[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 975 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 975

 To amend title XVIII of the Social Security Act to reduce fraud under 
                         the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 5, 2009

   Mr. Martinez (for himself, Mr. Cornyn, Ms. Collins, Mr. Nelson of 
  Florida, Mr. Alexander, Mr. Graham, Mr. Vitter, Mr. DeMint, and Mr. 
    Corker) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to reduce fraud under 
                         the Medicare program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Seniors and Taxpayers Obligation 
Protection Act of 2009''.

SEC. 2. REQUIRING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO CHANGE 
              THE MEDICARE BENEFICIARY IDENTIFIER USED TO IDENTIFY 
              MEDICARE BENEFICIARIES UNDER THE MEDICARE PROGRAM.

    (a) Procedures.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, in order to protect beneficiaries from 
        identity theft, the Secretary of Health and Human Services (in 
        this section referred to as the ``Secretary'') shall establish 
        and implement procedures to change the Medicare beneficiary 
        identifier used to identify individuals entitled to benefits 
        under part A of title XVIII of the Social Security Act or 
        enrolled under part B of such title so that such an 
        individual's social security account number is not used.
            (2) Maintaining existing hicn structure.--In order to 
        minimize the impact of the change under paragraph (1) on 
        systems that communicate with Medicare beneficiary eligibility 
        systems, the procedures under paragraph (1) shall provide that 
        the new Medicare beneficiary identifier maintain the existing 
        Health Insurance Claim Number structure.
            (3) Protection against fraud.--The procedures under 
        paragraph (1) shall provide for a process for changing the 
        Medicare beneficiary identifier for an individual to a 
        different identifier in the case of the discovery of fraud, 
        including identity theft.
            (4) Phase-in authority.--
                    (A) In general.--Subject to subparagraphs (B) and 
                (C), the Secretary may phase in the change under 
                paragraph (1) in such manner as the Secretary 
                determines appropriate.
                    (B) Limit.--The phase-in period under subparagraph 
                (A) shall not exceed 10 years.
                    (C) Newly entitled and enrolled individuals.--The 
                Secretary shall ensure that the change under paragraph 
                (1) is implemented not later than January 1, 2010, with 
                respect to any individual who first becomes entitled to 
                benefits under part A of title XVIII of the Social 
                Security Act or enrolled under part B of such title on 
                or after such date.
    (b) Education and Outreach.--The Secretary shall establish a 
program of education and outreach for individuals entitled to, or 
enrolled for, benefits under part A of title XVIII of the Social 
Security Act or enrolled under part B of such title, providers of 
services (as defined in subsection (u) of section 1861 of such Act (42 
U.S.C. 1395x)), and suppliers (as defined in subsection (d) of such 
section) on the change under paragraph (1).
    (c) Data Matching.--
            (1) Access to certain information.--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--
                    ``(i) enter into an agreement with the Secretary 
                for the purpose of matching data in the system of 
                records of the Commissioner with data in the system of 
                records of the Secretary, so long as the requirements 
                of subparagraphs (A) and (B) of paragraph (3) are met, 
                in order to determine--
                            ``(I) whether a beneficiary under the 
                        program under title XVIII, XIX, or XXI is dead, 
                        imprisoned, or otherwise not eligible for 
                        benefits under such program; and
                            ``(II) whether a provider of services or a 
                        supplier under the program under title XVIII, 
                        XIX, or XXI is dead, imprisoned, or otherwise 
                        not eligible to furnish or receive payment for 
                        furnishing items and services under such 
                        program; and
                    ``(ii) include in such agreement safeguards to 
                assure the maintenance of the confidentiality of any 
                information disclosed and procedures to permit the 
                Secretary to use such information for the purpose 
                described in clause (i).
            ``(B) Information provided pursuant to an agreement under 
        this paragraph shall be provided at such time, in such place, 
        and in such manner as the Commissioner determines appropriate.
            ``(C) Information provided pursuant to an agreement under 
        this paragraph shall include information regarding whether--
                    ``(i) the name (including the first name and any 
                family name or surname), the date of birth (including 
                the month, day, and year), and social security number 
                of an individual provided to the Commissioner match the 
                information contained in the Commissioner's records, 
                and
                    ``(ii) such individual is shown on the records of 
                the Commissioner as being deceased.''.
            (2) Investigation based on certain information.--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. ACCESS TO CERTAIN DATA AND INVESTIGATION OF CLAIMS 
              INVOLVING INDIVIDUALS WHO ARE NOT ELIGIBLE FOR BENEFITS 
              OR ARE NOT ELIGIBLE PROVIDERS OF SERVICES OR SUPPLIERS.

