[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 2964 Introduced in Senate (IS)]

111th CONGRESS
  2d Session
                                S. 2964

   To amend titles XVIII, XIX, and XXI of the Social Security Act to 
prevent fraud, waste, and abuse under Medicare, Medicaid, and CHIP, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 28, 2010

 Mr. Grassley introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend titles XVIII, XIX, and XXI of the Social Security Act to 
prevent fraud, waste, and abuse under Medicare, Medicaid, and CHIP, and 
                          for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Strengthening 
Program Integrity and Accountability in Health Care Act''.
    (b) Table of Contents.--The table of contents of this title is as 
follows:

Sec. 1. Short title; table of contents.
                 TITLE I--MEDICARE, MEDICAID, AND CHIP

Sec. 101. Provider screening and other enrollment requirements under 
                            Medicare, Medicaid, and CHIP.
Sec. 102. Enhanced Medicare and Medicaid program integrity provisions.
Sec. 103. Elimination of duplication between the Healthcare Integrity 
                            and Protection Data Bank and the National 
                            Practitioner Data Bank.
Sec. 104. Maximum period for submission of Medicare claims reduced to 
                            not more than 12 months.
Sec. 105. Physicians who order items or services required to be 
                            Medicare enrolled physicians or eligible 
                            professionals.
Sec. 106. Requirement for physicians to provide documentation on 
                            referrals to programs at high risk of waste 
                            and abuse.
Sec. 107. Face to face encounter with patient required before 
                            physicians may certify eligibility for home 
                            health services or durable medical 
                            equipment under Medicare.
Sec. 108. Enhanced penalties.
Sec. 109. Medicare self-referral disclosure protocol.
Sec. 110. Expansion of the Recovery Audit Contractor (RAC) program.
Sec. 111. Requirements for the transmission of management implication 
                            reports by the HHS OIG.
Sec. 112. Medical ID theft information sharing program and 
                            clearinghouse.
                TITLE II--ADDITIONAL MEDICAID PROVISIONS

Sec. 201. Termination of provider participation under Medicaid if 
                            terminated under Medicare or other State 
                            plan.
Sec. 202. Medicaid exclusion from participation relating to certain 
                            ownership, control, and management 
                            affiliations.
Sec. 203. Billing agents, clearinghouses, or other alternate payees 
                            required to register under Medicaid.
Sec. 204. Requirement to report expanded set of data elements under 
                            MMIS to detect fraud and abuse.
Sec. 205. Prohibition on payments to institutions or entities located 
                            outside of the United States.
Sec. 206. Overpayments.
Sec. 207. Mandatory State use of national correct coding initiative.
Sec. 208. Payment for illegal unapproved drugs.
Sec. 209. General effective date.
                    TITLE III--ADDITIONAL PROVISIONS

Sec. 301. Requiring individuals or entities that participate in or 
                            conduct activities under Federal health 
                            care programs to comply with certain 
                            Congressional requests.
Sec. 302. Amendments to the False Claims Act.
Sec. 303. Dismissal of certain actions or claims under the False Claims 
                            Act.

                 TITLE I--MEDICARE, MEDICAID, AND CHIP

SEC. 101. PROVIDER SCREENING AND OTHER ENROLLMENT REQUIREMENTS UNDER 
              MEDICARE, MEDICAID, AND CHIP.

    (a) Medicare.--Section 1866(j) of the Social Security Act (42 
U.S.C. 1395cc(j)) is amended--
            (1) in paragraph (1)(A), by adding at the end the 
        following: ``Such process shall include screening of providers 
        and suppliers in accordance with paragraph (2), a provisional 
        period of enhanced oversight in accordance with paragraph (3), 
        disclosure requirements in accordance with paragraph (4), the 
        imposition of temporary enrollment moratoria in accordance with 
        paragraph (5), and the establishment of compliance programs in 
        accordance with paragraph (6).'';
            (2) by redesignating paragraph (2) as paragraph (7); and
            (3) by inserting after paragraph (1) the following:
            ``(2) Provider screening.--
                    ``(A) Procedures.--Not later than 180 days after 
                the date of enactment of this paragraph, the Secretary, 
                in consultation with the Inspector General of the 
                Department of Health and Human Services, shall 
                establish procedures under which screening is conducted 
                with respect to providers of medical or other items or 
                services and suppliers under the program under this 
                title, the Medicaid program under title XIX, and the 
                CHIP program under title XXI.
                    ``(B) Level of screening.--The Secretary shall 
                determine the level of screening conducted under this 
                paragraph according to the risk of fraud, waste, and 
                abuse, as determined by the Secretary, with respect to 
                the category of provider of medical or other items or 
                services or supplier. Such screening--
                            ``(i) shall include a licensure check, 
                        which may include such checks across States; 
                        and
                            ``(ii) may, as the Secretary determines 
                        appropriate based on the risk of fraud, waste, 
                        and abuse described in the preceding sentence, 
                        include--
                                    ``(I) a criminal background check;
                                    ``(II) fingerprinting;
                                    ``(III) unscheduled and unannounced 
                                site visits, including preenrollment 
                                site visits;
                                    ``(IV) database checks (including 
                                such checks across States); and
                                    ``(V) such other screening as the 
                                Secretary determines appropriate.
                    ``(C) Application fees.--
                            ``(i) Institutional providers.--Except as 
                        provided in clause (ii), the Secretary shall 
                        impose a fee on each institutional provider of 
                        medical or other items or services or supplier 
                        (such as a hospital or skilled nursing 
                        facility) with respect to which screening is 
                        conducted under this paragraph in an amount 
                        equal to--
                                    ``(I) for 2011, $500; and
                                    ``(II) for 2012 and each subsequent 
                                year, the amount determined under this 
                                clause for the preceding year, adjusted 
                                by the percentage change in the 
                                consumer price index for all urban 
                                consumers (all items; United States 
                                city average) for the 12-month period 
                                ending with June of the previous year.
                            ``(ii) Hardship exception; waiver for 
                        certain medicaid providers.--The Secretary may, 
                        on a case-by-case basis, exempt a provider of 
                        medical or other items or services or supplier 
                        from the imposition of an application fee under 
                        this subparagraph if the Secretary determines 
                        that the imposition of the application fee 
                        would result in a hardship. The Secretary may 
                        waive the application fee under this 
                        subparagraph for providers enrolled in a State 
                        Medicaid program for whom the State 
                        demonstrates that imposition of the fee would 
                        impede beneficiary access to care.
                            ``(iii) Use of funds.--Amounts collected as 
                        a result of the imposition of a fee under this 
                        subparagraph shall be used by the Secretary for 
                        program integrity efforts, including to cover 
                        the costs of conducting screening under this 
                        paragraph and to carry out this subsection and 
                        section 1128J.
                    ``(D) Application and enforcement.--
                            ``(i) New providers of services and 
                        suppliers.--The screening under this paragraph 
                        shall apply, in the case of a provider of 
                        medical or other items or services or supplier 
                        who is not enrolled in the program under this 
                        title, title XIX, or title XXI as of the date 
                        of enactment of this paragraph, on or after the 
                        date that is 1 year after such date of 
                        enactment.
                            ``(ii) Current providers of services and 
                        suppliers.--The screening under this paragraph 
                        shall apply, in the case of a provider of 
                        medical or other items or services or supplier 
                        who is enrolled in the program under this 
                        title, title XIX, or title XXI as of such date 
                        of enactment, on or after the date that is 2 
                        years after such date of enactment.
                            ``(iii) Revalidation of enrollment.--
                        Effective beginning on the date that is 180 
                        days after such date of enactment, the 
                        screening under this paragraph shall apply with 
                        respect to the revalidation of enrollment of a 
                        provider of medical or other items or services 
                        or supplier in the program under this title, 
                        title XIX, or title XXI.
                            ``(iv) Limitation on enrollment and 
                        revalidation of enrollment.--In no case may a 
                        provider of medical or other items or services 
                        or supplier who has not been screened under 
                        this paragraph be initially enrolled or 
                        reenrolled in the program under this title, 
                        title XIX, or title XXI on or after the date 
                        that is 3 years after such date of enactment.
                    ``(E) Expedited rulemaking.--The Secretary may 
                promulgate an interim final rule to carry out this 
                paragraph.
            ``(3) Provisional period of enhanced oversight for new 
        providers of services and suppliers.--
                    ``(A) In general.--The Secretary shall establish 
                procedures to provide for a provisional period of not 
                less than 30 days and not more than 1 year during which 
                new providers of medical or other items or services and 
                suppliers, as the Secretary determines appropriate, 
                including categories of providers or suppliers, would 
                be subject to enhanced oversight, such as prepayment 
                review and payment caps, under the program under this 
                title, the Medicaid program under title XIX, and the 
                CHIP program under title XXI.
                    ``(B) Implementation.--The Secretary may establish 
                by program instruction or otherwise the procedures 
                under this paragraph.
            ``(4) Increased disclosure requirements.--
                    ``(A) Disclosure.--A provider of medical or other 
                items or services or supplier who submits an 
                application for enrollment or revalidation of 
                enrollment in the program under this title, title XIX, 
                or title XXI on or after the date that is 1 year after 
