[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4105 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 4105

 To impose a moratorium on the use of recovery audit contractors under 
                    the Medicare Integrity Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 7, 2007

  Mrs. Capps introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, 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 impose a moratorium on the use of recovery audit contractors under 
                    the Medicare Integrity Program.

    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 ``Medicare Recovery Audit Contractor 
Program Moratorium Act of 2007''.

SEC. 2. MEDICARE RECOVERY AUDIT CONTRACTOR PROGRAM MORATORIUM.

    (a) In General.--Except as provided in subsection (c), the 
Secretary of Health and Human Services--
            (1) shall suspend all further activities under the Medicare 
        recovery audit contractor program (as defined in subsection 
        (e)(2));
            (2) shall not permit recovery audit contractors--
                    (A) to identify any additional underpayments or 
                overpayments; or
                    (B) to effect any additional recoupments; and
            (3) shall not enter into any new contracts under the 
        program.
    (b) Termination.--The moratorium effected under subsection (a) 
shall end one year after the date of the enactment of this Act.
    (c) Applicability.--
            (1) Protection of appeal rights.--Subsection (a) shall not 
        affect appeals under the Medicare recovery audit contractor 
        program.
            (2) Medicare secondary payer activities.--Subsection (a) 
        shall not affect Medicare secondary payer activities performed 
        by recovery audit contractors.
    (d) Reports.--
            (1) CMS report evaluating the program.--
                    (A) In general.--Not later than 90 days after the 
                date of the enactment of this Act, the Administrator of 
                the Centers for Medicare & Medicaid Services shall 
                submit to the Congress a report evaluating the Medicare 
                recovery audit contractor program.
                    (B) Contents of report.--Such report shall include 
                the following information, with respect to the Medicare 
                recovery audit contractor program:
                            (i) The number of claims provided by the 
                        Centers for Medicare & Medicaid Services to 
                        recovery audit contractors.
                            (ii) The number of claims requested by 
                        recovery audit contractors.
                            (iii) The number of claims reviewed by 
                        recovery audit contractors.
                            (iv) The number of claims described in 
                        clause (iii) reviewed through an automated 
                        process and the number of such claims otherwise 
                        reviewed by recovery audit contractors.
                            (v) The number and dollar amount of claims 
                        that recovery audit contractors sought to 
                        recoup after identifying such claims as 
                        overpayments.
                            (vi) The number of appeals made by 
                        providers and suppliers in response to 
                        recoupment of payments by a recovery audit 
                        contractor.
                            (vii) The outcome of such appeals.
                    (C) Form of data.--
                            (i) The information described in 
                        subparagraph (B) shall be reported--
                                    (I) for activities under the 
                                Medicare recovery audit contractor 
                                program in each calendar quarter; and
                                    (II) on a national, State, and 
                                county basis and according to provider 
                                group.
                            (ii) Information described in subparagraph 
                        (B) concerning appeals shall be reported by 
                        appeal level.
            (2) GAO report.--
                    (A) In general.--Not later than 60 days after the 
                date the report is submitted to the Congress under 
                paragraph (1), the Comptroller General of the United 
                States shall submit a report to the Congress regarding 
                the use of recovery audit contractors in the Medicare 
                Integrity program.
                    (B) Contents of report.--Such report shall include 
                the following:
                            (i) An examination of the information 
                        described in each of clauses (i) through (vi) 
                        of paragraph (1)(B).
                            (ii) An examination of the role of recovery 
                        audit contractors in the Medicare oversight 
                        process.
                            (iii) A comparison of the roles of recovery 
                        audit contractors with the roles of quality 
                        improvement organizations and Medicare 
                        administrative contractors.
                            (iv) An examination of the extent to which 
                        the process used by recovery audit contractors 
                        is consistent with Medicare policy regarding 
                        claims denials and appeals.
                    (C) Recommendations.--Such report shall include 
                recommendations--
                            (i) to improve the accuracy and efficiency 
                        of recovery audit contractors; and
                            (ii) to ensure compliance of recovery audit 
                        contractors with Medicare policy concerning 
                        denials and appeals.
            (3) Quarterly reports.--
                    (A) In general.--Not later than 60 days after the 
                end of each calendar quarter beginning after the end of 
                the moratorium under subsection (a), the Administrator 
                of the Centers for Medicare & Medicaid Services shall 
                submit to the Congress a report on the conduct of the 
                Medicare recovery audit contractor program during the 
                quarter.
                    (B) Contents of report.--Each report under 
                subparagraph (A) shall include, with respect to a 
                quarter, the information described in each of clauses 
                (i) through (vi) of paragraph (1)(B) for such quarter.
                    (C) Form of data.--The information required under 
                subparagraph (B) shall be reported on a national, 
                State, and county basis and according to provider 
                group.
    (e) Definitions.--For the purposes of this section:
            (1) Medicare administrative contractor.--The term 
        ``Medicare administrative contractor'' has the meaning given 
        such term in section 1874A of the Social Security Act (42 
        U.S.C. 1395kk-1).
            (2) Medicare recovery audit contractor program.--The term 
        ``Medicare recovery audit contractor program'' means recovery 
        audit contractor--
                    (A) activities under section 306 of the Medicare 
                Prescription Drug, Improvement, and Modernization Act 
                of 2003 (Public Law 108-173); and
                    (B) activities under section 1893(h) of the Social 
                Security Act (42 U.S.C. 1395ddd(h)).
            (3) Medicare secondary payer activities.--The term 
        ``Medicare secondary payer activities'' means an activity 
        undertaken to obtain compliance with, and enforce, section 
        1862(b) of the Social Security Act.
            (4) Provider.--The term ``provider'' means a provider of 
        services as defined in section 1861(n) of the Social Security 
        Act (42 U.S.C. 1395x(n)).
            (5) Quality improvement organization.--The term ``quality 
        improvement organization'' means a utilization and quality 
        control peer review organization as defined in section 1152 of 
        the Social Security Act (42 U.S.C. 1320c-1).
            (6) Recovery audit contractor.--The term ``recovery audit 
        contractor'' means a contractor operating under the Medicare 
        recovery audit contractor program.
            (7) Supplier.--The term ``supplier'' has the meaning given 
        such term in section 1861(d) of the Social Security Act (42 
        U.S.C. 1395x(d)).
    (f) Conforming Amendments.--
            (1) Social security act.--Section 1893(h)(1) of the Social 
        Security Act (42 U.S.C. 1395ddd(h)(1)) is amended by striking 
        ``Under the Program'' and inserting ``Subject to section 2 of 
        the Medicare Recovery Audit Contractor Program Moratorium Act 
        of 2007, under the Program''.
            (2) Medicare prescription drug, improvement, and 
        modernization act of 2003.--Section 306(a) of the Medicare 
        Prescription Drug, Improvement, and Modernization Act of 2003 
        (Public Law 108-173) is amended by striking ``The Secretary 
        shall conduct'' and inserting ``Subject to section 2 of the 
        Medicare Recovery Audit Contractor Program Moratorium Act of 
        2007, the Secretary shall conduct''.
    (g) Technical Amendment.--Section 306(f) of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173) is amended by striking ``information' means information'' 
and all that follows.
                                 <all>