1.Short
title; table of contents
(a)This Act may be cited
as the Medicare and Medicaid Fighting
Fraud and Abuse to Save Taxpayers’ Dollars Act
or the
Medicare and Medicaid FAST
Act
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of
contents.
TITLE I—Preventing prescription drug waste, fraud, and
abuse
Sec. 101. Requiring valid National Provider Identifiers of
prescribers on pharmacy claims and limiting access to the National Provider
Identifier Registry.
Sec. 102. Encouraging the establishment of State Prescription
Drug Monitoring Programs.
Sec. 103. Updating of DEA database of controlled substances
providers.
TITLE II—Curbing improper payments
Sec. 201. Addressing vulnerabilities identified by Recovery
Audit Contractors.
Sec. 202. Improving Senior Medicare Patrol and fraud reporting
rewards.
Sec. 203. Prohibiting the display of Social Security account
numbers on newly issued Medicare identification cards and communications
provided to Medicare beneficiaries.
Sec. 204. Requiring prepayment review of all claims for durable
medical equipment at high risk of waste, fraud, and abuse.
Sec. 205. Strengthening Medicaid Program integrity through
flexibility.
TITLE III—Improving data sharing across agencies and
programs
Sec. 301. Improving data sharing across agencies and
programs.
Sec. 302. Expanding automated prepayment review of Medicare
claims.
Sec. 303. Improving the sharing of data between the Federal
Government and State Medicaid programs.
Sec. 304. Improving claims processing and detection of fraud
within the Medicaid and CHIP programs.
Sec. 305. Reports.
TITLE IV—Improving CMS contractor performance
Sec. 401. Establishing Medicare administrative contractor error
reduction incentives.
Sec. 402. Separating provider enrollment and screening from
Medicare administrative contractors.
Sec. 403. Developing measurable performance metrics for
Medicare contractors.
TITLE V—Other provisions
Sec. 501. Strengthening penalties for the illegal distribution
of a Medicare, Medicaid, or CHIP beneficiary identification or billing
privileges.
Sec. 502. Providing implementation funding.
<enum>I</enum><header>Preventing
prescription drug waste, fraud, and abuse</header>
<section id="idFC92A0D4B3C54E15B0A051396B77F6CC"><enum>101.</enum><header>Requiring
valid National Provider Identifiers of prescribers on pharmacy claims and
limiting access to the National Provider Identifier Registry</header>
<subsection id="id62BBEBEC7B0240DC827C1F62DF7A8B47"><enum>(a)</enum><header>Requiring valid
National Provider Identifiers of prescribers on pharmacy claims</header><text display-inline="yes-display-inline">Section 1860D–4(c) of the Social Security
Act (42 U.S.C. 1395w–104(c)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="idA9151E24317F4FFDA0083E6A31FCDC89" style="OLC">
<paragraph id="id8F042A1ED04C4FBEA32FD8E4782EE7D3"><enum>(4)</enum><header>Requiring valid
National Provider Identifiers of prescribers on pharmacy claims</header>
<subparagraph id="id6B664D64D83F44EC9A15D101BB1FB0A8"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">For plan year 2013
and subsequent plan years, subject to subparagraph (B), the Secretary shall
prohibit PDP sponsors of prescription drug plans from paying claims for
prescription drugs under this part that do not include the valid National
Provider Identifier for the drug's prescriber.</text>
</subparagraph><subparagraph id="idFDA23967E08641138B1C2471FCD1C38E"><enum>(B)</enum><header>Procedures</header><text display-inline="yes-display-inline">The Secretary shall establish—</text>
<clause id="id022294DB01E7400E9F9813EC31410DB8"><enum>(i)</enum><text display-inline="yes-display-inline">procedures for determining the validity of
National Provider Identifiers under subparagraph (A); and</text>
</clause><clause id="id9E6F06671EEF4E9FBE14896142D62CE0"><enum>(ii)</enum><text>procedures for