                the date of enactment of this paragraph shall disclose 
                (in a form and manner and at such time as determined by 
                the Secretary) any current or previous affiliation 
                (directly or indirectly) with a provider of medical or 
                other items or services or supplier that has 
                uncollected debt, has been or is subject to a payment 
                suspension under a Federal health care program (as 
                defined in section 1128B(f)), has been excluded from 
                participation under the program under this title, the 
                Medicaid program under title XIX, or the CHIP program 
                under title XXI, or has had its billing privileges 
                denied or revoked.
                    ``(B) Authority to deny enrollment.--If the 
                Secretary determines that such previous affiliation 
                poses an undue risk of fraud, waste, or abuse, the 
                Secretary may deny such application. Such a denial 
                shall be subject to appeal in accordance with paragraph 
                (7).
            ``(5) Authority to adjust payments of providers of services 
        and suppliers with the same tax identification number for past-
        due obligations.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this title, in the case of an applicable 
                provider of services or supplier, the Secretary may 
                make any necessary adjustments to payments to the 
                applicable provider of services or supplier under the 
                program under this title in order to satisfy any past-
                due obligations described in subparagraph (B)(ii) of an 
                obligated provider of services or supplier.
                    ``(B) Definitions.--In this paragraph:
                            ``(i) In general.--The term `applicable 
                        provider of services or supplier' means a 
                        provider of services or supplier that has the 
                        same taxpayer identification number assigned 
                        under section 6109 of the Internal Revenue Code 
                        of 1986 as is assigned to the obligated 
                        provider of services or supplier under such 
                        section, regardless of whether the applicable 
                        provider of services or supplier is assigned a 
                        different billing number or national provider 
                        identification number under the program under 
                        this title than is assigned to the obligated 
                        provider of services or supplier.
                            ``(ii) Obligated provider of services or 
                        supplier.--The term `obligated provider of 
                        services or supplier' means a provider of 
                        services or supplier that owes a past-due 
                        obligation under the program under this title 
                        (as determined by the Secretary).
            ``(6) Temporary moratorium on enrollment of new 
        providers.--
                    ``(A) In general.--The Secretary may impose a 
                temporary moratorium on the enrollment of new providers 
                of services and suppliers, including categories of 
                providers of services and suppliers, in the program 
                under this title, under the Medicaid program under 
                title XIX, or under the CHIP program under title XXI if 
                the Secretary determines such moratorium is necessary 
                to prevent or combat fraud, waste, or abuse under 
                either such program.
                    ``(B) Limitation on review.--There shall be no 
                judicial review under section 1869, section 1878, or 
                otherwise, of a temporary moratorium imposed under 
                subparagraph (A).
            ``(7) Compliance programs.--
                    ``(A) In general.--On or after the date of 
                implementation determined by the Secretary under 
                subparagraph (C), a provider of medical or other items 
                or services or supplier within a particular industry 
                sector or category shall, as a condition of enrollment 
                in the program under this title, title XIX, or title 
                XXI, establish a compliance program that contains the 
                core elements established under subparagraph (B) with 
                respect to that provider or supplier and industry or 
                category.
                    ``(B) Establishment of core elements.--The 
                Secretary, in consultation with the Inspector General 
                of the Department of Health and Human Services, shall 
                establish core elements for a compliance program under 
                subparagraph (A) for providers or suppliers within a 
                particular industry or category.
                    ``(C) Timeline for implementation.--The Secretary 
                shall determine the timeline for the establishment of 
                the core elements under subparagraph (B) and the date 
                of the implementation of subparagraph (A) for providers 
                or suppliers within a particular industry or category. 
                The Secretary shall, in determining such date of 
                implementation, consider the extent to which the 
                adoption of compliance programs by a provider of 
                medical or other items or services or supplier is 
                widespread in a particular industry sector or with 
                respect to a particular provider or supplier 
                category.''.
    (b) Medicaid.--
            (1) State plan amendment.--Section 1902(a) of the Social 
        Security Act (42 U.S.C. 1396a(a)) is amended--
                    (A) in subsection (a)--
                            (i) by striking ``and'' at the end of 
                        paragraph (72);
                            (ii) by striking the period at the end of 
                        paragraph (73) and inserting a semicolon; and
                            (iii) by inserting after paragraph (73) the 
                        following:
            ``(74) provide that the State shall comply with provider 
        and supplier screening, oversight, and reporting requirements 
        in accordance with subsection (ii);''; and
                    (B) by adding at the end the following:
    ``(ii) Provider and Supplier Screening, Oversight, and Reporting 
Requirements.--For purposes of subsection (a)(74), the requirements of 
this subsection are the following:
            ``(1) Screening.--The State complies with the process for 
        screening providers and suppliers under this title, as 
        established by the Secretary under section 1886(j)(2).
            ``(2) Provisional period of enhanced oversight for new 
        providers and suppliers.--The State complies with procedures to 
        provide for a provisional period of enhanced oversight for new 
        providers and suppliers under this title, as established by the 
        Secretary under section 1886(j)(3).
            ``(3) Disclosure requirements.--The State requires 
        providers and suppliers under the State plan or under a waiver 
        of the plan to comply with the disclosure requirements 
        established by the Secretary under section 1886(j)(4).
            ``(4) Temporary moratorium on enrollment of new providers 
        or suppliers.--
                    ``(A) Temporary moratorium imposed by the 
                secretary.--
                            ``(i) In general.--Subject to clause (ii), 
                        the State complies with any temporary 
                        moratorium on the enrollment of new providers 
                        or suppliers imposed by the Secretary under 
                        section 1886(j)(6).
                            ``(ii) Exception.--A State shall not be 
                        required to comply with a temporary moratorium 
                        described in clause (i) if the State determines 
                        that the imposition of such temporary 
                        moratorium would adversely impact 
                        beneficiaries' access to medical assistance.
                    ``(B) Moratorium on enrollment of providers and 
                suppliers.--At the option of the State, the State 
                imposes, for purposes of entering into participation 
                agreements with providers or suppliers under the State 
                plan or under a waiver of the plan, periods of 
                enrollment moratoria, or numerical caps or other 
                limits, for providers or suppliers identified by the 
                Secretary as being at high-risk for fraud, waste, or 
                abuse as necessary to combat fraud, waste, or abuse, 
                but only if the State determines that the imposition of 
                any such period, cap, or other limits would not 
                adversely impact beneficiaries' access to medical 
                assistance.
            ``(5) Compliance programs.--The State requires providers 
        and suppliers under the State plan or under a waiver of the 
        plan to establish, in accordance with the requirements of 
        section 1866(j)(7), a compliance program that contains the core 
        elements established under subparagraph (B) of that section 
        1866(j)(7) for providers or suppliers within a particular 
        industry or category.
            ``(6) Reporting of adverse provider actions.--The State 
        complies with the national system for reporting criminal and 
        civil convictions, sanctions, negative licensure actions, and 
        other adverse provider actions to the Secretary, through the 
        Administrator of the Centers for Medicare & Medicaid Services, 
        in accordance with regulations of the Secretary.
            ``(7) Enrollment and npi of ordering or referring 
        providers.--The State requires--
                    ``(A) all ordering or referring physicians or other 
                professionals to be enrolled under the State plan or 
                under a waiver of the plan as a participating provider; 
                and
                    ``(B) the national provider identifier of any 
                ordering or referring physician or other professional 
                to be specified on any claim for payment that is based 
                on an order or referral of the physician or other 
                professional.
            ``(8) Other state oversight.--Nothing in this subsection 
        shall be interpreted to preclude or limit the ability of a 
        State to engage in provider and supplier screening or enhanced 
        provider and supplier oversight activities beyond those 
        required by the Secretary.''.
            (2) Disclosure of medicare terminated providers and 
        suppliers to states.--The Administrator of the Centers for 
        Medicare & Medicaid Services shall establish a process for 
        making available to the each State agency with responsibility 
        for administering a State Medicaid plan (or a waiver of such 
        plan) under title XIX of the Social Security Act or a child 
        health plan under title XXI the name, national provider 
        identifier, and other identifying information for any provider 
        of medical or other items or services or supplier under the 
        Medicare program under title XVIII or under the CHIP program 
        under title XXI that is terminated from participation under 
        that program within 30 days of the termination (and, with 
        respect to all such providers or suppliers who are terminated 
        from the Medicare program on the date of enactment of this Act, 
        within 90 days of such date).
            (3) Conforming amendment.--Section 1902(a)(23) of the 
        Social Security Act (42 U.S.C. 1396a), is amended by inserting 
        before the semicolon at the end the following: ``or by a 
        provider or supplier to which a moratorium under subsection 
        (ii)(4) is applied during the period of such moratorium''.
    (c) CHIP.--Section 2107(e)(1) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended--
            (1) by redesignating subparagraphs (D) through (L) as 
        subparagraphs (E) through (M), respectively; and
            (2) by inserting after subparagraph (C), the following:
                    ``(D) Subsections (a)(74) and (ii) of section 1902 
                (relating to provider and supplier screening, 
                oversight, and reporting requirements).''.

