[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5044 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5044

   To provide for enhanced penalties to combat Medicare and Medicaid 
  fraud, a Medicare data-mining system and biometric technology pilot 
    program, and a GAO study on Medicare administrative contractors.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 15, 2010

Mr. Klein of Florida (for himself and Ms. Ros-Lehtinen) introduced the 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, 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 enhanced penalties to combat Medicare and Medicaid 
  fraud, a Medicare data-mining system and biometric technology pilot 
    program, and a GAO study on Medicare administrative contractors.

    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 Fraud Enforcement and 
Prevention Act of 2010''.

SEC. 2. ENHANCED CRIMINAL PENALTIES TO COMBAT MEDICARE AND MEDICAID 
              FRAUD.

    (a) In General.--Section 1128B of the Social Security Act (42 
U.S.C. 1320a-7b) is amended--
            (1) in subsection (a), by striking ``$10,000 or imprisoned 
        for not more than one year'' and inserting ``$20,000 or 
        imprisoned for not more than two years''; and
            (2) in each of subsections (a), (b)(1), (b)(2), (c), and 
        (d), by striking ``$25,000 or imprisoned for not more than five 
        years'' and inserting ``$50,000 or imprisoned for not more than 
        10 years''.
    (b) Illegal Distribution of Medicare or Medicaid Beneficiary 
Identification or Billing Privileges.--Section 1128B of such Act (42 
U.S.C. 1320a-7b) is amended by adding at the end the following new 
subsection:
    ``(g) Whoever knowingly, intentionally, and with the intent to 
defraud purchases, sells, or distributes, or arranges for the purchase, 
sale, or distribution of two or more Medicare or Medicaid beneficiary 
identification numbers or billing privileges under title XVIII or title 
XIX shall be imprisoned for not more than three years or fined under 
title 18, United States Code (or, if greater, an amount equal to the 
monetary loss to the Federal and any State government as a result of 
such acts), or both.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to acts committed on or after the date of the enactment of this 
Act.

SEC. 3. ENHANCED CIVIL AUTHORITIES TO COMBAT MEDICARE AND MEDICAID 
              FRAUD.

    (a) Civil Monetary Penalties Law Alignment and Other Changes.--
            (1) Section 1128A(a) of the Social Security Act (42 U.S.C. 
        1320a-7a(a)) is amended--
                    (A) in paragraph (1), by striking ``to an officer, 
                employee, or agent of the United States, or of any 
                department or agency thereof, or of any State agency 
                (as defined in subsection (i)(1)),'';
                    (B) by inserting after paragraph (10), as added by 
                section 6402(d)(2) of the Patient Protection and 
                Affordable Care Act (Public Law 111-148) the following 
                new paragraphs:
            ``(11) conspires to commit a violation of this section; or
            ``(12) knowingly makes, uses, or causes to be made or used, 
        a false record or statement material to an obligation to pay or 
        transmit money or property to a Federal health care program, or 
        knowingly conceals or knowingly and improperly avoids or 
        decreases an obligation to pay or transmit money or property to 
        a Federal health care program;'';
                    (C) in the first sentence--
                            (i) by striking ``or in cases under 
                        paragraph (9)'' and inserting ``in cases under 
                        paragraph (9)''; and
                            (ii) by striking ``fact)'' and inserting 
                        ``fact), in cases under paragraph (11), $50,000 
                        for any violation described in this section 
                        committed in furtherance of the conspiracy 
                        involved, and in cases under paragraph (12), 
                        $50,000 for each false record or statement, or 
                        concealment, avoidance, or decrease''; and
                    (D) in the second sentence, by striking ``material 
                fact).'' and inserting ``material fact); or in cases 
                under paragraph (11), an assessment of not more than 3 
                times the total amount that would otherwise apply for 
                any violation described in this section committed in 
                furtherance of the conspiracy involved; or in cases 
                under paragraph (12), an assessment of not more than 3 
                times the total amount of the obligation to which the 
                false record or statement was material or that was 
                avoided or decreased.''.
            (2) Section 1128A(c)(1) of the Social Security Act (42 
        U.S.C. 1320a-7a(c)(1)) is amended by striking ``six years'' and 
        inserting ``10 years''.
            (3) Section 1128A(i) of the Social Security Act (42 U.S.C. 
        1320a-7a(i)) is amended--
                    (A) by amending paragraph (2) to read as follows:
            ``(2) The term `claim' means any application, request, or 
        demand, whether under contract, or otherwise, for money or 
        property for items and services under a Federal health care 
        program (as defined in section 1128B(f)), whether or not the 
        United States or a State agency has title to the money or 
        property, that--
                    ``(A) is presented or caused to be presented to an 
                officer, employee, or agent of the United States, or of 
                any department or agency thereof, or of any State 
                agency (as defined in subsection (i)(1)); or
                    ``(B) is made to a contractor, grantee, or other 
                recipient if the money or property is to be spent or 
                used on the Federal health care program's behalf or to 
                advance a Federal health care program interest, and if 
                the Federal health care program--
                            ``(i) provides or has provided any portion 
                        of the money or property requested or demanded; 
                        or
                            ``(ii) will reimburse such contractor, 
                        grantee, or other recipient for any portion of 
                        the money or property which is requested or 
                        demanded.'';
                    (B) by amending paragraph (3) to read as follows:
            ``(3) The term `item or service' means, without limitation, 
        any medical, social, management, administrative, or other item 
        or service used in connection with or directly or indirectly 
        related to a Federal health care program.'';
                    (C) in paragraph (7)--
                            (i) by striking ``term `should know' 
                        means'' and inserting ``terms `knowing', 
                        `knowingly', and `should know' mean'';
                            (ii) by redesignating subparagraphs (A) and 
                        (B) as subparagraphs (B) and (C), respectively;
                            (iii) by inserting before subparagraph (B), 
                        as redesignated by clause (ii), the following 
                        new subparagraph:
                    ``(A) has actual knowledge of the information;''; 
                and
                            (iv) in the matter following subparagraph 
                        (C), as redesignated by clause (ii)--
                                    (I) by inserting ``require'' after 
                                ``and''; and
                                    (II) by striking ``is required''; 
                                and
                    (D) by adding at the end the following new 
                paragraphs:
            ``(8) The term `obligation' means an established duty, 
        whether or not fixed, arising from an express or implied 
        contractual, grantor-grantee, or licensor licensee 
        relationship, from a fee-based or similar relationship, from 
        statute or regulation, or from the retention of any 
        overpayment.
            ``(9) The term `material' means having a natural tendency 
        to influence, or be capable of influencing, the payment or 
        receipt of money or property.''.
    (b) Exclusion of Responsible Corporate Officials.--Section 1128(b) 
of the Social Security Act (42 U.S.C. 1320a-7(b)) is amended by 
striking clauses (i) and (ii) of paragraph (15)(A) and inserting the 
following:
                            ``(i) who has or had a direct or indirect 
                        ownership or control interest in a sanctioned 
                        entity at the time of and who knew or should 
                        have known (as defined in section 1128(i)(7)) 
                        of any of the conduct that formed a basis for 
                        the conviction or exclusion described in 
                        subparagraph (B); or
                            ``(ii) who is or was an officer or managing 
                        employee (as defined in section 1126(b)) of 
                        such an entity at the time of any of the 
                        conduct that formed a basis for the conviction 
                        or exclusion so described.''.
    (c) Payment Suspensions.--Subsection (o)(1) of section 1862 of the 
Social Security Act (42 U.S.C. 42 U.S.C. 1395y), as added by section 
6402(h) of the Patient Protection and Affordable Care Act (Public Law 
111-148), is amended by striking ``may'' and inserting ``shall''.
    (d) Civil Monetary Penalties for False Statements or Delaying 
Inspections.--Paragraph (9) of section 1128A(a) of the Social Security 
Act (42 U.S.C. 1320a-7a(a)), as added by section 6408(a) of the Patient 
Protection and Affordable Care Act (Public Law 111-148), is amended by 
inserting ``or to timely provide information in response to a request 
authorized by section 1128J(b),'' after ``regulations),''.