transferring to the Inspector General of the Department of Health and Human
Services and appropriate law enforcement agencies and other oversight entities
information on those National Provider Identifiers and pharmacy claims,
including records related to such claims, that the Secretary determines are
invalid under clause (i).</text>
</clause></subparagraph><subparagraph id="idDEC2B9FA731848969A78888B919326E7"><enum>(C)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than January 1, 2014, the
Inspector General of the Department of Health and Human Services shall submit
to Congress a report on the effectiveness of the procedures established under
subparagraph
(B).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="idB9C26C94A98D49E5BF8CCF7198C626E4"><enum>(b)</enum><header>Limiting access
to National Provider Identifier Registry</header>
<paragraph id="id023832CCBA104CEFBACC5B8AE69E135F"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
subsection referred to as the <term>Secretary</term>), in consultation with the
Attorney General, the Inspector General of the Department of Health and Human
Services, the Chairman of the Federal Trade Commission, and affected parties
(including prescription drug plans under part D of title XVIII of the Social
Security Act (42 U.S.C. 1395w–101 et seq.), MA–PD plans under part C of title
XVIII of the Social Security Act (42 U.S.C. 1395w–21 et seq.), pharmacies,
physicians, and pharmacy computer vendors), shall establish procedures and
rules to restrict access to the National Provider Identifier Registry in order
to deter its fraudulent use.</text>
</paragraph><paragraph id="idA343BB8B635F4C4C9B660B9B1870F885"><enum>(2)</enum><header>Access</header><text>The
procedures established under paragraph (1) shall provide governmental and
non-governmental entities, as appropriate, access to such Registry under data
use agreements and in accordance with rules established by the Secretary under
such paragraph.</text>
</paragraph></subsection></section><section commented="no" id="id783D13CFE291437CA3A7EDF81EDFBFA0"><enum>102.</enum><header>Encouraging
the establishment of State Prescription Drug Monitoring Programs</header>
<subsection commented="no" id="id92DD849F84744766A39BC33A3490899A"><enum>(a)</enum><header>Encouraging the
establishment of State Prescription Drug Monitoring
Programs</header><text>Title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="id0492913BF97A44BEB33750025C249D14" style="OLC">
<section commented="no" id="id9152114C34F14084BB8D6B0B9C3ED987"><enum>1947.</enum><header>Encouraging
the establishment of State Prescription Drug Monitoring Programs</header>
<subsection commented="no" id="id1707B0BEC56F44D69E4889D2E2F025E0"><enum>(a)</enum><header>In
general</header><text>To encourage the establishment and use of a State
Prescription Drug Monitoring Program, notwithstanding sections 1905(b) and
1927(g), and for purposes of paragraphs (2)(B) and (3)(A) of section 1903(d),
if a State has established a State Prescription Drug Monitoring Program that
has been certified as meeting the requirements under subsection (b), with
respect to any amounts recovered by or paid to a State subsequent to the date
of such certification that are related to an overpayment due to fraud, waste,
or abuse in connection the provision of covered services under the State plan,
the Federal medical assistance percentage with respect to such amounts shall be
decreased by 10 percentage points. A State may use such amounts recovered by or
paid to the State to support the State Prescription Drug Monitoring Program
established by the State.</text>
</subsection><subsection commented="no" id="idB47C82427F9C4F37BC582911EFCA66FD"><enum>(b)</enum><header>Requirements</header><text>For
purposes of subsection (a), the requirements of this subsection are that the