    ``(a) Data Agreement.--The Secretary shall enter into an agreement 
with the Commissioner of Social Security pursuant to section 205(r)(9).
    ``(b) Investigation of Claims Involving Certain Individuals Who Are 
Not Eligible for Benefits or Are Not Eligible Providers of Services or 
Suppliers.--
            ``(1) In general.--The Secretary shall, in the case where a 
        provider of services or a supplier under the program under 
        title XVIII, XIX, or XXI submits a claim for payment for items 
        or services furnished to an individual who the Secretary 
        determines, as a result of information provided pursuant to 
        such agreement, is not eligible for benefits under such 
        program, or where the Secretary determines, as a result of such 
        information, that such provider of services or supplier is not 
        eligible to furnish or receive payment for furnishing such 
        items or services, conduct an investigation with respect to the 
        provider of services or supplier. If the Secretary determines 
        further action is appropriate, the Secretary shall refer the 
        investigation to the Inspector General of the Department of 
        Health and Human Services.
            ``(2) Assessment of implementation and effectiveness by the 
        oig.--The Inspector General of the Department of Health and 
        Human Services shall test the implementation of the provisions 
        of this section (including the implementation of the agreement 
        under section 205(r)(9)) and conduct such period assessments of 
        such implementation as the Inspector General determines 
        necessary to determine the effectiveness of such 
        implementation.''.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 3. MONTHLY VERIFICATION OF ACCURACY OF CLAIMS FOR PAYMENT FOR 
              PHYSICIANS' SERVICES.

    (a) In General.--Section 1893 of the Social Security Act (42 U.S.C. 
1395ddd) is amended--
            (1) in subsection (b), by adding at the end the following 
        new paragraph:
            ``(7) The monthly verification of the accuracy of claims 
        for payment for physicians' services under the system under 
        subsection (i).''; and
            (2) by adding at the end the following new subsection:
    ``(i) Monthly Verification of Accuracy of Claims for Payment for 
Physicians' Services.--
            ``(1) System.--
                    ``(A) In general.--Not later than 1 year after the 
                date of the enactment of this subsection, the Secretary 
                shall establish and implement a system to verify 
                (electronically or otherwise, taking into consideration 
                the administrative burden of such verification on 
                physicians and group practices) on a monthly basis that 
                the claims for payment under part B for physicians' 
                services furnished in high risk areas are--
                            ``(i) for physicians' services actually 
                        furnished by the physician or the physician's 
                        group practice; and
                            ``(ii) otherwise accurate.
                    ``(B) No determination of medical necessity.--In no 
                case shall any verification conducted under the system 
                established under subparagraph (A) include a 
                determination of the medical necessity of the 
                physicians' service.
            ``(2) Verification.--Under the system, the Secretary, at 
        the end of each month, shall provide the physician or the group 
        practice with a detailed list of such claims for payment that 
        were submitted during the month in order for the physician or 
        the group practice to review and verify the list. In providing 
        the detailed list, the Secretary shall use the provider number 
        of the physician or the group practice.
            ``(3) Audits.--The Secretary shall conduct audits of the 
        review and verification by physicians and group practices of 
        the detailed list provided under paragraph (2). Such audits 
        shall assess whether the physician or group practice conducted 
        such review and verification in a fraudulent manner. In the 
        case where the Secretary determines such review and 
        verification was conducted in a fraudulent manner, the 
        Secretary shall recoup any payments resulting from the 
        fraudulent review and verification and impose a civil money 
        penalty in an amount determined appropriate by the Secretary on 
        the physician or group practice who conducted the fraudulent 
        review and verification. The provisions of section 1128A (other 
        than subsections (a) and (b)) shall apply to a civil money 
        penalty under the previous sentence in the same manner as such 
        provisions apply to a penalty or proceeding under section 
        1128A(a).
            ``(4) High risk areas defined.--In this subsection, the 
        term `high risk area' means a county designated as a high risk 
        area under subsection (j)(1).
            ``(5) Report by the secretary.--Not later than 1 year after 
        implementation of the system established under paragraph (1), 
        the Secretary shall submit a report to Congress on the progress 
        of such implementation. Such report shall include 
        recommendations--
                    ``(A) on how to improve such implementation, 
                including whether the system should be expanded to 
                include verification of claims for payment under part B 
                for physicians' services furnished in additional areas; 
                and
                    ``(B) for such legislation and administrative 
                action as the Secretary determines appropriate.''.
    (b) Authorization of Appropriations.--To carry out the amendments 
made by this section, there are authorized to be appropriated such sums 
as may be necessary for each of fiscal years 2010 through 2014.