SEC. 102. ENHANCED MEDICARE AND MEDICAID PROGRAM INTEGRITY PROVISIONS.

    (a) In General.--Part A of title XI of the Social Security Act (42 
U.S.C. 1301 et seq.) is amended by inserting after section 1128F the 
following new section:

``SEC. 1128G. MEDICARE AND MEDICAID PROGRAM INTEGRITY PROVISIONS.

    ``(a) Data Matching.--
            ``(1) Integrated data repository.--
                    ``(A) Inclusion of certain data.--
                            ``(i) In general.--The Integrated Data 
                        Repository of the Centers for Medicare & 
                        Medicaid Services shall include, at a minimum, 
                        claims and payment data from the following:
                                    ``(I) The programs under titles 
                                XVIII and XIX (including parts A, B, C, 
                                and D of title XVIII).
                                    ``(II) The program under title XXI.
                                    ``(III) Health-related programs 
                                administered by the Secretary of 
                                Veterans Affairs.
                                    ``(IV) Health-related programs 
                                administered by the Secretary of 
                                Defense.
                                    ``(V) The program of old-age, 
                                survivors, and disability insurance 
                                benefits established under title II.
                                    ``(VI) The Indian Health Service 
                                and the Contract Health Service 
                                program.
                            ``(ii) Priority for inclusion of certain 
                        data.--Inclusion of the data described in 
                        subclause (I) of such clause in the Integrated 
                        Data Repository shall be a priority. Data 
                        described in subclauses (II) through (VI) of 
                        such clause shall be included in the Integrated 
                        Data Repository as appropriate.
                    ``(B) Data sharing and matching.--
                            ``(i) In general.--The Secretary shall 
                        enter into agreements with the individuals 
                        described in clause (ii) under which such 
                        individuals share and match data in the system 
                        of records of the respective agencies of such 
                        individuals with data in the system of records 
                        of the Department of Health and Human Services 
                        for the purpose of identifying potential fraud, 
                        waste, and abuse under the programs under 
                        titles XVIII and XIX.
                            ``(ii) Individuals described.--The 
                        following individuals are described in this 
                        clause:
                                    ``(I) The Commissioner of Social 
                                Security.
                                    ``(II) The Secretary of Veterans 
                                Affairs.
                                    ``(III) The Secretary of Defense.
                                    ``(IV) The Director of the Indian 
                                Health Service.
                            ``(iii) Definition of system of records.--
                        For purposes of this paragraph, the term 
                        `system of records' has the meaning given such 
                        term in section 552a(a)(5) of title 5, United 
                        States Code.
            ``(2) Access to claims and payment databases.--For purposes 
        of conducting law enforcement and oversight activities and to 
        the extent consistent with applicable information, privacy, 
        security, and disclosure laws, including the regulations 
        promulgated under the Health Insurance Portability and 
        Accountability Act of 1996 and section 552a of title 5, United 
        States Code, and subject to any information systems security 
        requirements under such laws or otherwise required by the 
        Secretary, the Inspector General of the Department of Health 
        and Human Services and the Attorney General shall have access 
        to claims and payment data of the Department of Health and 
        Human Services and its contractors related to titles XVIII, 
        XIX, and XXI.
    ``(b) OIG Authority To Obtain Information.--
            ``(1) In general.--Notwithstanding and in addition to any 
        other provision of law, the Inspector General of the Department 
        of Health and Human Services may, for purposes of protecting 
        the integrity of the programs under titles XVIII and XIX, 
        obtain information from any individual (including a beneficiary 
        provided all applicable privacy protections are followed) or 
        entity that--
                    ``(A) is a provider of medical or other items or 
                services, supplier, grant recipient, contractor, or 
                subcontractor; or
                    ``(B) directly or indirectly provides, orders, 
                manufactures, distributes, arranges for, prescribes, 
                supplies, or receives medical or other items or 
                services payable by any Federal health care program (as 
                defined in section 1128B(f)) regardless of how the item 
                or service is paid for, or to whom such payment is 
                made.
            ``(2) Inclusion of certain information.--Information which 
        the Inspector General may obtain under paragraph (1) includes 
        any supporting documentation necessary to validate claims for 
        payment or payments under title XVIII or XIX, including a 
        prescribing physician's medical records for an individual who 
        is prescribed an item or service which is covered under part B 
        of title XVIII, a covered part D drug (as defined in section 
        1860D-2(e)) for which payment is made under an MA-PD plan under 
        part C of such title, or a prescription drug plan under part D 
        of such title, and any records necessary for evaluation of the 
        economy, efficiency, and effectiveness of the programs under 
        titles XVIII and XIX.
    ``(c) Administrative Remedy for Knowing Participation by 
Beneficiary in Health Care Fraud Scheme.--
            ``(1) In general.--In addition to any other applicable 
        remedies, if an applicable individual has knowingly 
        participated in a Federal health care fraud offense or a 
        conspiracy to commit a Federal health care fraud offense, the 
        Secretary shall impose an appropriate administrative penalty 
        commensurate with the offense or conspiracy.
            ``(2) Applicable individual.--For purposes of paragraph 
        (1), the term `applicable individual' means an individual--
                    ``(A) entitled to, or enrolled for, benefits under 
                part A of title XVIII or enrolled under part B of such 
                title;
                    ``(B) eligible for medical assistance under a State 
                plan under title XIX or under a waiver of such plan; or
                    ``(C) eligible for child health assistance under a 
                child health plan under title XXI.
    ``(d) Reporting and Returning of Overpayments.--
            ``(1) In general.--If a person has received an overpayment, 
        the person shall--
                    ``(A) report and return the overpayment to the 
                Secretary, the State, an intermediary, a carrier, or a 
                contractor, as appropriate, at the correct address; and
                    ``(B) notify the Secretary, State, intermediary, 
                carrier, or contractor to whom the overpayment was 
                returned in writing of the reason for the overpayment.
            ``(2) Deadline for reporting and returning overpayments.--
        An overpayment must be reported and returned under paragraph 
        (1) by the later of--
                    ``(A) the date which is 60 days after the date on 
                which the overpayment was identified; or
                    ``(B) the date any corresponding cost report is 
                due, if applicable.
            ``(3) Enforcement.--Any overpayment retained by a person 
        after the deadline for reporting and returning the overpayment 
        under paragraph (2) is an obligation (as defined in section 
        3729(b)(3) of title 31, United States Code) for purposes of 
        section 3729 of such title.
            ``(4) Definitions.--In this subsection:
                    ``(A) Knowing and knowingly.--The terms `knowing' 
                and `knowingly' have the meaning given those terms in 
                section 3729(b) of title 31, United States Code.
                    ``(B) Overpayment.--The term `overpayment' means 
                any funds that a person receives or retains under title 
                XVIII or XIX to which the person, after applicable 
                reconciliation, is not entitled under such title.
                    ``(C) Person.--
                            ``(i) In general.--The term `person' means 
                        a provider of services, supplier, Medicaid 
                        managed care organization (as defined in 
                        section 1903(m)(1)(A)), Medicare Advantage 
                        organization (as defined in section 
                        1859(a)(1)), or PDP sponsor (as defined in 
                        section 1860D-41(a)(13)).
                            ``(ii) Exclusion.--Such term does not 
                        include a beneficiary.
    ``(e) Inclusion of National Provider Identifier on All Applications 
and Claims.--The Secretary shall promulgate a regulation that requires, 
not later than January 1, 2011, all providers of medical or other items 
or services and suppliers under the programs under titles XVIII and XIX 
that qualify for a national provider identifier to include their 
national provider identifier on all applications to enroll in such 
programs and on all claims for payment submitted under such 
programs.''.
    (b) Access to Data.--
            (1) Medicare part d.--Section 1860D-15(f)(2) of the Social 
        Security Act (42 U.S.C. 1395w-116(f)(2)) is amended by striking 
        ``may be used by'' and all that follows through the period at 
        the end and inserting ``may be used--
                    ``(A) by officers, employees, and contractors of 
                the Department of Health and Human Services for the 
                purposes of, and to the extent necessary in--
                            ``(i) carrying out this section; and
                            ``(ii) conducting oversight, evaluation, 
                        and enforcement under this title; and
                    ``(B) by the Attorney General and the Comptroller 
                General of the United States for the purposes of, and 
                to the extent necessary in, carrying out health 
                oversight activities.''.
            (2) Data matching.--Section 552a(a)(8)(B) of title 5, 
        United States Code, is amended--
                    (A) in clause (vii), by striking ``or'' at the end;
                    (B) in clause (viii), by inserting ``or'' after the 
                semicolon; and
                    (C) by adding at the end the following new clause:
                            ``(ix) matches performed by the Secretary 
                        of Health and Human Services or the Inspector 
                        General of the Department of Health and Human 
                        Services with respect to potential fraud, 
                        waste, and abuse, including matches of a system 
                        of records with non-Federal records;''.
            (3) Matching agreements with the commissioner of social 
        security.--Section 205(r) of the Social Security Act (42 U.S.C. 
        405(r)) is amended by adding at the end the following new 
        paragraph:
            ``(9)(A) The Commissioner of Social Security shall, upon 
        the request of the Secretary or the Inspector General of the 
        Department of Health and Human Services--
                    ``(i) enter into an agreement with the Secretary or 
                such Inspector General for the purpose of matching data 
                in the system of records of the Social Security 
                Administration and the system of records of the 
                Department of Health and Human Services; and
                    ``(ii) include in such agreement safeguards to 
                assure the maintenance of the confidentiality of any 
                information disclosed.
            ``(B) For purposes of this paragraph, the term `system of 
        records' has the meaning given such term in section 552a(a)(5) 
        of title 5, United States Code.''.
    (c) Withholding of Federal Matching Payments for States That Fail 
To Report Enrollee Encounter Data in the Medicaid Statistical 
Information System.--Section 1903(i) of the Social Security Act (42 
U.S.C. 1396b(i)) is amended--
            (1) in paragraph (23), by striking ``or'' at the end;
            (2) in paragraph (24), by striking the period at the end 
        and inserting ``; or''; and
            (3) by adding at the end the following new paragraph:.
            ``(25) with respect to any amounts expended for medical 
        assistance for individuals for whom the State does not report 
        enrollee encounter data (as defined by the Secretary) to the 
        Medicaid Statistical Information System (MSIS) in a timely 
        manner (as determined by the Secretary).''.
    (d) Permissive Exclusions and Civil Monetary Penalties.--
            (1) Permissive exclusions.--Section 1128(b) of the Social 
        Security Act (42 U.S.C. 1320a-7(b)) is amended--
                    (A) 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 the sanctioned 
                        entity and who knew or should have known (as 
                        defined in section 1128A(i)(7)) of the action 
                        constituting the 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 the action 
                        constituting the basis for the conviction or 
                        exclusion so described.''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(16) Making false statements or misrepresentation of 
        material facts.--Any individual or entity that knowingly makes 
        or causes to be made any false statement, omission, or 
        misrepresentation of a material fact in any application, 
        agreement, bid, or contract to participate or enroll as a 
        provider of services or supplier under a Federal health care 
        program (as defined in section 1128B(f)), including Medicare 
        Advantage organizations under part C of title XVIII, 
        prescription drug plan sponsors under part D of title XVIII, 
        Medicaid managed care organizations under title XIX, and 
        entities that apply to participate as providers of services or 
        suppliers in such managed care organizations and such plans.''.
            (2) Civil monetary penalties.--
                    (A) In general.--Section 1128A(a) of the Social 
                Security Act (42 U.S.C. 1320a-7a(a)) is amended--
                            (i) in paragraph (1)(D), by striking ``was 
                        excluded'' and all that follows through the 
                        period at the end and inserting ``was excluded 
                        from the Federal health care program (as 
                        defined in section 1128B(f)) under which the 
                        claim was made pursuant to Federal law.'';
                            (ii) in paragraph (6), by striking ``or'' 
                        at the end;
                            (iii) by inserting after paragraph (7), the 
                        following new paragraphs:
            ``(8) orders or prescribes a medical or other item or 
        service during a period in which the person was excluded from a 
        Federal health care program (as so defined), in the case where 
        the person knows or should know that a claim for such medical 
        or other item or service will be made under such a program;
            ``(9) knowingly makes or causes to be made any false 
        statement, omission, or misrepresentation of a material fact in 
        any application, bid, or contract to participate or enroll as a 
        provider of services or a supplier under a Federal health care 
        program (as so defined), including Medicare Advantage 
        organizations under part C of title XVIII, prescription drug 
        plan sponsors under part D of title XVIII, Medicaid managed 
        care organizations under title XIX, and entities that apply to 
        participate as providers of services or suppliers in such 
        managed care organizations and such plans;
            ``(10) knows of an overpayment (as defined in paragraph (4) 
        of section 1128G(d)) and does not report and return the 
        overpayment in accordance with such section;'';
                            (iv) in the first sentence--
                                    (I) by striking the ``or'' after 
                                ``prohibited relationship occurs;''; 
                                and
                                    (II) by striking ``act)'' and 
                                inserting ``act; or in cases under 
                                paragraph (9), $50,000 for each false 
                                statement or misrepresentation of a 
                                material fact)''; and
                            (v) in the second sentence, by striking 
                        ``purpose)'' and inserting ``purpose; or in 
                        cases under paragraph (9), an assessment of not 
                        more than 3 times the total amount claimed for 
                        each item or service for which payment was made 
                        based upon the application containing the false 
                        statement or misrepresentation of a material 
                        fact)''.
                    (B) Clarification of treatment of certain 
