II 111th CONGRESS 2d Session S. 2964 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.

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.