Attorney General certifies to the Secretary that the State has established a
State Prescription Drug Monitoring Program. In making a certification under the
preceding sentence, the Attorney General shall take into consideration
requirements with respect to Prescription Drug Monitoring Programs under the
Harold Rogers Prescription Drug Monitoring Program administered by the
Department of Justice or the National All Schedules Prescription Electronic
Reporting program administered by the Department of Health and Human
Services.</text>
</subsection><subsection commented="no" id="id2587F282E92A4FCCB504B6B948514BEB"><enum>(c)</enum><header>Commission To
examine interoperability and other related issues</header>
<paragraph commented="no" id="id3449D3B902A44FE3849D2FA99FEE43E9"><enum>(1)</enum><header>Establishment</header><text>The
Secretary and the Attorney General shall jointly establish a Commission to
examine interoperability and other issues related to State Prescription Drug
Monitoring Programs, including—</text>
<subparagraph commented="no" id="idAB6B3A01C69446B49D9FE0A72D32C8CD"><enum>(A)</enum><text>best practices
with respect to uniform electronic formats for the reporting, sharing, and
disclosure of information under such Programs; and</text>
</subparagraph><subparagraph commented="no" id="idBE2A0838109542CFB28741F1F820914B"><enum>(B)</enum><text>the ability to
interface with such Programs.</text>
</subparagraph></paragraph><paragraph commented="no" id="id2513D6DE150A48CCBC8C6F2ACD44F7ED"><enum>(2)</enum><header>Membership</header><text>The
Commission shall be composed of the following members:</text>
<subparagraph commented="no" id="id7CD9CE770FD54046935A38D26071B3B3"><enum>(A)</enum><text>The
Secretary.</text>
</subparagraph><subparagraph commented="no" id="id8B18294B5A604218B07793BC467C3CA7"><enum>(B)</enum><text>The Attorney
General.</text>
</subparagraph><subparagraph commented="no" id="id13ADD108C37D4EABB8BFE00C3C3F8F57"><enum>(C)</enum><text>The heads of
other appropriate agencies (as determined jointly by the Secretary and the
Attorney General).</text>
</subparagraph><subparagraph commented="no" id="id4718350EB274449F89A94248BB347176"><enum>(D)</enum><text>Stakeholders
appointed jointly by the Secretary and the Attorney General.</text>
</subparagraph></paragraph><paragraph commented="no" id="ID40CD19C2755743E0A877328695537261"><enum>(3)</enum><header>No compensation
of members</header>
<subparagraph id="ID1A40196105E04287A11950D7E5282201"><enum>(A)</enum><header>Non-federal
employees</header><text>A member of the Commission who is not an officer or
employee of the Federal Government shall serve without compensation.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDF170DB3F2EB24A4DA5FE6C27B54F1CFD"><enum>(B)</enum><header>Federal
employees</header><text>A member of the Commission who is an officer or
employee of the Federal Government shall serve without compensation in addition
to the compensation received for the services of the member as an officer or
employee of the Federal Government.</text>
</subparagraph></paragraph><paragraph commented="no" id="idA3587FFBF98E4FDBA93C1E6B3A5DADB3"><enum>(4)</enum><header>Duration</header><text>The
Commission shall terminate on the date that is 3 years after the date of
enactment of the <short-title>Medicare and Medicaid
Fighting Fraud and Abuse to Save Taxpayers’ Dollars
Act</short-title></text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="id9BD53A05817D447A91CEDF20E4C8F551"><enum>(b)</enum><header>Inclusion of
Prescription Drug Monitoring Programs in Medicare part D
oversight</header><text>Not later than 180 days after the date of enactment of
this Act, the Secretary of Health and Human Services shall submit to Congress a
plan on how Medicare part D oversight contractors and other oversight
activities under part D of title XVIII of the Social Security Act (42 U.S.C.