SEC. 4. ENHANCED SCREENING, MEDICARE DATA-MINING SYSTEM; BIOMETRIC 
              TECHNOLOGY PILOT PROGRAM.

    (a) Enhanced Screening.--Section 1866(j)(2)(B)(ii) of the Social 
Security Act (42 U.S.C. 1395cc(j)), as inserted by section 6401(a)(3) 
of the Patient Protection and Affordable Care Act (Public Law 111-148), 
is amended by striking ``may'' and inserting ``shall''.
    (b) Access to Real Time Claims and Payment Data.--
Section1128J(a)(2) of the Social Security Act, as added by section 
6402(a) of the Patient Protection and Affordable Care Act (Public Law 
111-148), is amended--
            (1) by inserting ``including real time claims and payment 
        data,'' after ``access to claims and payment data''; and
            (2) by adding at the end the following sentence: ``In 
        carrying out this section, the Inspector General of the 
        Department of Health and Human Services, in consultation with 
        the Attorney General, shall implement mechanisms for the 
        sharing of information about suspected fraud relating to the 
        Federal health care programs under titles XVIII, XIX, and XXI 
        with other appropriate law enforcement officials.''.
    (c) Biometric Technology Pilot Program.--
            (1) In general.--By not later than one year after the date 
        of the enactment of this Act, the Secretary of Health and Human 
        Services shall carry out a 5-year pilot program that implements 
        biometric technology to ensure that individuals entitled to 
        benefits under part A of title XVIII of the Social Security Act 
        or enrolled under part B of such title are physically present 
        at the time and place of receipt of certain items and services 
        (specified by the Secretary) for which payment may be made 
        under such title. Under such pilot program the Secretary may 
        provide for financial incentives to encourage voluntary 
        participation of providers of services (as defined in section 
        1861(u) of such Act) and suppliers (as defined in section 
        1861(d) of such Act).
            (2) Reports.--The Secretary of Health and Human Services 
        shall, for each of the third, fourth, and fifth years of the 
        pilot program under paragraph (1), submit to Congress a report 
        on the effectiveness of the pilot program in reducing the 
        occurrence of waste, fraud, and abuse in the Medicare program 
        under title XVIII of the Social Security Act.
            (3) Authorization of appropriations.--For purpose of 
        carrying out paragraph (1), there is authorized to be 
        appropriated such sums as may be necessary.

SEC. 5. GAO STUDY AND REPORT.

    (a) Study.--The Comptroller General of the United States shall 
conduct a study on Medicare administrative contractors under section 
1874A of the Social Security Act, including Recovery Audit Contractors, 
regarding the following areas:
            (1) Training and expertise in identifying fraud, including 
        the education levels of the key individuals tasked to identify 
        or refer potential cases of fraud, and whether the Centers for 
        Medicare & Medicaid Services should be providing more training 
        to contractors, or require contractors to hire experts with 
        greater medical training.
            (2) Acquisition and implementation of data mining software 
        among Medicare administrative contractors, if applicable, and 
        the ability or availability of such software to provide real-
        time data mining capabilities.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall complete the study under this section and submit a report to 
Congress regarding the findings of the study and recommendations for 
legislation and administrative action.
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