SEC. 4. DETECTION OF MEDICARE FRAUD AND ABUSE.

    (a) In General.--Section 1893 of the Social Security Act (42 U.S.C. 
1395ddd), as amended by section 3, is amended--
            (1) in subsection (b), by adding at the end the following 
        new paragraph:
            ``(8) Implementation of fraud and abuse detection methods 
        under subsection (j).'';
            (2) in subsection (c), by adding at the end of the flush 
        matter following paragraph (4), the following new sentence ``In 
        the case of an activity described in subsection (b)(8), an 
        entity shall only be eligible to enter into a contract under 
        the Program to carry out the activity if the entity is selected 
        through a competitive bidding process in accordance with 
        subsection (j)(3).''; and
            (3) by adding at the end the following new subsection:
    ``(j) Detection of Medicare Fraud and Abuse.--
            ``(1) Establishment of system to identify counties most 
        vulnerable to fraud.--Not later than 6 months after the date of 
        enactment of this subsection, the Secretary shall establish a 
        system to identify the 50 counties most vulnerable to fraud 
        with respect to items and services furnished by providers of 
        services (other than hospitals and critical access hospitals) 
        and suppliers based on the degree of county-specific 
        reimbursement and analysis of payment trends under this title. 
        The Secretary shall designate the counties identified under the 
        preceding sentence as `high risk areas'.
            ``(2) Fraud and abuse detection.--
                    ``(A) Initial implementation.--The Secretary shall 
                establish procedures for the implementation of fraud 
                and abuse detection methods under this title with 
                respect to items and services furnished by such 
                providers of services and suppliers in high risk areas 
                designated under paragraph (1) (and, beginning not 
                later than 18 months after the date of enactment of 
                this subsection, with respect to items and services 
                furnished by such providers of services and suppliers 
                in areas not so designated) including the following:
                            ``(i) In the case of a new applicant to be 
                        a supplier, a background check, a pre-
                        enrollment site visit, and random unannounced 
                        site visits after enrollment.
                            ``(ii) Not less than 5 years after the date 
                        of enactment of this subsection, in the case of 
                        a supplier who is not a new applicant, re-
                        enrollment under this title, including a 
                        background check and a site-visit as part of 
                        the application process for such re-enrollment, 
                        and random unannounced site visits after such 
                        re-enrollment.
                            ``(iii) Data analysis to establish 
                        prepayment claim edits designed to target the 
                        claims for payment under this title for such 
                        items and services that are most likely to be 
                        fraudulent.
                            ``(iv) Prepayment benefit integrity reviews 
                        for claims for payment under this title for 
                        such items and services that are suspended as a 
                        result of such edits.
                    ``(B) Requirement for participation.--In no case 
                may a provider of services or supplier who does not 
                meet the requirements under subparagraph (A) 
                (including, in the case of a supplier, the requirement 
                of a background check) participate in the program under 
                this title.
                    ``(C) Background checks.--The Secretary shall 
                determine the extent of the background check conducted 
                under subparagraph (A), including whether--
                            ``(i) a fingerprint check is necessary;
                            ``(ii) a background check shall be 
                        conducted with respect to additional employees, 
                        board members, contractors or other interested 
                        parties of the supplier; and
                            ``(iii) any additional national background 
                        checks regarding exclusion from participation 
                        in Federal programs (such as the program under 
                        this title, title XIX, or title XXI), adverse 
                        actions taken by State licensing boards, 
                        bankruptcies, outstanding taxes, or other 
                        indications identified by the Inspector General 
                        of the Department of Health and Human Services 
                        are necessary.
                    ``(D) Expanded implementation.--Not later than 24 
                months after the date of enactment of this subsection, 
                the Secretary shall establish procedures for the 
                implementation of such fraud and abuse detection 
                methods under this title with respect to items and 
                services furnished by all providers of services and 
                suppliers, including those not in high risk areas 
                designated under paragraph (1).
            ``(3) Competitive bidding.--In selecting entities to carry 
        out this subsection, the Secretary shall use a competitive 
        bidding process.
            ``(4) Report to congress.--The Secretary shall submit to 
        Congress an annual report on the effectiveness of activities 
        conducted under this subsection, including a description of any 
        savings to the program under this title as a result of such 
        activities and the overall administrative cost of such 
        activities and a determination as to the amount of funding 
        needed to carry out this subsection for subsequent fiscal 
        years, together with recommendations for such legislation and 
        administrative action as the Secretary determines 
        appropriate.''.
    (b) Authorization of Appropriations.--To carry out the amendments 
made by this section, there are authorized to be appropriated--
            (1) such sums as may be necessary, not to exceed 
        $50,000,000, for each of fiscal years 2010 through 2014; and
            (2) such sums as may be necessary, not to exceed an amount 
        the Secretary determines appropriate in the most recent report 
        submitted to Congress under section 1893(j)(4) of the Social 
        Security Act, as added by subsection (a), for each subsequent 
        fiscal year.