                charitable and other innocuous programs.--Section 
                1128A(i)(6) of the Social Security Act (42 U.S.C. 
                1320a-7a(i)(6)) is amended--
                            (i) in subparagraph (C), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (D), as redesignated 
                        by section 4331(e) of the Balanced Budget Act 
                        of 1997 (Public Law 105-33), by striking the 
                        period at the end and inserting a semicolon;
                            (iii) by redesignating subparagraph (D), as 
                        added by section 4523(c) of such Act, as 
                        subparagraph (E) and striking the period at the 
                        end and inserting ``; or''; and
                            (iv) by adding at the end the following new 
                        subparagraphs:
                    ``(F) any other remuneration which promotes access 
                to care and poses a low risk of harm to patients and 
                Federal health care programs (as defined in section 
                1128B(f) and designated by the Secretary under 
                regulations);
                    ``(G) the offer or transfer of items or services 
                for free or less than fair market value by a person, 
                if--
                            ``(i) the items or services consist of 
                        coupons, rebates, or other rewards from a 
                        retailer;
                            ``(ii) the items or services are offered or 
                        transferred on equal terms available to the 
                        general public, regardless of health insurance 
                        status; and
                            ``(iii) the offer or transfer of the items 
                        or services is not tied to the provision of 
                        other items or services reimbursed in whole or 
                        in part by the program under title XVIII or a 
                        State health care program (as defined in 
                        section 1128(h));
                    ``(H) the offer or transfer of items or services 
                for free or less than fair market value by a person, 
                if--
                            ``(i) the items or services are not offered 
                        as part of any advertisement or solicitation;
                            ``(ii) the items or services are not tied 
                        to the provision of other services reimbursed 
                        in whole or in part by the program under title 
                        XVIII or a State health care program (as so 
                        defined);
                            ``(iii) there is a reasonable connection 
                        between the items or services and the medical 
                        care of the individual; and
                            ``(iv) the person provides the items or 
                        services after determining in good faith that 
                        the individual is in financial need; or
                    ``(I) effective on a date specified by the 
                Secretary (but not earlier than January 1, 2011), the 
                waiver by a PDP sponsor of a prescription drug plan 
                under part D of title XVIII or an MA organization 
                offering an MA-PD plan under part C of such title of 
                any copayment for the first fill of a covered part D 
                drug (as defined in section 1860D-2(e)) that is a 
                generic drug for individuals enrolled in the 
                prescription drug plan or MA-PD plan, respectively.''.
    (e) Testimonial Subpoena Authority in Exclusion-Only Cases.--
Section 1128(f) of the Social Security Act (42 U.S.C. 1320a-7(f)) is 
amended by adding at the end the following new paragraph:
            ``(4) The provisions of subsections (d) and (e) of section 
        205 shall apply with respect to this section to the same extent 
        as they are applicable with respect to title II. The Secretary 
        may delegate the authority granted by section 205(d) (as made 
        applicable to this section) to the Inspector General of the 
        Department of Health and Human Services for purposes of any 
        investigation under this section.''.
    (f) Revising the Intent Requirement for Health Care Fraud.--Section 
1128B of the Social Security Act (42 U.S.C. 1320a-7b) is amended by 
adding at the end the following new subsection:
    ``(g) With respect to violations of this section, a person need not 
have actual knowledge of this section or specific intent to commit a 
violation of this section.''.
    (g) Surety Bond Requirements.--
            (1) Durable medical equipment.--Section 1834(a)(16)(B) of 
        the Social Security Act (42 U.S.C. 1395m(a)(16)(B)) is amended 
        by inserting ``that the Secretary determines is commensurate 
        with the volume of the billing of the supplier'' before the 
        period at the end.
            (2) Home health agencies.--Section 1861(o)(7)(C) of the 
        Social Security Act (42 U.S.C. 1395x(o)(7)(C)) is amended by 
        inserting ``that the Secretary determines is commensurate with 
        the volume of the billing of the home health agency'' before 
        the semicolon at the end.
            (3) Requirements for certain other providers of services 
        and suppliers.--Section 1862 of the Social Security Act (42 
        U.S.C. 1395y) is amended by adding at the end the following new 
        subsection:
    ``(n) Requirement of a Surety Bond for Certain Providers of 
Services and Suppliers.--
            ``(1) In general.--The Secretary may require a provider of 
        services or supplier described in paragraph (2) to provide the 
        Secretary on a continuing basis with a surety bond in a form 
        specified by the Secretary in an amount (not less than $50,000) 
        that the Secretary determines is commensurate with the volume 
        of the billing of the provider of services or supplier. The 
        Secretary may waive the requirement of a bond under the 
        preceding sentence in the case of a provider of services or 
        supplier that provides a comparable surety bond under State 
        law.
            ``(2) Provider of services or supplier described.--A 
        provider of services or supplier described in this paragraph is 
        a provider of services or supplier the Secretary determines 
        appropriate based on the level of risk involved with respect to 
        the provider of services or supplier, and consistent with the 
        surety bond requirements under sections 1834(a)(16)(B) and 
        1861(o)(7)(C).''.
    (h) Suspension of Medicare and Medicaid Payments Pending 
Investigation of Credible Allegations of Fraud.--
            (1) Medicare.--Section 1862 of the Social Security Act (42 
        U.S.C. 1395y), as amended by subsection (g)(3), is amended by 
        adding at the end the following new subsection:
    ``(o) Suspension Authority.--
            ``(1) In general.--The Secretary shall suspend payment to a 
        provider of services or supplier under this title pending an 
        investigation of credible allegations of fraud against the 
        provider of services or supplier, unless the Secretary finds 
        good cause not to suspend such payment.
            ``(2) Consultation.--The Secretary shall consult with the 
        Inspector General of the Department of Health and Human 
        Services in determining whether there is a credible allegation 
        of fraud against a provider of services or supplier.
            ``(3) Promulgation of regulations.--The Secretary shall 
        promulgate regulations to carry out this subsection and section 
        1903(i)(2)(C).''.
            (2) Medicaid.--Section 1903(i)(2) of such Act (42 U.S.C. 
        1396b(i)(2)) is amended--
                    (A) in subparagraph (A), by striking ``or'' at the 
                end; and
                    (B) by inserting after subparagraph (B), the 
                following:
                    ``(C) by any individual or entity to whom the State 
                has failed to suspend payments under the plan during 
                any period when there is pending an investigation of a 
                credible allegation of fraud against the individual or 
                entity, as determined by the State in accordance with 
                regulations promulgated by the Secretary for purposes 
                of section 1862(o) and this subparagraph, unless the 
                State determines in accordance with such regulations 
                there is good cause not to suspend such payments; or''.
    (i) Extension of Number of Days in Which Medicare Claims Are 
Required To Be Paid in Order to Prevent or Combat Fraud, Waste, or 
Abuse.--
            (1) Part a claims.--Section 1816(c)(2) of the Social 
        Security Act (42 U.S.C. 1395h(c)(2)) is amended--
                    (A) in subparagraph (B)(ii)(V), by striking ``with 
                respect'' and inserting ``subject to subparagraph (D), 
                with respect''; and
                    (B) 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.''.
            (2) Part b claims.--Section 1842(c)(2) of the Social 
        Security Act (42 U.S.C. 1395u(c)(2)) is amended--
                    (A) in subparagraph (B)(ii)(V), by striking ``with 
                respect'' and inserting ``subject to subparagraph (D), 
                with respect''; and
                    (B) 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.''.
            (3) Effective date.--
                    (A) In general.--The amendments made by this 
                subsection shall take effect on the day that is 6 
                months after the date of the enactment of this Act.
                    (B) Expediting implementation.--The Secretary shall 
                promulgate regulations to carry out the amendments made 
                by this subsection 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.
    (j) Increased Funding To Fight Fraud and Abuse.--
            (1) In general.--Section 1817(k) of the Social Security Act 
        (42 U.S.C. 1395i(k)) is amended--
                    (A) by adding at the end the following new 
                paragraph:
            ``(7) Additional funding.--In addition to the funds 
        otherwise appropriated to the Account from the Trust Fund under 
        paragraphs (3) and (4) and for purposes described in paragraphs 
        (3)(C) and (4)(A), there are hereby appropriated an additional 
        $10,000,000 to such Account from such Trust Fund for each of 
        fiscal years 2011 through 2020. The funds appropriated under 
        this paragraph shall be allocated in the same proportion as the 
        total funding appropriated with respect to paragraphs (3)(A) 
        and (4)(A) was allocated with respect to fiscal year 2010, and 
        shall be available without further appropriation until 
        expended.''; and
                    (B) in paragraph (4)(A), by inserting ``until 
                expended'' after ``appropriation''.
            (2) Indexing of amounts appropriated.--
                    (A) Departments of health and human services and 
                justice.--Section 1817(k)(3)(A)(i) of the Social 
                Security Act (42 U.S.C. 1395i(k)(3)(A)(i)) is amended--
                            (i) in subclause (III), by inserting 
                        ``and'' at the end;
                            (ii) in subclause (IV)--
                                    (I) by striking ``for each of 
                                fiscal years 2007, 2008, 2009, and 
                                2010'' and inserting ``for each fiscal 
                                year after fiscal year 2006''; and
                                    (II) by striking ``; and'' and 
                                inserting a period; and
                            (iii) by striking subclause (V).
                    (B) Office of the inspector general of the 
                department of health and human services.--Section 
                1817(k)(3)(A)(ii) of such Act (42 U.S.C. 
                1395i(k)(3)(A)(ii)) is amended--
                            (i) in subclause (VIII), by inserting 
                        ``and'' at the end;
                            (ii) in subclause (IX)--
                                    (I) by striking ``for each of 
                                fiscal years 2008, 2009, and 2010'' and 
                                inserting ``for each fiscal year after 
                                fiscal year 2007''; and
                                    (II) by striking ``; and'' and 
                                inserting a period; and
                            (iii) by striking subclause (X).
                    (C) Federal bureau of investigation.--Section 
                1817(k)(3)(B) of the Social Security Act (42 U.S.C. 
                1395i(k)(3)(B)) is amended--
                            (i) in clause (vii), by inserting ``and'' 
                        at the end;
                            (ii) in clause (viii)--
                                    (I) by striking ``for each of 
                                fiscal years 2007, 2008, 2009, and 
                                2010'' and inserting ``for each fiscal 
                                year after fiscal year 2006''; and
                                    (II) by striking ``; and'' and 
                                inserting a period; and
                            (iii) by striking clause (ix).
                    (D) Medicare integrity program.--Section 
                1817(k)(4)(C) of the Social Security Act (42 U.S.C. 
                1395i(k)(4)(C)) is amended by adding at the end the 
                following new clause:
                            ``(ii) For each fiscal year after 2010, by 
                        the percentage increase in the consumer price 
                        index for all urban consumers (all items; 
                        United States city average) over the previous 
                        year.''.
    (k) Medicare Integrity Program and Medicaid Integrity Program.--
            (1) Medicare integrity program.--
                    (A) Requirement to provide performance 
                statistics.--Section 1893(c) of the Social Security Act 
                (42 U.S.C. 1395ddd(c)) is amended--
                            (i) in paragraph (3), by striking ``and'' 
                        at the end;
                            (ii) by redesignating paragraph (4) as 
                        paragraph (5); and
                            (iii) by inserting after paragraph (3) the 
                        following new paragraph:
            ``(4) the entity agrees to provide the Secretary and the 
        Inspector General of the Department of Health and Human 
        Services with such performance statistics (including the number 
        and amount of overpayments recovered, the number of fraud 
        referrals, and the return on investment of such activities by 
        the entity) as the Secretary or the Inspector General may 
        request; and''.
                    (B) Evaluations and annual report.--Section 1893 of 
                the Social Security Act (42 U.S.C. 1395ddd) is amended 
                by adding at the end the following new subsection:
    ``(i) Evaluations and Annual Report.--
            ``(1) Evaluations.--The Secretary shall conduct evaluations 
        of eligible entities which the Secretary contracts with under 
        the Program not less frequently than every 3 years.
            ``(2) Annual report.--Not later than 180 days after the end 
        of each fiscal year (beginning with fiscal year 2011), the 
        Secretary shall submit a report to Congress which identifies--
                    ``(A) the use of funds, including funds transferred 
                from the Federal Hospital Insurance Trust Fund under 
                section 1817 and the Federal Supplementary Insurance 
                Trust Fund under section 1841, to carry out this 
                section; and
                    ``(B) the effectiveness of the use of such 
                funds.''.
                    (C) Flexibility in pursuing fraud and abuse.--
                Section 1893(a) of the Social Security Act (42 U.S.C. 
                1395ddd(a)) is amended by inserting ``, or otherwise,'' 
                after ``entities''.
            (2) Medicaid integrity program.--
                    (A) Requirement to provide performance 
                statistics.--Section 1936(c)(2) of the Social Security 
                Act (42 U.S.C. 1396u-6(c)(2)) is amended--
                            (i) by redesignating subparagraph (D) as 
                        subparagraph (E); and
                            (ii) by inserting after subparagraph (C) 
                        the following new subparagraph:
                    ``(D) The entity agrees to provide the Secretary 
                and the Inspector General of the Department of Health 
                and Human Services with such performance statistics 
                (including the number and amount of overpayments 
                recovered, the number of fraud referrals, and the 
                return on investment of such activities by the entity) 
                as the Secretary or the Inspector General may 
                request.''.
                    (B) Evaluations and annual report.--Section 1936(e) 
                of the Social Security Act (42 U.S.C. 1396u-7(e)) is 
                amended--
                            (i) by redesignating paragraph (4) as 
                        paragraph (5); and
                            (ii) by inserting after paragraph (3) the 
                        following new paragraph:
            ``(4) Evaluations.--The Secretary shall conduct evaluations 
        of eligible entities which the Secretary contracts with under 
        the Program not less frequently than every 3 years.''.
    (l) Expanded Application of Hardship Waivers for Exclusions.--
Section 1128(c)(3)(B) of the Social Security Act (42 U.S.C. 1320a-
7(c)(3)(B)) is amended by striking ``individuals entitled to benefits 
under part A of title XVIII or enrolled under part B of such title, or 
both'' and inserting ``beneficiaries (as defined in section 
1128A(i)(5)) of that program''.