1395w–101 et seq.) can utilize State Prescription Drug Monitoring
Programs.</text>
</subsection></section><section id="idF076197BA86C423AB8EB4F520C7C576A"><enum>103.</enum><header>Updating of
DEA database of controlled substances providers</header>
<subsection id="id90A0F2C14A37495BBEC68B3385B53234"><enum>(a)</enum><header>In
general</header>
<paragraph id="idA2D7FB7D93D84634BC23B1CD3C3CA163"><enum>(1)</enum><header>Updating based
on Death Master File</header><text display-inline="yes-display-inline">Not less
frequently than on a daily basis, the Attorney General shall update the
database of the Drug Enforcement Agency of persons registered to manufacture,
distribute, or dispense a controlled substance under part C of title II of the
Controlled Substances Act (21 U.S.C. 821 et seq.) to reflect any changes in the
information in the Death Master File of the Social Security
Administration.</text>
</paragraph><paragraph id="IDe7894f00a9c64eeeabc0600f072ae328"><enum>(2)</enum><header>Updating based
on other information reported to the Social Security
Administration</header><text>The Attorney General shall enter into an agreement
with the Commissioner of Social Security to obtain information regarding deaths
reported to the Commissioner, including death information reported to the
Commissioner under section 205(r) of the Social Security Act (42 U.5.C.
405(r)), in order to update the database of the Drug Enforcement Agency of
persons registered to manufacture, distribute, or dispense a controlled
substance under part C of title II of the Controlled Substances Act (21 U.S.C.
821 et seq.) to reflect any deaths reported to the Commissioner of Social
Security. The Attorney General shall take any actions required by the agreement
with the Commissioner to maintain the confidentiality of such data and to
assure that the data is used solely for the purposes of this paragraph.</text>
</paragraph></subsection><subsection id="id52C98816804B44498BECC5E0DCE6BC77"><enum>(b)</enum><header>Limiting access
to DEA database of registrants</header>
<paragraph id="ID77aef7ac92a4488194076c17e51a58e1"><enum>(1)</enum><header>In
general</header><text>The Attorney General, in consultation with the Secretary
of Health and Human Services, the Inspector General of the Department of Health
and Human Services, the Chairman of the Federal Trade Commission, and affected
parties (including prescription drug plans under part D of title XVIII of the
Social Security Act (42 U.S.C. 1395w–101 et seq.), MA–PD plans under part C of
title XVIII of the Social Security Act (42 U.S.C. 1395w–21 et seq.),
pharmacies, physicians, and pharmacy computer vendors), shall establish
procedures and rules to restrict access to the database of the Drug Enforcement
Agency of persons registered to manufacturer, distribute, or dispense a
controlled substance under part C of title II of the Controlled Substances Act
(21 U.S.C. 821 et seq.) in order to deter its fraudulent use.</text>
</paragraph><paragraph id="ID6e520289d8c34d599d6db0afc268f31d"><enum>(2)</enum><header>Access</header><text>The
procedures established under paragraph (1) shall provide governmental and
non-governmental entities, as appropriate, access to such database under data
use agreements and in accordance with rules established by the Attorney General
under such paragraph.</text>
</paragraph></subsection><subsection id="ID539dad24f6d64a53a7b9b84d1294661a"><enum>(c)</enum><header>Review and
investigation of invalid DEA registration numbers</header><text>The Attorney
General, in consultation with the Secretary of Health and Human Services, the
Inspector General of the Department of Health and Human Services, the Chairman
of the Federal Trade Commission, and affected parties (including prescription
drug plans under part D of title XVIII of the Social Security Act (42 U.S.C.