SEC. 5. USE OF TECHNOLOGY FOR REAL-TIME DATA REVIEW.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section:

``SEC. 1899. USE OF TECHNOLOGY FOR REAL-TIME DATA REVIEW.

    ``(a) In General.--The Secretary of Health and Human Services shall 
establish procedures for the use of technology (similar to that used 
with respect to the analysis of credit card charging patterns) to 
provide real-time data analysis of claims for payment under the 
Medicare program under title XVIII of the Social Security Act to 
identify and investigate unusual billing or order practices under the 
Medicare program that could indicate fraud or abuse.
    ``(b) Competitive Bidding.--The procedures established under 
subsection (a) shall ensure that the implementation of such technology 
is conducted through a competitive bidding process.''.

SEC. 6. EDITS ON 855S MEDICARE ENROLLMENT APPLICATION.

    Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is 
amended by adding at the end the following new paragraph:
            ``(22) Confirmation with national supplier clearinghouse 
        prior to payment.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of this paragraph, the Secretary 
                shall establish procedures to require carriers, prior 
                to paying a claim for payment for durable medical 
                equipment, prosthetics, orthotics, and supplies under 
                this title, to confirm with the National Supplier 
                Clearinghouse--
                            ``(i) that the National Provider Identifier 
                        of the physician or practitioner prescribing or 
                        ordering the item or service is valid and 
                        active;
                            ``(ii) that the Medicare identification 
                        number of the supplier is valid and active; and
                            ``(iii) that the item or service for which 
                        the claim for payment is submitted was properly 
                        identified on the CMS-855S Medicare enrollment 
                        application.
                    ``(B) Online database for implementation.--Not 
                later than 18 months after the date of enactment of 
                this paragraph, the Secretary shall establish an online 
                database similar to that used for the National Provider 
                Identifier to enable providers of services, 
                accreditors, carriers, and the National Supplier 
                Clearinghouse to view information on specialties and 
                the types of items and services each supplier has 
                indicated on the CMS-855S Medicare enrollment 
                application submitted by the supplier.
                    ``(C) Notification of claim denial and 
                resubmission.--In the case where a claim for payment 
                for durable medical equipment, prosthetics, orthotics, 
                and supplies under this title is denied because the 
                item or service furnished does not correctly match up 
                with the information on file with the National Supplier 
                Clearinghouse--
                            ``(i) the National Supplier Clearinghouse 
                        shall--
                                    ``(I) provide the supplier written 
                                notification of the reason for such 
                                denial; and
                                    ``(II) allow the supplier 60 days 
                                to provide the National Supplier 
                                Clearinghouse with appropriate 
                                certification, licensing, or 
                                accreditation; and
                            ``(ii) the Secretary shall waive applicable 
                        requirements relating to the time frame for the 
                        submission of claims for payment under this 
                        title in order to permit the resubmission of 
                        such claim if payment of such claim would 
                        otherwise be allowed under this title.''.