SEC. 103. ELIMINATION OF DUPLICATION BETWEEN THE HEALTHCARE INTEGRITY 
              AND PROTECTION DATA BANK AND THE NATIONAL PRACTITIONER 
              DATA BANK.

    (a) Information Reported by Federal Agencies and Health Plans.--
Section 1128E of the Social Security Act (42 U.S.C. 1320a-7e) is 
amended--
            (1) by striking subsection (a) and inserting the following:
    ``(a) In General.--The Secretary shall maintain a national health 
care fraud and abuse data collection program under this section for the 
reporting of certain final adverse actions (not including settlements 
in which no findings of liability have been made) against health care 
providers, suppliers, or practitioners as required by subsection (b), 
with access as set forth in subsection (d), and shall furnish the 
information collected under this section to the National Practitioner 
Data Bank established pursuant to the Health Care Quality Improvement 
Act of 1986 (42 U.S.C. 11101 et seq.).'';
            (2) by striking subsection (d) and inserting the following:
    ``(d) Access to Reported Information.--
            ``(1) Availability.--The information collected under this 
        section shall be available from the National Practitioner Data 
        Bank to the agencies, authorities, and officials which are 
        provided under section 1921(b) information reported under 
        section 1921(a).
            ``(2) Fees for disclosure.--The Secretary may establish or 
        approve reasonable fees for the disclosure of information under 
        this section. The amount of such a fee may not exceed the costs 
        of processing the requests for disclosure and of providing such 
        information. Such fees shall be available to the Secretary to 
        cover such costs.'';
            (3) by striking subsection (f) and inserting the following:
    ``(f) Appropriate Coordination.--In implementing this section, the 
Secretary shall provide for the maximum appropriate coordination with 
part B of the Health Care Quality Improvement Act of 1986 (42 U.S.C. 
11131 et seq.) and section 1921.''; and
            (4) in subsection (g)--
                    (A) in paragraph (1)(A)--
                            (i) in clause (iii)--
                                    (I) by striking ``or State'' each 
                                place it appears;
                                    (II) by redesignating subclauses 
                                (II) and (III) as subclauses (III) and 
                                (IV), respectively; and
                                    (III) by inserting after subclause 
                                (I) the following new subclause:
                                    ``(II) any dismissal or closure of 
                                the proceedings by reason of the 
                                provider, supplier, or practitioner 
                                surrendering their license or leaving 
                                the State or jurisdiction''; and
                            (ii) by striking clause (iv) and inserting 
                        the following:
                            ``(iv) Exclusion from participation in a 
                        Federal health care program (as defined in 
                        section 1128B(f)).'';
                    (B) in paragraph (3)--
                            (i) by striking subparagraphs (D) and (E); 
                        and
                            (ii) by redesignating subparagraph (F) as 
                        subparagraph (D); and
                    (C) in subparagraph (D) (as so redesignated), by 
                striking ``or State''.
    (b) Information Reported by State Law or Fraud Enforcement 
Agencies.--Section 1921 of the Social Security Act (42 U.S.C. 1396r-2) 
is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) by striking ``system.--The State'' and 
                        all that follows through the semicolon and 
                        inserting system.--
                    ``(A) Licensing or certification actions.--The 
                State must have in effect a system of reporting the 
                following information with respect to formal 
                proceedings (as defined by the Secretary in 
                regulations) concluded against a health care 
                practitioner or entity by a State licensing or 
                certification agency:'';
                            (ii) by redesignating subparagraphs (A) 
                        through (D) as clauses (i) through (iv), 
                        respectively, and indenting appropriately;
                            (iii) in subparagraph (A)(iii) (as so 
                        redesignated)--
                                    (I) by striking ``the license of'' 
                                and inserting ``license or the right to 
                                apply for, or renew, a license by''; 
                                and
                                    (II) by inserting 
                                ``nonrenewability,'' after ``voluntary 
                                surrender,''; and
                            (iv) by adding at the end the following new 
                        subparagraph:
                    ``(B) Other final adverse actions.--The State must 
                have in effect a system of reporting information with 
                respect to any final adverse action (not including 
                settlements in which no findings of liability have been 
                made) taken against a health care provider, supplier, 
                or practitioner by a State law or fraud enforcement 
                agency.''; and
                    (B) in paragraph (2), by striking ``the authority 
                described in paragraph (1)'' and inserting ``a State 
                licensing or certification agency or State law or fraud 
                enforcement agency'';
            (2) in subsection (b)--
                    (A) by striking paragraph (2) and inserting the 
                following:
            ``(2) to State licensing or certification agencies and 
        Federal agencies responsible for the licensing and 
        certification of health care providers, suppliers, and licensed 
        health care practitioners;'';
                    (B) in each of paragraphs (4) and (6), by inserting 
                ``, but only with respect to information provided 
                pursuant to subsection (a)(1)(A)'' before the comma at 
                the end;
                    (C) by striking paragraph (5) and inserting the 
                following:
            ``(5) to State law or fraud enforcement agencies,'';
                    (D) by redesignating paragraphs (7) and (8) as 
                paragraphs (8) and (9), respectively; and
                    (E) by inserting after paragraph (6) the following 
                new paragraph:
            ``(7) to health plans (as defined in section 1128C(c));'';
            (3) by redesignating subsection (d) as subsection (h), and 
        by inserting after subsection (c) the following new 
        subsections:
    ``(d) Disclosure and Correction of Information.--
            ``(1) Disclosure.--With respect to information reported 
        pursuant to subsection (a)(1), the Secretary shall--
                    ``(A) provide for disclosure of the information, 
                upon request, to the health care practitioner who, or 
                the entity that, is the subject of the information 
                reported; and
                    ``(B) establish procedures for the case where the 
                health care practitioner or entity disputes the 
                accuracy of the information reported.
            ``(2) Corrections.--Each State licensing or certification 
        agency and State law or fraud enforcement agency shall report 
        corrections of information already reported about any formal 
        proceeding or final adverse action described in subsection (a), 
        in such form and manner as the Secretary prescribes by 
        regulation.
    ``(e) Fees for Disclosure.--The Secretary may establish or approve 
reasonable fees for the disclosure of information under this section. 
The amount of such a fee may not exceed the costs of processing the 
requests for disclosure and of providing such information. Such fees 
shall be available to the Secretary to cover such costs.
    ``(f) Protection From Liability for Reporting.--No person or 
entity, including any agency designated by the Secretary in subsection 
(b), shall be held liable in any civil action with respect to any 
reporting of information as required under this section, without 
knowledge of the falsity of the information contained in the report.
    ``(g) References.--For purposes of this section:
            ``(1) State licensing or certification agency.--The term 
        `State licensing or certification agency' includes any 
        authority of a State (or of a political subdivision thereof) 
        responsible for the licensing of health care practitioners (or 
        any peer review organization or private accreditation entity 
        reviewing the services provided by health care practitioners) 
        or entities.
            ``(2) State law or fraud enforcement agency.--The term 
        `State law or fraud enforcement agency' includes--
                    ``(A) a State law enforcement agency; and
                    ``(B) a State Medicaid fraud control unit (as 
                defined in section 1903(q)).
            ``(3) Final adverse action.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                term `final adverse action' includes--
                            ``(i) civil judgments against a health care 
                        provider, supplier, or practitioner in State 
                        court related to the delivery of a health care 
                        item or service;
                            ``(ii) State criminal convictions related 
                        to the delivery of a health care item or 
                        service;
                            ``(iii) exclusion from participation in 
                        State health care programs (as defined in 
                        section 1128(h));
                            ``(iv) any licensing or certification 
                        action described in subsection (a)(1)(A) taken 
                        against a supplier by a State licensing or 
                        certification agency; and
                            ``(v) any other adjudicated actions or 
                        decisions that the Secretary shall establish by 
                        regulation.
                    ``(B) Exception.--Such term does not include any 
                action with respect to a malpractice claim.''; and
            (4) in subsection (h), as so redesignated, by striking 
        ``The Secretary'' and all that follows through the period at 
        the end and inserting ``In implementing this section, the 
        Secretary shall provide for the maximum appropriate 
        coordination with part B of the Health Care Quality Improvement 
        Act of 1986 (42 U.S.C. 11131 et seq.) and section 1128E.''.
    (c) Conforming Amendment.--Section 1128C(a)(1) of the Social 
Security Act (42 U.S.C. 1320a-7c(a)(1)) is amended--
            (1) in subparagraph (C), by adding ``and'' after the comma 
        at the end;
            (2) in subparagraph (D), by striking ``, and'' and 
        inserting a period; and
            (3) by striking subparagraph (E).
    (d) Transition Process; Effective Date.--
            (1) In general.--Effective on the date of enactment of this 
        Act, the Secretary of Health and Human Services (in this 
        section referred to as the ``Secretary'') shall implement a 
        transition process under which, by not later than the end of 
        the transition period described in paragraph (5), the Secretary 
        shall cease operating the Healthcare Integrity and Protection 
        Data Bank established under section 1128E of the Social 
        Security Act (as in effect before the effective date specified 
        in paragraph (6)) and shall transfer all data collected in the 
        Healthcare Integrity and Protection Data Bank to the National 
        Practitioner Data Bank established pursuant to the Health Care 
        Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.). 
        During such transition process, the Secretary shall have in 
        effect appropriate procedures to ensure that data collection 
        and access to the Healthcare Integrity and Protection Data Bank 
        and the National Practitioner Data Bank are not disrupted.
            (2) Regulations.--The Secretary shall promulgate 
        regulations to carry out the amendments made by subsections (a) 
        and (b).
            (3) Funding.--
                    (A) Availability of fees.--Fees collected pursuant 
                to section 1128E(d)(2) of the Social Security Act prior 
                to the effective date specified in paragraph (6) for 
                the disclosure of information in the Healthcare 
                Integrity and Protection Data Bank shall be available 
                to the Secretary, without fiscal year limitation, for 
                payment of costs related to the transition process 
                described in paragraph (1). Any such fees remaining 
                after the transition period is complete shall be 
                available to the Secretary, without fiscal year 
                limitation, for payment of the costs of operating the 
                National Practitioner Data Bank.
                    (B) Availability of additional funds.--In addition 
                to the fees described in subparagraph (A), any funds 
                available to the Secretary or to the Inspector General 
                of the Department of Health and Human Services for a 
                purpose related to combating health care fraud, waste, 
                or abuse shall be available to the extent necessary for 
                operating the Healthcare Integrity and Protection Data 
                Bank during the transition period, including systems 
                testing and other activities necessary to ensure that 
                information formerly reported to the Healthcare 
                Integrity and Protection Data Bank will be accessible 
                through the National Practitioner Data Bank after the 
                end of such transition period.
            (4) Special provision for access to the national 
        practitioner data bank by the department of veterans affairs.--
                    (A) In general.--Notwithstanding any other 
                provision of law, during the 1-year period that begins 
                on the effective date specified in paragraph (6), the 
                information described in subparagraph (B) shall be 
                available from the National Practitioner Data Bank to 
                the Secretary of Veterans Affairs without charge.
                    (B) Information described.--For purposes of 
                subparagraph (A), the information described in this 
                subparagraph is the information that would, but for the 
                amendments made by this section, have been available to 
                the Secretary of Veterans Affairs from the Healthcare 
                Integrity and Protection Data Bank.
            (5) Transition period defined.--For purposes of this 
        subsection, the term ``transition period'' means the period 
        that begins on the date of enactment of this Act and ends on 
        the later of--
                    (A) the date that is 1 year after such date of 
                enactment; or
                    (B) the effective date of the regulations 
                promulgated under paragraph (2).
            (6) Effective date.--The amendments made by subsections 
        (a), (b), and (c) shall take effect on the first day after the 
        final day of the transition period.

SEC. 104. MAXIMUM PERIOD FOR SUBMISSION OF MEDICARE CLAIMS REDUCED TO 
              NOT MORE THAN 12 MONTHS.

    (a) Reducing Maximum Period for Submission.--
            (1) Part a.--Section 1814(a) of the Social Security Act (42 
        U.S.C. 1395f(a)(1)) is amended--
                    (A) in paragraph (1), by striking ``period of 3 
                calendar years'' and all that follows through the 
                semicolon and inserting ``period ending 1 calendar year 
                after the date of service;''; and
                    (B) by adding at the end the following new 
                sentence: ``In applying paragraph (1), the Secretary 
                may specify exceptions to the 1 calendar year period 
                specified in such paragraph.''
            (2) Part b.--
                    (A) Section 1842(b)(3) of such Act (42 U.S.C. 
                1395u(b)(3)(B)) is amended--
                            (i) in subparagraph (B), in the flush 
                        language following clause (ii), by striking 
                        ``close of the calendar year following the year 
                        in which such service is furnished (deeming any 
                        service furnished in the last 3 months of any 
                        calendar year to have been furnished in the 
                        succeeding calendar year)'' and inserting 
                        ``period ending 1 calendar year after the date 
                        of service''; and
                            (ii) by adding at the end the following new 
                        sentence: ``In applying subparagraph (B), the 
                        Secretary may specify exceptions to the 1 
                        calendar year period specified in such 
                        subparagraph.''
                    (B) Section 1835(a) of such Act (42 U.S.C. 
                1395n(a)) is amended--
                            (i) in paragraph (1), by striking ``period 
                        of 3 calendar years'' and all that follows 
                        through the semicolon and inserting ``period 
                        ending 1 calendar year after the date of 
                        service;''; and
                            (ii) by adding at the end the following new 
                        sentence: ``In applying paragraph (1), the 
                        Secretary may specify exceptions to the 1 
                        calendar year period specified in such 
                        paragraph.''
    (b) Effective Date.--
            (1) In general.--The amendments made by subsection (a) 
        shall apply to services furnished on or after March 1, 2010.
            (2) Services furnished before march 2010.--In the case of 
        services furnished before March 1, 2010, a bill or request for 
        payment under section 1814(a)(1), 1842(b)(3)(B), or 1835(a) 
        shall be filed not later that December 31, 2010.

