ii) and (iii), and
                            (ii) by redesignating clause (iv) as clause 
                        (ii).
                    (B) Section 1862(b)(1)(b).--Section 1862(b)(1)(B) 
                (42 U.S.C. 1395y(b)(1)(B)) is amended--
                            (i) in the heading, by striking ``Large'',
                            (ii) in clause (i), by striking ``large 
                        group health plan (as defined in clause (iv))'' 
                        and inserting ``group health plan'', and
                            (iii) by striking clause (iv).
                    (C) Section 1862(b)(2).--The second sentence of 
                section 1862(b)(2)(A) (42 U.S.C. 1395y(b)(2)(A)) is 
                amended by striking ``or large group health plan''.
                    (D) Section 1862(b)(3).--Section 1862(b)(3)(C) (42 
                U.S.C. 1395y(b)(3)(C)) is amended--
                            (i) in the heading, by striking ``or a 
                        large group health plan'', and
                            (ii) in the first sentence, by striking 
                        ``or a large group health plan''.
                    (E) Section 1837(i)(1).--Section 1837(i)(1) (42 
                U.S.C. 1395p(i)(1)) is amended--
                            (i) in the first sentence, in subparagraph 
                        (A), by striking ``(or the individual's 
                        spouse's) current employment status'' and 
                        inserting ``current employment status (or the 
                        current employment status of a family member of 
                        the individual)''; and
                            (ii) by striking the second sentence.
                    (F) Section 1837(i)(2).--Section 1837(i)(2) (42 
                U.S.C. 1395p(i)(2)) is amended--
                            (i) in the first sentence, in subparagraph 
                        (B), by striking ``(or the individual's 
                        spouse's) current employment status'' and 
                        inserting ``current employment status (or the 
                        current employment status of a family member of 
                        the individual)''; and
                            (ii) by striking the second sentence.
                    (G) Section 1837(i)(3).--Section 1837(i)(3) (42 
                U.S.C. 1395p(i)(3)) is amended--
                            (i) by striking subparagraph (B), and
                            (ii) by striking ``(3)(A)'' and inserting 
                        ``(3)''.
                    (H) Section 1839(b).--Paragraph (2) of the second 
                sentence of section 1839(b) (42 U.S.C. 1395r(b)) is 
                amended by striking ``by reason of the individual's'' 
                and all that follows through ``section 
                1862(b)(1)(B)(iv))''.
                    (I) Section 5000 of the internal revenue code.--
                Section 5000(c) of the Internal Revenue Code of 1986 is 
                amended by striking ``or large group health plan'' and 
                all that follows up to the period and inserting ``that 
                at any time during a calendar year does not comply with 
                any applicable requirement of paragraph (1) or (2) of 
                section 1862(b) of the Social Security Act''.

SEC. 403. INFORMATION REQUIREMENTS.

    (a) Information From Group Health Plans.--Section 1862(b) (42 
U.S.C. 1395y(b)) is amended by adding at the end the following:
            ``(7) Information from group health plans.--
                    ``(A) Provision of information by group health 
                plans.--The administrator of a group health plan (other 
                than a plan exempt, under paragraph (1)(E)(v), from the 
                requirements of paragraph (1)) shall provide to the 
                Secretary any or all of the information elements listed 
                in subparagraph (C) in the manner and at times (but not 
                more frequently than 4 times per year) the Secretary 
                may specify, with respect to each individual covered 
                under the plan and entitled to benefits under this 
                title.
                    ``(B) Provision of information by employers and 
                employee organizations.--An employer (or employee 
                organization) that maintains or participates in a group 
                health plan (other than a plan exempt, under paragraph 
                (1)(E)(v), from the requirements of paragraph (1)) 
                shall provide to the administrator of the plan any or 
                all of the information elements listed in subparagraph 
                (C) in the manner and at times (but not more frequently 
                than 4 times per year) the Secretary may specify, with 
                respect to each individual covered under the plan and 
                entitled to benefits under this title.
                    ``(C) Information elements to be provided.--The 
                information elements to be provided under subparagraph 
                (A) or (B) are:
                            ``(i) Elements concerning the individual.--
                        Elements concerning the individual are as 
                        follows:
                                    ``(I) The individual's name.
                                    ``(II) The individual's date of 
                                birth.
                                    ``(III) The individual's social 
                                security number.
                                    ``(IV) The number assigned by the 
                                Secretary to the individual for claims 
                                under this title.
                                    ``(V) The family relationship of 
                                the individual to the person who has or 
                                had current employment status with the 
                                employer.
                            ``(ii) Elements concerning the family 
                        member with current or former employment 
                        status.--Elements concerning the family member 
                        with current or former employment status are as 
                        follows:
                                    ``(I) The name of the person in the 
                                individual's family who has or had 
                                current employment status with the 
                                employer.
                                    ``(II) That person's social 
                                security number.
                                    ``(III) The number or other 
                                identifier assigned by the plan to that 
                                person.
                                    ``(IV) The periods of coverage for 
                                that person under the plan.
                                    ``(V) The employment status of that 
                                person (current or former) during those 
                                periods of coverage.
                                    ``(VI) The classes (of that 
                                person's family members) covered under 
                                the plan.
                            ``(iii) Plan elements.--Plan elements are 
                        as follows:
                                    ``(I) The nature of the items and 
                                services covered under the plan.
                                    ``(II) The name and address to 
                                which claims under the plan are to be 
                                sent.
                            ``(iv) Elements concerning the employer.--
                        Elements concerning the employer are as 
                        follows:
                                    ``(I) The employer's name.
                                    ``(II) The employer's address.
                                    ``(III) The employer identification 
                                number of the employer.
                    ``(D) Use of identifiers.--The administrator of a 
                group health plan shall utilize an identifier for the 
                plan (that the Secretary may furnish) in providing 
                information under subparagraph (A) and in other 
                transactions, as may be specified by the Secretary, 
                related to the provisions of this subsection.
                    ``(E) Applicability of electronic transmission 
                requirements.--Part C of title XI applies to the 
                preceding subparagraphs of this paragraph.
                    ``(F) Penalty for noncompliance.--Any entity that 
                knowingly and willfully fails to comply with a 
                requirement imposed by subparagraphs (A), (B), (C), 
                (D), or (E) is subject to a civil money penalty not to 
                exceed $1,000 for each incident of failure. The 
                provisions of section 1128A (other than subsections (a) 
                and (b)) apply to a civil money penalty under the 
                previous sentence in the same manner as those 
                provisions apply to a penalty or proceeding under 
                section 1128A(a).''.
    (b) Effective Date.--The amendment made by subsection (a) is 
effective 180 days after the date of enactment of this Act.