SEC. 7. STRATEGIC PLAN FOR THE DEVELOPMENT OF A SERIAL NUMBER TRACKING 
              SYSTEM FOR DURABLE MEDICAL EQUIPMENT.

    Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), as 
amended by section 6(a), is amended by adding at the end the following 
new paragraph:
            ``(23) Strategic plan for the development of a serial 
        number tracking system for durable medical equipment.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of this paragraph, the Secretary 
                shall develop a strategic plan for the development and 
                implementation of a serial number tracking system for 
                durable medical equipment.
                    ``(B) Serial number tracking system for durable 
                medical equipment.--The plan developed under 
                subparagraph (A) shall include mechanisms to ensure 
                that an item of durable medical equipment which has not 
                been issued a unique identifier under the unique device 
                identification system established under section 519(f) 
                of the Federal Food, Drug, and Cosmetic Act bears a 
                unique identifier, unless the Secretary already 
                requires an alternative placement or provides an 
                exception for a particular item or type of durable 
                medical equipment under such section 519(f).
                    ``(C) Provision of unique identifier to the 
                secretary.--The plan developed under subparagraph (A) 
                shall include appropriate mechanisms for manufacturers 
                of items of durable medical equipment to submit to the 
                Secretary unique identifiers issued under subparagraph 
                (B) or such section 519(f) with respect to such items. 
                The plan shall include mechanisms for the Secretary to 
                provide for the storage of such unique identifier in 
                accordance with subparagraph (F)(i).
                    ``(D) Requirements for manufacturers and 
                wholesalers.--The plan developed under subparagraph (A) 
                shall include mechanisms for manufacturers of items of 
                durable medical equipment, or, in the case where a 
                wholesaler provides an item of durable medical 
                equipment to suppliers, wholesalers, to--
                            ``(i) upon issuing an item to a supplier, 
                        develop a product description for the item 
                        which includes--
                                    ``(I) the unique identifier of the 
                                item;
                                    ``(II) the specific Healthcare 
                                Common Procedure Coding System (HCPCS) 
                                code for the item;
                                    ``(III) the name of the supplier 
                                the item was shipped to; and
                                    ``(IV) the supplier's Medicare 
                                identification number; and
                            ``(ii) submit the product description 
                        developed under clause (i) to the Secretary for 
                        storage in the unique identifier database in 
                        accordance with subparagraph (F)(i).
                    ``(E) Requirements for suppliers.--The plan 
                developed under subparagraph (A) shall include 
                mechanisms to ensure that suppliers of items of durable 
                medical equipment--
                            ``(i) upon issuing the item to a 
                        beneficiary, note the unique identifier of such 
                        item on--
                                    ``(I) the claim form submitted for 
                                such item; and
                                    ``(II) when appropriate or 
                                otherwise required, the detailed 
                                product description of the item;
                            ``(ii) in the case where the item is issued 
                        to a beneficiary on a rental basis, designate 
                        the unique identifier with an `R' after the 
                        number to indicate that the item was rented, 
                        and not purchased, by the beneficiary; and
                            ``(iii) upon return of the item to the 
                        supplier, notify the Secretary--
                                    ``(I) before reissuing that item 
                                and resubmitting that number on such a 
                                claim form; or
                                    ``(II) upon resubmitting that 
                                number on such a claim form.
                    ``(F) Responsibilities for the secretary.--
                            ``(i) Maintenance of database of serial 
                        numbers.--The plan developed under subparagraph 
                        (A) shall include the responsibility of the 
                        Secretary to establish and maintain a database 
                        containing the unique identifiers submitted by 
                        manufacturers of items of durable medical 
                        equipment under subparagraph (C).
                            ``(ii) Payment.--
                                    ``(I) Limitation.--Subject to 
                                subclause (II), the plan developed 
                                under subparagraph (A) shall include 
                                mechanisms to ensure that payment may 
                                only be made for an item of durable 