SEC. 105. PHYSICIANS WHO ORDER ITEMS OR SERVICES REQUIRED TO BE 
              MEDICARE ENROLLED PHYSICIANS OR ELIGIBLE PROFESSIONALS.

    (a) DME.--Section 1834(a)(11)(B) of the Social Security Act (42 
U.S.C. 1395m(a)(11)(B)) is amended by striking ``physician'' and 
inserting ``physician enrolled under section 1866(j) or an eligible 
professional under section 1848(k)(3)(B) that is enrolled under section 
1866(j)''.
    (b) Home Health Services.--
            (1) Part a.--Section 1814(a)(2) of such Act (42 U.S.C. 
        1395(a)(2)) is amended in the matter preceding subparagraph (A) 
        by inserting ``in the case of services described in 
        subparagraph (C), a physician enrolled under section 1866(j) or 
        an eligible professional under section 1848(k)(3)(B),'' before 
        ``or, in the case of services''.
            (2) Part b.--Section 1835(a)(2) of such Act (42 U.S.C. 
        1395n(a)(2)) is amended in the matter preceding subparagraph 
        (A) by inserting ``, or in the case of services described in 
        subparagraph (A), a physician enrolled under section 1866(j) or 
        an eligible professional under section 1848(k)(3)(B),'' after 
        ``a physician''.
    (c) Application to Other Items or Services.--The Secretary may 
extend the requirement applied by the amendments made by subsections 
(a) and (b) to durable medical equipment and home health services 
(relating to requiring certifications and written orders to be made by 
enrolled physicians and health professions) to all other categories of 
items or services under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.), including covered part D drugs as defined in 
section 1860D-2(e) of such Act (42 U.S.C. 1395w-102), that are ordered, 
prescribed, or referred by a physician enrolled under section 1866(j) 
of such Act (42 U.S.C. 1395cc(j)) or an eligible professional under 
section 1848(k)(3)(B) of such Act (42 U.S.C. 1395w-4(k)(3)(B)).
    (d) Effective Date.--The amendments made by this section shall 
apply to written orders and certifications made on or after July 1, 
2010.

SEC. 106. REQUIREMENT FOR PHYSICIANS TO PROVIDE DOCUMENTATION ON 
              REFERRALS TO PROGRAMS AT HIGH RISK OF WASTE AND ABUSE.

    (a) Physicians and Other Suppliers.--Section 1842(h) of the Social 
Security Act (42 U.S.C. 1395u(h)) is amended by adding at the end the 
following new paragraph:
    ``(9) The Secretary may revoke enrollment, for a period of not more 
than one year for each act, for a physician or supplier under section 
1866(j) if such physician or supplier fails to maintain and, upon 
request of the Secretary, provide access to documentation relating to 
written orders or requests for payment for durable medical equipment, 
certifications for home health services, or referrals for other items 
or services written or ordered by such physician or supplier under this 
title, as specified by the Secretary.''.
    (b) Providers of Services.--Section 1866(a)(1) of such Act (42 
U.S.C. 1395cc) is further amended--
            (1) in subparagraph (U), by striking at the end ``and'';
            (2) in subparagraph (V), by striking the period at the end 
        and adding ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(W) maintain and, upon request of the Secretary, 
                provide access to documentation relating to written 
                orders or requests for payment for durable medical 
                equipment, certifications for home health services, or 
                referrals for other items or services written or 
                ordered by the provider under this title, as specified 
                by the Secretary.''.
    (c) OIG Permissive Exclusion Authority.--Section 1128(b)(11) of the 
Social Security Act (42 U.S.C. 1320a-7(b)(11)) is amended by inserting 
``, ordering, referring for furnishing, or certifying the need for'' 
after ``furnishing''.
    (d) Effective Date.--The amendments made by this section shall 
apply to orders, certifications, and referrals made on or after March 
1, 2010.

SEC. 107. FACE TO FACE ENCOUNTER WITH PATIENT REQUIRED BEFORE 
              PHYSICIANS MAY CERTIFY ELIGIBILITY FOR HOME HEALTH 
              SERVICES OR DURABLE MEDICAL EQUIPMENT UNDER MEDICARE.

    (a) Condition of Payment for Home Health Services.--
            (1) Part a.--Section 1814(a)(2)(C) of such Act is amended--
                    (A) by striking ``and such services'' and inserting 
                ``such services''; and
                    (B) by inserting after ``care of a physician'' the 
                following: ``, and, in the case of a certification made 
                by a physician after March 1, 2010, prior to making 
                such certification the physician must document that the 
                physician himself or herself has had a face-to-face 
                encounter (including through use of telehealth, subject 
                to the requirements in section 1834(m), and other than 
                with respect to encounters that are incident to 
                services involved) with the individual within a 
                reasonable timeframe as determined by the Secretary''.
            (2) Part b.--Section 1835(a)(2)(A) of the Social Security 
        Act is amended--
                    (A) by striking ``and'' before ``(iii)''; and
                    (B) by inserting after ``care of a physician'' the 
                following: ``, and (iv) in the case of a certification 
                after March 1, 2010, prior to making such certification 
                the physician must document that the physician has had 
                a face-to-face encounter (including through use of 
                telehealth and other than with respect to encounters 
                that are incident to services involved) with the 
                individual during the 6-month period preceding such 
                certification, or other reasonable timeframe as 
                determined by the Secretary''.
    (b) Condition of Payment for Durable Medical Equipment.--Section 
1834(a)(11)(B) of the Social Security Act (42 U.S.C. 1395m(a)(11)(B)) 
is amended--
            (1) by striking ``Order.--The Secretary'' and inserting 
        ``Order.--
                            ``(i) In general.--The Secretary''; and
            (2) by adding at the end the following new clause:
                            ``(ii) Requirement for face to face 
                        encounter.--The Secretary shall require that 
                        such an order be written pursuant to the 
                        physician documenting that a physician, a 
                        physician assistant, a nurse practitioner, or a 
                        clinical nurse specialist (as those terms are 
                        defined in section 1861(aa)(5)) has had a face-
                        to-face encounter (including through use of 
                        telehealth under subsection (m) and other than 
                        with respect to encounters that are incident to 
                        services involved) with the individual involved 
                        during the 6-month period preceding such 
                        written order, or other reasonable timeframe as 
                        determined by the Secretary.''.
    (c) Application to Other Areas Under Medicare.--The Secretary may 
apply the face-to-face encounter requirement described in the 
amendments made by subsections (a) and (b) to other items and services 
for which payment is provided under title XVIII of the Social Security 
Act based upon a finding that such an decision would reduce the risk of 
waste, fraud, or abuse.
    (d) Application to Medicaid.--The requirements pursuant to the 
amendments made by subsections (a) and (b) shall apply in the case of 
physicians making certifications for home health services under title 
XIX of the Social Security Act in the same manner and to the same 
extent as such requirements apply in the case of physicians making such 
certifications under title XVIII of such Act.

SEC. 108. ENHANCED PENALTIES.

    (a) Civil Monetary Penalties for False Statements or Delaying 
Inspections.--Section 1128A(a) of the Social Security Act (42 U.S.C. 
1320a-7a(a)), as amended by section 102(d)(2)(A), is amended--
            (1) by inserting after paragraph (10) the following new 
        paragraphs:
            ``(11) knowingly makes, uses, or causes to be made or used, 
        a false record or statement material to a false or fraudulent 
        claim for payment for items and services furnished under a 
        Federal health care program; or
            ``(12) fails to grant timely access, upon reasonable 
        request (as defined by the Secretary in regulations), to the 
        Inspector General of the Department of Health and Human 
        Services, for the purpose of audits, investigations, 
        evaluations, or other statutory functions of the Inspector 
        General of the Department of Health and Human Services;''; and
            (2) in the first sentence (as so amended)--
                    (A) by striking ``or in cases under paragraph (9)'' 
                and inserting ``in cases under paragraph (9)''; and
                    (B) by striking ``a material fact)'' and inserting 
                ``a material fact, in cases under paragraph (11), 
                $50,000 for each false record or statement, or in cases 
                under paragraph (12), $15,000 for each day of the 
                failure described in such paragraph)''.
    (b) Medicare Advantage and Part D Plans.--
            (1) Ensuring timely inspections relating to contracts with 
        ma organizations.--Section 1857(d)(2) of such Act (42 U.S.C. 
        1395w-27(d)(2)) is amended--
                    (A) in subparagraph (A), by inserting ``timely'' 
                before ``inspect''; and
                    (B) in subparagraph (B), by inserting ``timely'' 
                before ``audit and inspect''.
            (2) Marketing violations.--Section 1857(g)(1) of the Social 
        Security Act (42 U.S.C. 1395w-27(g)(1)) is amended--
                    (A) in subparagraph (F), by striking ``or'' at the 
                end;
                    (B) by inserting after subparagraph (G) the 
                following new subparagraphs:
                    ``(H) except as provided under subparagraph (C) or 
                (D) of section 1860D-1(b)(1), enrolls an individual in 
                any plan under this part without the prior consent of 
                the individual or the designee of the individual;
                    ``(I) transfers an individual enrolled under this 
                part from one plan to another without the prior consent 
                of the individual or the designee of the individual or 
                solely for the purpose of earning a commission;
                    ``(J) fails to comply with marketing restrictions 
                described in subsections (h) and (j) of section 1851 or 
                applicable implementing regulations or guidance; or
                    ``(K) employs or contracts with any individual or 
                entity who engages in the conduct described in 
                subparagraphs (A) through (J) of this paragraph;''; and
                    (C) by adding at the end the following new 
                sentence: ``The Secretary may provide, in addition to 
                any other remedies authorized by law, for any of the 
                remedies described in paragraph (2), if the Secretary 
                determines that any employee or agent of such 
                organization, or any provider or supplier who contracts 
                with such organization, has engaged in any conduct 
                described in subparagraphs (A) through (K) of this 
                paragraph.''.
            (3) Provision of false information.--Section 1857(g)(2)(A) 
        of the Social Security Act (42 U.S.C. 1395w-27(g)(2)(A)) is 
        amended by inserting ``except with respect to a determination 
        under subparagraph (E), an assessment of not more than the 
        amount claimed by such plan or plan sponsor based upon the 
        misrepresentation or falsified information involved,'' after 
        ``for each such determination,''.
    (c) Obstruction of Program Audits.--Section 1128(b)(2) of the 
Social Security Act (42 U.S.C. 1320a-7(b)(2)) is amended--
            (1) in the heading, by inserting ``or audit'' after 
        ``investigation''; and
            (2) by striking ``investigation into'' and all that follows 
        through the period and inserting ``investigation or audit 
        related to--
                            ``(i) any offense described in paragraph 
                        (1) or in subsection (a); or
                            ``(ii) the use of funds received, directly 
                        or indirectly, from any Federal health care 
                        program (as defined in section 1128B(f)).''.
    (d) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to acts committed 
        on or after January 1, 2010.
            (2) Exception.--The amendments made by subsection (b)(1) 
        take effect on the date of enactment of this Act.

SEC. 109. MEDICARE SELF-REFERRAL DISCLOSURE PROTOCOL.