SEC. 404. CLARIFICATION OF TIME AND FILING LIMITATIONS.

    (a) In General.--Section 1862(b)(2)(B) (42 U.S.C. 1395y(b)(2)(B)) 
is amended by adding at the end the following:
                            ``(v) Time, filing, and related provisions 
                        under primary plan.--Requirements under a 
                        primary plan as to the filing of a claim, time 
                        limitations for the filing of a claim, 
                        information not maintained by the Secretary, or 
                        notification or preadmission review, shall not 
                        apply to a claim by the United States under 
                        clause (ii) or (iii).''.
    (b) Effective Date.--The amendment made by subsection (a) applies 
to items and services furnished after 1997.

SEC. 405. CLARIFICATION OF LIABILITY OF THIRD PARTY ADMINISTRATORS.

    (a) In General.--Section 1862(b)(2)(B)(ii) (42 U.S.C. 
1395y(b)(2)(B)(ii)) is amended by inserting ``, or which determines 
claims under the primary plan'' after ``primary plan''.
    (b) Claims Between Parties Other Than the United States.--Section 
1862(b)(2)(B) (42 U.S.C. 1395y(b)(2)(B)) (as amended by section 404 of 
this Act) is amended by adding at the end the following:
                            ``(vi) Claims between parties other than 
                        the united states.--A claim by the United 
                        States under clause (ii) or (iii) shall not 
                        preclude claims between other parties.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished after 1997.

SEC. 406. CLARIFICATION OF PAYMENT AMOUNTS TO MEDICARE.

    (a) In General.--Section 1862(b)(2)(B)(i) (42 U.S.C. 
1395y(b)(2)(B)(i)) is amended to read as follows:
                            ``(i) Repayment required.--
                                    ``(I) In general.--Any payment 
                                under this title, with respect to any 
                                item or service for which payment by a 
                                primary plan is required under the 
                                preceding provisions of this 
                                subsection, shall be conditioned on 
                                reimbursement to the appropriate Trust 
                                Fund established by this title when 
                                notice or other information is received 
                                that payment for that item or service 
                                has been or should have been made under 
                                those provisions. If reimbursement is 
                                not made to the appropriate Trust Fund 
                                before the expiration of the 60-day 
                                period that begins on the date such 
                                notice or other information is 
                                received, the Secretary may charge 
                                interest (beginning with the date on 
                                which the notice or other information 
                                is received) on the amount of the 
                                reimbursement until reimbursement is 
                                made (at a rate determined by the 
                                Secretary in accordance with 
                                regulations of the Secretary of the 
                                Treasury applicable to charges for late 
                                payments).
                                    ``(II) Determination of amount 
                                owed.--The amount owed by a primary 
                                plan under the first sentence of 
                                subclause (I) is the lesser of the full 
                                primary payment required (if that 
                                amount is readily determinable) and the 
                                amount paid under this title for that 
                                item or service.''.
    (b) Conforming and Technical Amendments.--
            (1) Subparagraphs (A)(i)(I) and (B)(i) of section 
        1862(b)(1) (42 U.S.C. 1395y(b)(1)) are each amended by 
        inserting ``(or eligible to be covered)'' after ``covered''.
            (2) Section 1862(b)(1)(C)(ii) (42 U.S.C. 
        1395y(b)(1)(C)(ii)) is amended by striking ``covered by such 
        plan''.
            (3) Section 1862(b)(2)(A) (42 U.S.C. 1395y(b)(2)(A)) is 
        amended in the matter preceding clause (i) by striking ``, 
        except as provided in subparagraph (B),''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished after 1997.
                                 <all>