1395w–101 et seq.), MA–PD plans under part C of title XVIII of the Social
Security Act (42 U.S.C. 1395w–21 et seq.), pharmacies, physicians, and pharmacy
computer vendors), shall establish procedures and rules to review and
investigate pharmacy claims under such part D that contain a registration
number that was not assigned by the Attorney General under the Controlled
Substances Act (21 U.S.C. 801 et seq.) to a practitioner (as defined in section
102 of such Act (21 U.S.C. 802)). Such procedures shall include the matching of
National Provider Identifiers submitted under section 1860D–4(c)(4) of the
Social Security Act, as added by section 101(a), to such registration numbers
and the investigation of such registration numbers that are matched to a
National Provider Identifier determined to be invalid under such
section.</text>
</subsection><subsection id="id85DE491827B54C7D852BCBD7BFB7AD9A"><enum>(d)</enum><header>Sense of
Congress</header><text>It is the sense of Congress that the Attorney General
should include in the updates required under subsection (a) any other
information determined relevant by the Attorney General, such as information
from State Medical Boards.</text>
</subsection></section><enum>II</enum><header>Curbing improper
payments</header>
<section id="id66CBD3F60DF0472CB60EF6AC191B029A"><enum>201.</enum><header>Addressing
vulnerabilities identified by Recovery Audit Contractors</header><text display-inline="no-display-inline">Section 1893(h) of the Social Security Act
(42 U.S.C. 1395ddd(h)) is amended—</text>
<paragraph id="id99591768EC4149F493152FC592B5BC95"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (1)(C), by inserting
<quote>and for provider education and overpayment appeals</quote> before the
period;</text>
</paragraph><paragraph id="idA45F87261B0D407F919288B962A703E6"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (8)—</text>
<subparagraph id="id6A72CE958807421498AB3453AED0E0E7"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote><header-in-text level="paragraph" style="OLC">report</header-in-text>.—The Secretary</quote>
and inserting “<header-in-text level="paragraph" style="OLC">report</header-in-text>.—</text>
<quoted-block display-inline="no-display-inline" id="idAE9F1B95F4834B5A9B0B92B38A79F927" style="OLC">
<subparagraph id="idA3F3578D415249A2A23F5AF7A949FFCF"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to
subparagraph (C), the Secretary</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="idBF01455BEBB7485D9D4632FB46D503DE"><enum>(B)</enum><text>by adding after
subparagraph (A), as inserted by subparagraph (A), the following new
subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="id50E0794369CB4AAB8024162DF09C72AE" style="OLC">
<subparagraph id="ID3b032bbf25ee4338b82dc017a17eed02"><enum>(B)</enum><header>Inclusion of
improper payment vulnerabilities identified</header><text>Each report submitted
under subparagraph (A) shall, subject to subparagraph (C), include—</text>
<clause id="id4D94941D25A34C75B29DEC6095804BB2"><enum>(i)</enum><text>a
description of—</text>
<subclause id="id497436A998A549D18F21C3D09AFAA6A6"><enum>(I)</enum><text>the types and
financial cost to the program under this title of improper payment
vulnerabilities identified by recovery audit contractors under this subsection;
and</text>
</subclause><subclause id="id96BC243619084FF1B363CF25F6E87C1C"><enum>(II)</enum><text>how the
Secretary is addressing such improper payment vulnerabilities; and</text>
</subclause></clause><clause id="id65CF3D11415249B9B3BEE36320C63106"><enum>(ii)</enum><text>an assessment of
the effectiveness of changes made to payment policies and procedures under this
title in order to address the vulnerabilities so identified.</text>
</clause></subparagraph><subparagraph id="id63AB8851BAE2485A86762AF13F0F9FB4"><enum>(C)</enum><header>Limitation</header><text>The
Secretary shall ensure that each report submitted under subparagraph (A) does
not include information that the Secretary determines would be sensitive or
would otherwise negatively impact program
integrity.</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id39137A7A5A3B47518A8A24BF6E7C2B7A"><enum>(3)</enum><text display-inline="yes-display-inline">by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id25E554A0AE5A4374896505DF4241C852" style="OLC">
<paragraph id="id09F3C7A27F92479B85E18D4D6CB74E8B"><enum>(10)</enum><header>Addressing
improper payment vulnerabilities</header><text display-inline="yes-display-inline">The Secretary shall address improper
payment vulnerabilities identified by recovery audit contractors under this