    (a) Development of Self-Referral Disclosure Protocol.--
            (1) In general.--The Secretary of Health and Human 
        Services, in cooperation with the Inspector General of the 
        Department of Health and Human Services, shall establish, not 
        later than 6 months after the date of the enactment of this 
        Act, a protocol to enable health care providers of services and 
        suppliers to disclose an actual or potential violation of 
        section 1877 of the Social Security Act (42 U.S.C. 1395nn) 
        pursuant to a self-referral disclosure protocol (in this 
        section referred to as an ``SRDP''). The SRDP shall include 
        direction to health care providers of services and suppliers 
        on--
                    (A) a specific person, official, or office to whom 
                such disclosures shall be made; and
                    (B) instruction on the implication of the SRDP on 
                corporate integrity agreements and corporate compliance 
                agreements.
            (2) Publication on internet website of srdp information.--
        The Secretary of Health and Human Services shall post 
        information on the public Internet website of the Centers for 
        Medicare & Medicaid Services to inform relevant stakeholders of 
        how to disclose actual or potential violations pursuant to an 
        SRDP.
            (3) Relation to advisory opinions.--The SRDP shall be 
        separate from the advisory opinion process set forth in 
        regulations implementing section 1877(g) of the Social Security 
        Act.
    (b) Reduction in Amounts Owed.--The Secretary of Health and Human 
Services is authorized to reduce the amount due and owing for all 
violations under section 1877 of the Social Security Act to an amount 
less than that specified in subsection (g) of such section. In 
establishing such amount for a violation, the Secretary may consider 
the following factors:
            (1) The nature and extent of the improper or illegal 
        practice.
            (2) The timeliness of such self-disclosure.
            (3) The cooperation in providing additional information 
        related to the disclosure.
            (4) Such other factors as the Secretary considers 
        appropriate.
    (c) Report.--Not later than 18 months after the date on which the 
SRDP protocol is established under subsection (a)(1), the Secretary 
shall submit to Congress a report on the implementation of this 
section. Such report shall include--
            (1) the number of health care providers of services and 
        suppliers making disclosures pursuant to the SRDP;
            (2) the amounts collected pursuant to the SRDP;
            (3) the types of violations reported under the SRDP; and
            (4) such other information as may be necessary to evaluate 
        the impact of this section.

SEC. 110. EXPANSION OF THE RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM.

    (a) Expansion to Medicaid.--
            (1) State plan amendment.--Section 1902(a)(42) of the 
        Social Security Act (42 U.S.C. 1396a(a)(42)) is amended--
                    (A) by striking ``that the records'' and inserting 
                ``that--
                    ``(A) the records'';
                    (B) by inserting ``and'' after the semicolon; and
                    (C) by adding at the end the following:
                    ``(B) not later than December 31, 2010, the State 
                shall--
                            ``(i) establish a program under which the 
                        State contracts (consistent with State law and 
                        in the same manner as the Secretary enters into 
                        contracts with recovery audit contractors under 
                        section 1893(h), subject to such exceptions or 
                        requirements as the Secretary may require for 
                        purposes of this title or a particular State) 
                        with 1 or more recovery audit contractors for 
                        the purpose of identifying underpayments and 
                        overpayments and recouping overpayments under 
                        the State plan and under any waiver of the 
                        State plan with respect to all services for 
                        which payment is made to any entity under such 
                        plan or waiver; and
                            ``(ii) provide assurances satisfactory to 
                        the Secretary that--
                                    ``(I) under such contracts, payment 
                                shall be made to such a contractor only 
                                from amounts recovered;
                                    ``(II) from such amounts recovered, 
                                payment--
                                            ``(aa) shall be made on a 
                                        contingent basis for collecting 
                                        overpayments; and
                                            ``(bb) may be made in such 
                                        amounts as the State may 
                                        specify for identifying 
                                        underpayments;
                                    ``(III) the State has an adequate 
                                process for entities to appeal any 
                                adverse determination made by such 
                                contractors; and
                                    ``(IV) such program is carried out 
                                in accordance with such requirements as 
                                the Secretary shall specify, 
                                including--
                                            ``(aa) for purposes of 
                                        section 1903(a)(7), that 
                                        amounts expended by the State 
                                        to carry out the program shall 
                                        be considered amounts expended 
                                        as necessary for the proper and 
                                        efficient administration of the 
                                        State plan or a waiver of the 
                                        plan;
                                            ``(bb) that section 1903(d) 
                                        shall apply to amounts 
                                        recovered under the program; 
                                        and
                                            ``(cc) that the State and 
                                        any such contractors under 
                                        contract with the State shall 
                                        coordinate such recovery audit 
                                        efforts with other contractors 
                                        or entities performing audits 
                                        of entities receiving payments 
                                        under the State plan or waiver 
                                        in the State, including efforts 
                                        with Federal and State law 
                                        enforcement with respect to the 
                                        Department of Justice, 
                                        including the Federal Bureau of 
                                        Investigations, the Inspector 
                                        General of the Department of 
                                        Health and Human Services, and 
                                        the State Medicaid fraud 
                                        control unit; and''.
            (2) Coordination; regulations.--
                    (A) In general.--The Secretary of Health and Human 
                Services, acting through the Administrator of the 
                Centers for Medicare & Medicaid Services, shall 
                coordinate the expansion of the Recovery Audit 
                Contractor program to Medicaid with States, 
                particularly with respect to each State that enters 
                into a contract with a recovery audit contractor for 
                purposes of the State's Medicaid program prior to 
                December 31, 2010.
                    (B) Regulations.--The Secretary of Health and Human 
                Services shall promulgate regulations to carry out this 
                subsection and the amendments made by this subsection, 
                including with respect to conditions of Federal 
                financial participation, as specified by the Secretary.
    (b) Expansion to Medicare Parts C and D.--Section 1893(h) of the 
Social Security Act (42 U.S.C. 1395ddd(h)) is amended--
            (1) in paragraph (1), in the matter preceding subparagraph 
        (A), by striking ``part A or B'' and inserting ``this title'';
            (2) in paragraph (2), by striking ``parts A and B'' and 
        inserting ``this title'';
            (3) in paragraph (3), by inserting ``(not later than 
        December 31, 2010, in the case of contracts relating to 
        payments made under part C or D)'' after ``2010'';
            (4) in paragraph (4), in the matter preceding subparagraph 
        (A), by striking ``part A or B'' and inserting ``this title''; 
        and
            (5) by adding at the end the following:
            ``(9) Special rules relating to parts c and d.--The 
        Secretary shall enter into contracts under paragraph (1) to 
        require recovery audit contractors to--
                    ``(A) ensure that each MA plan under part C has an 
                anti- fraud plan in effect and to review the 
                effectiveness of each such anti-fraud plan;
                    ``(B) ensure that each prescription drug plan under 
                part D has an anti- fraud plan in effect and to review 
                the effectiveness of each such anti-fraud plan;
                    ``(C) examine claims for reinsurance payments under 
                section 1860D-15(b) to determine whether prescription 
                drug plans submitting such claims incurred costs in 
                excess of the allowable reinsurance costs permitted 
                under paragraph (2) of that section; and
                    ``(D) review estimates submitted by prescription 
                drug plans by private plans with respect to the 
                enrollment of high cost beneficiaries (as defined by 
                the Secretary) and to compare such estimates with the 
                numbers of such beneficiaries actually enrolled by such 
                plans.''.
    (c) Annual Report.--The Secretary of Health and Human Services, 
acting through the Administrator of the Centers for Medicare & Medicaid 
Services, shall submit an annual report to Congress concerning the 
effectiveness of the Recovery Audit Contractor program under Medicaid 
and Medicare and shall include such reports recommendations for 
expanding or improving the program.

SEC. 111. REQUIREMENTS FOR THE TRANSMISSION OF MANAGEMENT IMPLICATION 
              REPORTS BY THE HHS OIG.

    Section 1128G of the Social Security Act, as added by section 
102(a), is amended by adding at the end the following new subsection:
    ``(f) Transmission of Management Implication Reports by the HHS 
OIG.--
            ``(1) Congressional notification.--Not later than 30 days 
        after the transmission by the Inspector General of the 
        Department of Health and Human Services to another agency of 
        the Department of Health and Human Services of a management 
        implication report, the Inspector General shall notify the 
        relevant committees of Congress of such transmission.
            ``(2) Secretarial response.--The Secretary shall respond to 
        a management implication report transmitted under paragraph (1) 
        not later than 90 days after such transmission.
            ``(3) Relevant committees of congress defined.--In this 
        subsection, the term `relevant committees of Congress' means 
        the Committees on Ways and Means and Energy and Commerce of the 
        House of Representatives and the Committee on Finance of the 
        Senate.''.

SEC. 112. MEDICAL ID THEFT INFORMATION SHARING PROGRAM AND 
              CLEARINGHOUSE.

    (a) Establishment.--Not later than 24 months after the date of 
enactment of this Act, the Secretary of Health and Human Services (in 
this section referred to as the ``Secretary''), acting through the 
Administrator of the Centers for Medicare & Medicaid Services and in 
coordination with the Chairman of the Federal Trade Commission, shall 
establish an information sharing program regarding beneficiary medical 
ID theft under the programs under titles XVIII, XIX, and XXI of the 
Social Security Act (in this section referred to as the ``program'').
    (b) Contents of Program.--The program shall include--
            (1) the establishment of methods to identify and detect 
        relevant warning signs of medical ID theft;
            (2) the establishment of appropriate responses to such 
        warning signs that would mitigate and prevent beneficiary 
        medical ID theft; and
            (3) the development of a detailed plan to update the 
        program as appropriate, taking into consideration such warning 
        signs and appropriate responses.
    (c) Establishment of Clearinghouse.--The Secretary, in coordination 
with the Chairman of the Federal Trade Commission, shall establish a 
clearinghouse at the Centers for Medicare & Medicaid Services that 
collects reports of ID theft against beneficiaries under the programs 
under titles XVIII, XIX, and XXI of the Social Security Act from the 
Federal Trade Commission and other sources determined appropriate by 
the Secretary. Such clearinghouse shall be used to fight medical ID 
theft against beneficiaries and to prevent the improper payment of 
claims under such programs.

                TITLE II--ADDITIONAL MEDICAID PROVISIONS

SEC. 201. TERMINATION OF PROVIDER PARTICIPATION UNDER MEDICAID IF 
              TERMINATED UNDER MEDICARE OR OTHER STATE PLAN.

    Section 1902(a)(39) of the Social Security Act (42 U.S.C. 42 U.S.C. 
1396a(a)) is amended by inserting after ``1128A,'' the following: 
``terminate the participation of any individual or entity in such 
program if (subject to such exceptions as are permitted with respect to 
exclusion under sections 1128(c)(3)(B) and 1128(d)(3)(B)) participation 
of such individual or entity is terminated under title XVIII or any 
other State plan under this title,''.

SEC. 202. MEDICAID EXCLUSION FROM PARTICIPATION RELATING TO CERTAIN 
              OWNERSHIP, CONTROL, AND MANAGEMENT AFFILIATIONS.

    Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by section 101(b), is amended by inserting after paragraph (74) 
the following:
            ``(75) provide that the State agency described in paragraph 
        (9) exclude, with respect to a period, any individual or entity 
        from participation in the program under the State plan if such 
        individual or entity owns, controls, or manages an entity that 
        (or if such entity is owned, controlled, or managed by an 
        individual or entity that)--
                    ``(A) has unpaid overpayments (as defined by the 
                Secretary) under this title during such period 
                determined by the Secretary or the State agency to be 
                delinquent;
                    ``(B) is suspended or excluded from participation 
                under or whose participation is terminated under this 
                title during such period; or
                    ``(C) is affiliated with an individual or entity 
                that has been suspended or excluded from participation 
                under this title or whose participation is terminated 
                under this title during such period;''.

SEC. 203. BILLING AGENTS, CLEARINGHOUSES, OR OTHER ALTERNATE PAYEES 
              REQUIRED TO REGISTER UNDER MEDICAID.

    (a) In General.--Section 1902(a) of the Social Security Act (42 
U.S.C. 42 U.S.C. 1396a(a)), as amended by section 202(a), is amended by 
inserting after paragraph (75) the following:
            ``(76) provide that any agent, clearinghouse, or other 
        alternate payee (as defined by the Secretary) that submits 
        claims on behalf of a health care provider must register with 
        the State and the Secretary in a form and manner specified by 
        the Secretary; and''.

SEC. 204. REQUIREMENT TO REPORT EXPANDED SET OF DATA ELEMENTS UNDER 
              MMIS TO DETECT FRAUD AND ABUSE.

