[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 3730 Introduced in Senate (IS)]








109th CONGRESS
  2d Session
                                S. 3730

 To amend title XVIII of the Social Security Act to require the use of 
 recovery audit contractors under the Medicare Integrity Program with 
       respect to Medicare Secondary Payer claims and activities.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 25, 2006

   Mr. Crapo 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 require the use of 
 recovery audit contractors under the Medicare Integrity Program with 
       respect to Medicare Secondary Payer claims and activities.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ensuring the Integrity of the 
Medicare Program Act of 2006''.

SEC. 2. USE OF RECOVERY AUDIT CONTRACTORS UNDER THE MEDICARE INTEGRITY 
              PROGRAM FOR AUDITS OF MEDICARE SECONDARY PAYER CLAIMS AND 
              ACTIVITIES.

    (a) In General.--Section 1893 of the Social Security Act (42 U.S.C. 
1395ddd), as amended by section 6034(d) of the Deficit Reduction Act of 
2006 (Public Law 109-171), is amended by adding at the end the 
following new subsection:
    ``(h) Use of Recovery Audit Contractors for Audits of Medicare 
Secondary Payer Claims and Activities.--
            ``(1) In general.--Under the Program, the Secretary, using 
        a competitive procurement process, shall enter into contracts 
        with recovery audit contractors in accordance with this 
        subsection for the purpose of identifying underpayments and 
        overpayments and recouping overpayments with respect to 
        Medicare Secondary Payer claims and activities for which 
        payment is made under part A or B. Under the contracts--
                    ``(A) payment shall be made to such a contractor on 
                a contingent basis at a rate determined by the 
                Secretary; and
                    ``(B) such percentage as the Secretary may specify 
                of the amount recovered shall be retained by the 
                Secretary and shall be available to the program 
                management account of the Centers for Medicare & 
                Medicaid Services.
            ``(2) Use on a national basis.--The Secretary shall 
        designate audit and recovery regions for the use of recovery 
        audit contractors on a national basis. Each such region shall 
        be covered under a contract with a recovery audit contractor 
        (or contractors, if the Secretary determines appropriate).
            ``(3) Audit and recovery periods.--Each contract with a 
        recovery audit contractor shall provide that audit and recovery 
        activities may be conducted with respect to payments made under 
        part A or B with respect to Medicare Secondary Payer claims and 
        activities--
                    ``(A) during the current fiscal year;
                    ``(B) retrospectively (for a period of not more 
                than 4 fiscal years prior to the current fiscal year); 
                and
                    ``(C) with respect to continuing fiscal years.
            ``(4) Qualifications of contractors.--A recovery audit 
        contractor is eligible to enter into a contract under this 
        subsection to carry out the activities described in paragraph 
        (1) if the contractor--
                    ``(A) has staff that has the appropriate clinical 
                knowledge of, and experience with, the payment rules 
                and regulations under the program under this title or 
                the contractor has, or will contract with, another 
                entity that has such knowledgeable and experienced 
                staff; and
                    ``(B) is not a fiscal intermediary under section 
                1816, a carrier under section 1842, a Medicare 
                Administrative Contractor under section 1874A, or a 
                Coordination of Benefits Contractor of the Centers for 
                Medicare & Medicaid Services.
            ``(5) Preference for entities with demonstrated 
        proficiency.--In awarding contracts to recovery audit 
        contractors under this section, the Secretary shall give 
        preference to those risk entities that the Secretary determines 
        have demonstrated more than 3 years direct management 
        experience and a proficiency for cost control or recovery 
        audits with private insurers, health care providers, health 
        plans, or under the medicaid program under title XIX.
            ``(6) Construction relating to conduct of investigation of 
        fraud.--A recovery of an overpayment to a provider by a 
        recovery audit contractor shall not be construed to prohibit 
        the Secretary or the Attorney General from investigating and 
        prosecuting, if appropriate, allegations of fraud or abuse 
        arising from such overpayment.
            ``(7) Report.--The Secretary shall annually submit to 
        Congress a report on the use of recovery audit contractors 
        under the Program. Such report shall include information on the 
        performance of recovery audit contractors in identifying 
        underpayments and overpayments and recouping overpayments, 
        including an evaluation of the comparative performance of audit 
        recovery contractors with respect to each audit recovery region 
        designated under paragraph (2).
            ``(8) Waiver.--The Secretary shall waive such provisions of 
        this title as may be necessary to provide for payment of 
        recovery audit contractors under this subsection in accordance 
        with paragraph (1).''.
    (b) Access to National Directory of New Hires Database.--The 
Secretary of Labor shall provide for access by the Centers for Medicare 
& Medicaid Services and recovery audit contractors conducting audit and 
recovery activities under section 1893(h) of the Social Security Act, 
as added by subsection (a), to the National Directory of New Hires 
database.
    (c) Access to Coordination of Benefits Contractor Database.--The 
Secretary of Labor shall provide for access by the Centers for Medicare 
& Medicaid Services and recovery audit contractors conducting audit and 
recovery activities under section 1893(h) of the Social Security Act, 
as added by subsection (a), to the database of the Coordination of 
Benefits Contractor of the Centers for Medicare & Medicaid Services 
with respect to the audit and recovery periods described in paragraph 
(3) such section 1893(h).
    (d) Sunset of Demonstration Project for Use of Recovery Audit 
Contractors With Respect to Medicare Secondary Payer Claims and 
Activities.--Section 306(b)(2) of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 
Stat. 2256) is amended--
            (1) by striking ``Duration.--The project'' and inserting 
        ``Duration.--
                    (A) In general.--Subject to subparagraph (B), the 
                project''; and
            (2) by inserting after subparagraph (A), as inserted by 
        paragraph (1), the following new subparagraph:
                    ``(B) Sunset of project with respect to medicare 
                secondary payer claims and activities.--The project 
                shall not be conducted with respect to Medicare 
                Secondary Payer claims and activities on or after the 
                date of enactment of the Ensuring the Integrity of the 
                Medicare Program Act of 2006, except that recovery 
                audit contracts entered into prior to such date with 
                respect to such claims and activities may be completed 
                pursuant to the terms and conditions of the 
                contract.''.
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