                                medical equipment if the unique 
                                identifier on the claim form submitted 
                                for such item matches the unique 
                                identifier submitted by the 
                                manufacturer of such item under 
                                subparagraph (C).
                                    ``(II) Exception to limitation 
                                after verification of receipt.--The 
                                plan developed under subparagraph (A) 
                                shall include mechanisms to ensure that 
                                in the case where the unique identifier 
                                is not on the claim form submitted for 
                                such item or does not match the unique 
                                identifier submitted by the 
                                manufacturer of such item under 
                                subparagraph (C), no payment shall be 
                                made under this part for the item of 
                                durable medical equipment until the 
                                Secretary has verified that the 
                                beneficiary has received such item in 
                                accordance with subclause (IV).
                                    ``(III) Duplicative unique 
                                identifiers.--The plan developed under 
                                subparagraph (A) shall include 
                                mechanisms to ensure that in the case 
                                where a unique identifier is submitted 
                                on more than 1 claim form submitted for 
                                such an item and there is no indication 
                                from the supplier that the item of 
                                durable medical equipment has been 
                                returned by 1 beneficiary and is now 
                                being used by another beneficiary, no 
                                payment shall be made under this part 
                                for such item of durable medical 
                                equipment unless the Secretary has 
                                verified that the beneficiary has 
                                received such item in accordance with 
                                subclause (IV).
                                    ``(IV) Verification.--The plan 
                                developed under subparagraph (A) shall 
                                include provisions for the Secretary to 
                                conduct any verification required under 
                                subclause (II) or (III) within 30 days 
                                after receipt by the Secretary of the 
                                relevant claim form. In the case where 
                                such verification is not completed 
                                within such time period, the Secretary 
                                shall pay such claim, complete the 
                                verification, and, in the case where 
                                the Secretary has entered into a 
                                contract with an entity for the conduct 
                                of such verification, recover any 
                                payments that would not have been made 
                                if the verification had been completed 
                                within such time period from such 
                                entity.
                            ``(iii) Quality control audits.--The plan 
                        developed under subparagraph (A) shall include 
                        a requirement that the Secretary conduct 
                        quality control audits to identify unusual 
                        billing patterns with respect to items of 
                        durable medical equipment for which payment is 
                        made under this part and may provide that the 
                        Secretary conduct unannounced site visits or 
                        commission other agencies to conduct such site 
                        visits as part of such quality control audits.
                            ``(iv) No use as a precertification 
                        mechanism.--The plan developed under 
                        subparagraph (A) shall include mechanisms to 
                        ensure that in no case shall a unique 
                        identifier issued under subparagraph (B) or 
                        section 519(f) of the Federal Food, Drug, and 
                        Cosmetic Act be used as a precertification 
                        mechanism for the supply of an item of durable 
                        medical equipment or the payment of a claim for 
                        such an item under this part.''.

SEC. 8. GAO STUDY AND REPORT ON EFFECTIVENESS OF SURETY BOND 
              REQUIREMENTS FOR SUPPLIERS OF DURABLE MEDICAL EQUIPMENT 
              IN COMBATING FRAUD.

    (a) Study.--The Comptroller General of the United States shall 
conduct a study on the effectiveness of the surety bond requirement 
under section 1834(a)(16) of the Social Security Act (42 U.S.C. 
1395m(a)(16)) in combating fraud.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Comptroller General shall submit to Congress a report 
containing the results of the study conducted under subsection (a), 
together with recommendations for such legislation and administrative 
action as the Comptroller General determines appropriate.
                                 <all>