    (a) In General.--Section 1903(r)(1)(F) of the Social Security Act 
(42 U.S.C. 1396b(r)(1)(F)) is amended by inserting after ``necessary'' 
the following: ``and including, for data submitted to the Secretary on 
or after March 1, 2010, data elements from the automated data system 
that the Secretary determines to be necessary for program integrity, 
program oversight, and administration, at such frequency as the 
Secretary shall determine''.
    (b) Managed Care Organizations.--
            (1) In general.--Section 1903(m)(2)(A)(xi) of the Social 
        Security Act (42 U.S.C. 1396b(m)(2)(A)(xi)) is amended by 
        inserting ``and for the provision of such data to the State at 
        a frequency and level of detail to be specified by the 
        Secretary'' after ``patients''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply with respect to contract years beginning on or 
        after March 1, 2010.

SEC. 205. PROHIBITION ON PAYMENTS TO INSTITUTIONS OR ENTITIES LOCATED 
              OUTSIDE OF THE UNITED STATES.

    Section 1902(a) of the Social Security Act (42 U.S.C. 1396b(a)), as 
amended by section 203, is amended by inserting after paragraph (76) 
the following new paragraph:
            ``(77) provide that the State shall not provide any 
        payments for items or services provided under the State plan or 
        under a waiver to any financial institution or entity located 
        outside of the United States.''.

SEC. 206. OVERPAYMENTS.

    (a) Extension of Period for Collection of Overpayments Due to 
Fraud.--
            (1) In general.--Section 1903(d)(2) of the Social Security 
        Act (42 U.S.C. 1396b(d)(2)) is amended--
                    (A) in subparagraph (C)--
                            (i) in the first sentence, by striking ``60 
                        days'' and inserting ``1 year''; and
                            (ii) in the second sentence, by striking 
                        ``60 days'' and inserting ``1-year period''; 
                        and
                    (B) in subparagraph (D)--
                            (i) in inserting ``(i)'' after ``(D)''; and
                            (ii) by adding at the end the following:
    ``(ii) In any case where the State is unable to recover a debt 
which represents an overpayment (or any portion thereof) made to a 
person or other entity due to fraud within 1 year of discovery because 
there is not a final determination of the amount of the overpayment 
under an administrative or judicial process (as applicable), including 
as a result of a judgment being under appeal, no adjustment shall be 
made in the Federal payment to such State on account of such 
overpayment (or portion thereof) before the date that is 30 days after 
the date on which a final judgment (including, if applicable, a final 
determination on an appeal) is made.''.
            (2) Effective date.--The amendments made by this subsection 
        take effect on the date of enactment of this Act and apply to 
        overpayments discovered on or after that date.
    (b) Corrective Action.--The Secretary shall promulgate regulations 
that require States to correct Federally identified claims 
overpayments, of an ongoing or recurring nature, with new Medicaid 
Management Information System (MMIS) edits, audits, or other 
appropriate corrective action.

SEC. 207. MANDATORY STATE USE OF NATIONAL CORRECT CODING INITIATIVE.

    Section 1903(r) of the Social Security Act (42 U.S.C. 1396b(r)) is 
amended--
            (1) in paragraph (1)(B)--
                    (A) in clause (ii), by striking ``and'' at the end;
                    (B) in clause (iii), by adding ``and'' after the 
                semi-colon; and
                    (C) by adding at the end the following new clause:
                            ``(iv) effective for claims filed on or 
                        after October 1, 2010, incorporate compatible 
                        methodologies of the National Correct Coding 
                        Initiative administered by the Secretary (or 
                        any successor initiative to promote correct 
                        coding and to control improper coding leading 
                        to inappropriate payment) and such other 
                        methodologies of that Initiative (or such other 
                        national correct coding methodologies) as the 
                        Secretary identifies in accordance with 
                        paragraph (4);''; and
            (2) by adding at the end the following new paragraph:
    ``(4) For purposes of paragraph (1)(B)(iv), the Secretary shall do 
the following:
            ``(A) Not later than September 1, 2010:
                    ``(i) Identify those methodologies of the National 
                Correct Coding Initiative administered by the Secretary 
                (or any successor initiative to promote correct coding 
                and to control improper coding leading to inappropriate 
                payment) which are compatible to claims filed under 
                this title.
                    ``(ii) Identify those methodologies of such 
                Initiative (or such other national correct coding 
                methodologies) that should be incorporated into claims 
                filed under this title with respect to items or 
                services for which States provide medical assistance 
                under this title and no national correct coding 
                methodologies have been established under such 
                Initiative with respect to title XVIII.
                    ``(iii) Notify States of--
                            ``(I) the methodologies identified under 
                        subparagraphs (A) and (B) (and of any other 
                        national correct coding methodologies 
                        identified under subparagraph (B)); and
                            ``(II) how States are to incorporate such 
                        methodologies into claims filed under this 
                        title.
            ``(B) Not later than March 1, 2011, submit a report to 
        Congress that includes the notice to States under clause (iii) 
        of subparagraph (A) and an analysis supporting the 
        identification of the methodologies made under clauses (i) and 
        (ii) of subparagraph (A).''.

SEC. 208. PAYMENT FOR ILLEGAL UNAPPROVED DRUGS.

    (a) Findings.--Congress finds that each year, the Medicaid program 
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
pays millions of dollars in reimbursement for covered outpatient drugs 
that are not approved by the Food and Drug Administration under a new 
drug application under section 505(b) of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 355(b)) or an abbreviated new drug application 
under section 505(j) of such Act, or that such drug is not subject such 
section 505 or section 512 due to the application of section 201(p) of 
such Act (21 U.S.C. 321(p)).
    (b) Listing of Drugs and Devices.--Section 510 of the Food, Drug 
and Cosmetic Act (21 U.S.C. 360) is amended--
            (1) in subsection (j)(1)(B)--
                    (A) in clause (i), by inserting ``in the case of a 
                drug, the authority under this Act that does not 
                require such drug to be subject to section 505 and 
                section 512,'' after ``labeling for such drug or 
                device,''; and
                    (B) in clause (ii), by inserting ``, in the case of 
                a drug, the authority under this Act that does not 
                require such drug to be subject to section 505 and 
                section 512,'' after ``for such drug or device''; and
            (2) in subsection (f)--
                    (A) by striking ``(f) The Secretary'' and inserting 
                the following:
    ``(f) Inspection by Public of Registration.--
            ``(1) In general.--The Secretary''; and
                    (B) by adding at the end the following:
            ``(2) List of drugs that are not approved under section 505 
        or 512.--Not later than January 1, 2011, the Secretary shall 
        make available to the public on the Internet website of the 
        Food and Drug Administration a list that includes, for each 
        drug described in subsection (j)(1)(B)--
                    ``(A) the drug;
                    ``(B) the person who listed such drug; and
                    ``(C) the authority under this Act that does not 
                require such drug to be subject to section 505 and 
                section 512, as provided by such person in such 
                list.''.
    (c) Payment for Covered Outpatient Drugs.--Section 1927 of the 
Social Security Act (42 U.S.C. 1396r-8) is amended by inserting at the 
end the following:
    ``(l) Condition.--Beginning January 1, 2011, no State shall make 
any payment under this section for any covered outpatient drug unless 
such State first verifies with the Food and Drug Administration that 
such covered outpatient drug has been approved by the Food and Drug 
Administration under a new drug application under section 505(b) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(b)) or an 
abbreviated new drug application under section 505(j) of such Act, or 
that such drug is not subject such section 505 or section 512 due to 
the application of section 201(p) of such Act (21 U.S.C. 321(p)). The 
Secretary shall have the authority to proscribe regulations to create 
an information sharing protocol to allow States to verify that a 
covered outpatient drug has been approved by the Food and Drug 
Administration.''.

SEC. 209. GENERAL EFFECTIVE DATE.

    (a) In General.--Except as otherwise provided in this subtitle, 
this subtitle and the amendments made by this subtitle take effect on 
January 1, 2011, without regard to whether final regulations to carry 
out such amendments and subtitle have been promulgated by that date.
    (b) Delay if State Legislation Required.--In the case of a State 
plan for medical assistance under title XIX of the Social Security Act 
or a child health plan under title XXI of such Act which the Secretary 
of Health and Human Services determines requires State legislation 
(other than legislation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the amendments made by this 
subtitle, the State plan or child health plan shall not be regarded as 
failing to comply with the requirements of such title solely on the 
basis of its failure to meet this additional requirement before the 
first day of the first calendar quarter beginning after the close of 
the first regular session of the State legislature that begins after 
the date of the enactment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a separate regular 
session of the State legislature.

                    TITLE III--ADDITIONAL PROVISIONS

SEC. 301. REQUIRING INDIVIDUALS OR ENTITIES THAT PARTICIPATE IN OR 
              CONDUCT ACTIVITIES UNDER FEDERAL HEALTH CARE PROGRAMS TO 
              COMPLY WITH CERTAIN CONGRESSIONAL REQUESTS.

    (a) In General.--Section 1128G of the Social Security Act, as added 
by section 102(a) and amended by section 111, is amended by adding at 
the end the following new subsection:
    ``(g) Compliance With Certain Requests by Individuals and Entities 
That Participate in or Conduct Activities Under Federal Health Care 
Programs.--
            ``(1) In general.--Any individual or entity that 
        participates in or conducts activities under a Federal health 
        care program (as defined in section 1128B(f)) shall, as a 
        condition of such participation or such conduct, comply (at a 
        time and in a manner specified by the Chairman or ranking 
        member) with any request submitted by the Chairman or the 
        ranking member of a relevant committee of Congress to the 
        individual or entity for the following:
                    ``(A) Documents.
                    ``(B) Information.
                    ``(C) Interviews.
            ``(2) Relevant committee of congress defined.--In this 
        subsection, the term `relevant committee of Congress' means the 
        Committees on Ways and Means and Energy and Commerce of the 
        House of Representatives and the Committee on Finance of the 
        Senate.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date that is 2 years after the date of enactment of this 
Act.

SEC. 302. AMENDMENTS TO THE FALSE CLAIMS ACT.

    Section 3730(h) of title 31, United States Code, is amended--
            (1) in paragraph (1), by striking ``or agent on behalf of 
        the employee, contractor, or agent or associated others in 
        furtherance of other efforts to stop 1 or more violations of 
        this subchapter'' and inserting ``agent or associated others in 
        furtherance of an action under this section or other efforts to 
        stop 1 or more violations of this subchapter''; and
            (2) by adding at the end the following:
            ``(3) Limitation on bringing civil action.--A civil action 
        under this subsection may not be brought more than 2 years 
        after the date when the retaliation occurred.''.

SEC. 303. DISMISSAL OF CERTAIN ACTIONS OR CLAIMS UNDER THE FALSE CLAIMS 
              ACT.

    Section 3730(e) of title 31, United States Code, is amended by 
striking paragraph (4) and inserting the following:
            ``(4)(A) The court shall dismiss an action or claim under 
        this section, unless opposed by the Government, if 
        substantially the same allegations or transactions as alleged 
        in the action or claim were publicly disclosed--
                    ``(i) in a Federal criminal, civil, or 
                administrative hearing in which the Government or its 
                agent is a party;
                    ``(ii) in a congressional, Government 
                Accountability Office, or other Federal report, 
                hearing, audit, or investigation; or
                    ``(iii) from the news media, unless the action is 
                brought by the Attorney General or the person bringing 
                the action is an original source of the information.
            ``(B) For purposes of this paragraph, the term `original 
        source' means an individual who--
                    ``(i) prior to a public disclosure under subsection 
                (e)(4)(a), has voluntarily disclosed to the Government 
                the information on which allegations or transactions in 
                a claim are based; or
                    ``(ii) has knowledge that is independent of and 
                materially adds to the publicly disclosed allegations 
                or transactions, and has voluntarily provided the 
                information to the Government before filing an action 
                under this section.''.
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