Short title

This Act may be cited as the

Medicare Fraud Enforcement and Prevention Act of 2011

Enhanced criminal penalties to combat Medicare and Medicaid fraud

(a)

In general

Section 1128B of the Social Security Act (42 U.S.C. 1320a–7b) is amended— (1)in subsection (a), by striking $10,000 or imprisoned for not more than one year and inserting $20,000 or imprisoned for not more than two years; and (2)in each of subsections (a), (b)(1), (b)(2), (c), and (d), by striking $25,000 or imprisoned for not more than five years and inserting $50,000 or imprisoned for not more than 10 years. (b)

Illegal distribution of Medicare or Medicaid beneficiary identification or billing privileges

Section 1128B of such Act (42 U.S.C. 1320a–7b) is amended by adding at the end the following new subsection:

(g)Whoever knowingly, intentionally, and with the intent to defraud purchases, sells, or distributes, or arranges for the purchase, sale, or distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges under title XVIII or title XIX shall be imprisoned for not more than 10 years or fined under title 18, United States Code (or, if greater, an amount equal to the monetary loss to the Federal and any State government as a result of such acts), or both.

(c)

Effective date

The amendments made by this section shall apply to acts committed on or after the date of the enactment of this Act.

Enhanced civil authorities to combat Medicare and Medicaid fraud

(a)

Civil monetary penalties law alignment and other changes

(1)Section 1128A(a) of the Social Security Act (42 U.S.C. 1320a–7a(a)) is amended— (A)in paragraph (1), by striking to an officer, employee, or agent of the United States, or of any department or agency thereof, or of any State agency (as defined in subsection (i)(1)),; (B)by inserting after paragraph (10), as added by section 6402(d)(2) of the Patient Protection and Affordable Care Act (Public Law 111–148) the following new paragraphs:

(11)conspires to commit a violation of this section; or (12)knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to a Federal health care program, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to a Federal health care program;

;

(C)in the first sentence— (i)by striking or in cases under paragraph (9) and inserting in cases under paragraph (9); and (ii)by striking fact) and inserting fact), in cases under paragraph (11), $50,000 for any violation described in this section committed in furtherance of the conspiracy involved, and in cases under paragraph (12), $50,000 for each false record or statement, or concealment, avoidance, or decrease; and (D)in the second sentence, by striking material fact). and inserting material fact); or in cases under paragraph (11), an assessment of not more than 3 times the total amount that would otherwise apply for any violation described in this section committed in furtherance of the conspiracy involved; or in cases under paragraph (12), an assessment of not more than 3 times the total amount of the obligation to which the false record or statement was material or that was avoided or decreased.. (2)Section 1128A(c)(1) of the Social Security Act (42 U.S.C. 1320a–7a(c)(1)) is amended by striking six years and inserting 10 years. (3)Section 1128A(i) of the Social Security Act (42 U.S.C. 1320a–7a(i)) is amended— (A)by amending paragraph (2) to read as follows:

(2)The term claim means any application, request, or demand, whether under contract, or otherwise, for money or property for items and services under a Federal health care program (as defined in section 1128B(f)), whether or not the United States or a State agency has title to the money or property, that— (A)is presented or caused to be presented to an officer, employee, or agent of the United States, or of any department or agency thereof, or of any State agency (as defined in subsection (i)(1)); or (B)is made to a contractor, grantee, or other recipient if the money or property is to be spent or used on the Federal health care program’s behalf or to advance a Federal health care program interest, and if the Federal health care program— (i)provides or has provided any portion of the money or property requested or demanded; or (ii)will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded.

;

(B)by amending paragraph (3) to read as follows:

(3)The term item or service means, without limitation, any medical, social, management, administrative, or other item or service used in connection with or directly or indirectly related to a Federal health care program.

;

(C)in paragraph (7)— (i)by striking term should know means and inserting terms knowing, knowingly, and should know mean; (ii)by redesignating subparagraphs (A) and (B) as subparagraphs (B) and (C), respectively; (iii)by inserting before subparagraph (B), as redesignated by clause (ii), the following new subparagraph:

(A)has actual knowledge of the information;

; and

(iv)in the matter following subparagraph (C), as redesignated by clause (ii)— (I)by inserting require after and; and (II)by striking is required; and (D)by adding at the end the following new paragraphs:

(8)The term obligation means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment. (9)The term material means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.

(b)

Exclusion of responsible corporate officials

Section 1128(b) of the Social Security Act (42 U.S.C. 1320a–7(b)) is amended 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 a sanctioned entity at the time of and who knew or should have known (as defined in section 1128(i)(7)) of any of the conduct that formed a 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 any of the conduct that formed a basis for the conviction or exclusion so described.

(c)

Payment suspensions

Subsection (o)(1) of section 1862 of the Social Security Act (42 U.S.C. 1395y), as added by section 6402(h) of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended by striking may and inserting shall. (d)

Civil monetary penalties for false statements or delaying inspections

Paragraph (9) of section 1128A(a) of the Social Security Act (42 U.S.C. 1320a–7a(a)), as added by section 6408(a) of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended by inserting or to timely provide information in response to a request authorized by section 1128J(b), after regulations),.

Enhanced screening, Medicare data-mining system; biometric technology pilot program

(a)

Enhanced screening

Section 1866(j)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395cc(j)), as inserted by section 6401(a)(3) of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended by striking may and inserting shall. (b)

Access to Real Time Claims and Payment Data

Section 1128J(a)(2) of the Social Security Act, as added by section 6402(a) of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended— (1)by inserting including real time claims and payment data, after access to claims and payment data; and (2)by adding at the end the following sentence: In carrying out this section, the Inspector General of the Department of Health and Human Services, in consultation with the Attorney General, shall implement mechanisms for the sharing of information about suspected fraud relating to the Federal health care programs under titles XVIII, XIX, and XXI with other appropriate law enforcement officials.. (c)

Biometric technology pilot program

(1)

In general

By not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall carry out a 5-year pilot program that implements biometric technology to ensure that individuals entitled to benefits under part A of title XVIII of the Social Security Act or enrolled under part B of such title are physically present at the time and place of receipt of certain items and services (specified by the Secretary) for which payment may be made under such title. Under such pilot program the Secretary may provide for financial incentives to encourage voluntary participation of providers of services (as defined in section 1861(u) of such Act) and suppliers (as defined in section 1861(d) of such Act). (2)

Reports

The Secretary of Health and Human Services shall, for each of the third, fourth, and fifth years of the pilot program under paragraph (1), submit to Congress a report on the effectiveness of the pilot program in reducing the occurrence of waste, fraud, and abuse in the Medicare program under title XVIII of the Social Security Act. (3)

Authorization of appropriations

For purpose of carrying out paragraph (1), there is authorized to be appropriated such sums as may be necessary.