[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 2774 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 2774

  To amend title XVIII of the Social Security Act to prevent Medicare 
             payments being lost to fraud, waste, or abuse.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 16, 2009

 Mr. Grassley 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 prevent Medicare 
             payments being lost to fraud, waste, or abuse.

    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 ``Fighting Medicare Payment Fraud Act 
of 2009''.

SEC. 2. EXTENSION OF NUMBER OF DAYS IN WHICH MEDICARE CLAIMS ARE 
              REQUIRED TO BE PAID IN ORDER TO PREVENT OR COMBAT FRAUD, 
              WASTE, OR ABUSE.

    (a) Part A Claims.--Section 1816(c)(2) of the Social Security Act 
(42 U.S.C. 1395h(c)(2)) is amended--
            (1) in subparagraph (B)(ii)(V), by striking ``with 
        respect'' and inserting ``subject to subparagraph (D), with 
        respect''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D)(i) Upon a determination by the Secretary that 
                there is a likelihood of fraud, waste, or abuse 
                involving a particular category of providers of 
                services or suppliers, categories of providers of 
                services or suppliers in a certain geographic area, or 
                individual providers of services or suppliers, the 
                Secretary shall extend the number of calendar days 
                described in subparagraph (B)(ii)(V) to--
                            ``(I) up to 365 calendar days with respect 
                        to claims submitted by--
                                    ``(aa) categories of providers of 
                                services or suppliers; or
                                    ``(bb) categories of providers of 
                                services or suppliers in a certain 
                                geographic area; or
                            ``(II) such time that the Secretary 
                        determines is necessary to ensure that the 
                        claims with respect to individual providers of 
                        services or suppliers are clean claims.
                    ``(ii) During the extended period of time under 
                subclauses (I) and (II) of clause (ii), the Secretary 
                shall engage in heightened scrutiny of claims, such as 
                prepayment review and other methods the Secretary 
                determines to be appropriate.
                    ``(iii) Not later than 90 days after the date of 
                enactment of this subparagraph and not less than 
                annually thereafter, the Inspector General of the 
                Department of Health and Human Services shall submit to 
                the Secretary a report containing recommendations with 
                respect to the application of this subparagraph and 
                section 1842(c)(2)(D). Not later than 60 days after 
                receiving such a report, the Secretary shall submit to 
                the Inspector General a written response to the 
                recommendations contained in the report.
                    ``(iv) There shall be no administrative or judicial 
                review under section 1869, section 1878, or otherwise 
                of the implementation of this subparagraph by the 
                Secretary.''.
    (b) Part B Claims.--Section 1842(c)(2) of the Social Security Act 
(42 U.S.C. 1395u(c)(2)) is amended--
            (1) in subparagraph (B)(ii)(V), by striking ``with 
        respect'' and inserting ``subject to subparagraph (D), with 
        respect''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D)(i) Upon a determination by the Secretary that 
                there is a likelihood of fraud, waste, or abuse 
                involving a particular category of providers of 
                services or suppliers, categories of providers of 
                services or suppliers in a certain geographic area, or 
                individual providers of services or suppliers, the 
                Secretary shall extend the number of calendar days 
                described in subparagraph (B)(ii)(V) to--
                            ``(I) up to 365 calendar days with respect 
                        to claims submitted by--
                                    ``(aa) categories of providers of 
                                services or suppliers; or
                                    ``(bb) categories of providers of 
                                services or suppliers in a certain 
                                geographic area; or
                            ``(II) such time that the Secretary 
                        determines is necessary to ensure that the 
                        claims with respect to individual providers of 
                        services or suppliers are clean claims.
                    ``(ii) During the extended period of time under 
                subclauses (I) and (II) of clause (ii), the Secretary 
                shall engage in heightened scrutiny of claims, such as 
                prepayment review and other methods the Secretary 
                determines to be appropriate.
                    ``(iii) There shall be no administrative or 
                judicial review under section 1869, section 1878, or 
                otherwise of the implementation of this subparagraph by 
                the Secretary.''.
    (c) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        take effect on the day that is 6 months after the date of the 
        enactment of this Act.
            (2) Expediting implementation.--The Secretary shall 
        promulgate regulations to carry out the amendments made by this 
        section which may be effective and final immediately on an 
        interim basis as of the date of publication of the interim 
        final regulation. If the Secretary provides for an interim 
        final regulation, the Secretary shall provide for a period of 
        public comment on such regulation after the date of 
        publication. The Secretary may change or revise such regulation 
        after completion of the period of public comment.
                                 <all>