II 111th CONGRESS 1st Session S. 2774 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.

1.

Short title

This Act may be cited as the Fighting Medicare Payment Fraud Act of 2009.

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.