subsection in a timely
manner.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="idF3F4CB8B4312434BBFF4EBB64CFC99E1"><enum>202.</enum><header>Improving
Senior Medicare Patrol and fraud reporting rewards</header>
<subsection id="id0E1A72F249E64A9390BB53A3FB2EB38A"><enum>(a)</enum><header>In
general</header><text>The Secretary shall develop a plan, including suggested
legislative changes to implement such plan, under which the Secretary shall
revise the beneficiary incentive program under section 203(b) of the Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1395b–5(b)) to
encourage greater participation by individuals to report fraud and abuse in the
Medicare program. Such plan shall include recommendations for ways to enhance
rewards for individuals reporting under the incentive program, including
providing a monetary reward prior to the full recovery of an
overpayment.</text>
</subsection><subsection id="id27D77A62FBC64FF2800684C576002CF0"><enum>(b)</enum><header>Public
awareness and education campaign</header><text>The plan developed under
subsection (a) shall also require the Secretary to use the Senior Medicare
Patrols authorized under section 411 of the Older Americans Act of 1965 (42
U.S.C. 3032) to conduct a public awareness and education campaign to encourage
participation in the revised beneficiary incentive program under subsection
(a).</text>
</subsection><subsection id="ID49487b525b474085a5e8794c25eff601"><enum>(c)</enum><header>Submission of
plan</header><text>Not later than 180 days after the date of enactment of this
Act, the Secretary shall submit to Congress the plan developed under subsection
(a).</text>
</subsection><subsection id="id20EFBE9F051A4D7490FDCE0764E84008"><enum>(d)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="idD0519643F2C34B608683082C3C172628"><enum>(1)</enum><header>Medicare
beneficiary</header><text>The term <term>Medicare beneficiary</term> means an
individual entitled to, or enrolled for, benefits under part A of title XVIII
of the Social Security Act (42 U.S.C. 1395c et seq.) or enrolled for benefits
under part B of such title (42 U.S.C. 1395j et seq.).</text>
</paragraph><paragraph id="id4E923570F2EA4B4292604950E54896D4"><enum>(2)</enum><header>Medicare
program</header><text>The term <term>Medicare program</term> means the program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).</text>
</paragraph><paragraph id="id8A5948F247D1450C98669CFA40539CDD"><enum>(3)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph></subsection></section><section id="ID35325DB541444DC29008047FAEBB0D96"><enum>203.</enum><header>Prohibiting
the display of Social Security account numbers on newly issued Medicare
identification cards and communications provided to Medicare
beneficiaries</header>
<subsection id="IDa385fc72d009413f8355c2695e9b0010"><enum>(a)</enum><header>In
general</header><text>Not later than 2 years after the date of enactment of
this Act, the Secretary of Health and Human Services, in consultation with the
Commissioner of Social Security, shall establish and begin to implement
procedures to eliminate the unnecessary collection, use, and display of Social
Security account numbers of Medicare beneficiaries.</text>
</subsection><subsection id="ID5a799ac718fa48828956606ac0d71ea8"><enum>(b)</enum><header>Newly issued
medicare cards and communications provided to beneficiaries</header>
<paragraph id="idFEF925ABFB9A49138A85A3A030490556"><enum>(1)</enum><header>Newly issued
cards</header>
<subparagraph id="id3587B9731ECC422E98F8049390AE7336"><enum>(A)</enum><header>In
general</header><text>Not later than 4 years after the date of enactment of
this Act, the Secretary of Health and Human Services, in consultation with the
Commissioner of Social Security, shall ensure that each newly issued Medicare
identification card meets the requirements described in subparagraph
(B).</text>
</subparagraph><subparagraph id="id809B7F21CCEC4D3E91CFE26070768ACA"><enum>(B)</enum><header>Requirements</header>
<clause id="id848D05E116394DF19575F8167373E9A0"><enum>(i)</enum><header>In
general</header><text>Subject to clauses (ii) and (iii), the requirements
described in this subparagraph are, with respect to a Medicare identification
card, that the card does not display or electronically store (in an unencrypted
format) a Medicare beneficiary’s Social Security account number.</text>
</clause><clause id="id5032C759A8494AC5A224CD48F4832222"><enum>(ii)</enum><header>Exception</header><text>The
Secretary may waive the requirements under clause (i) in the case where the
health insurance claim number of a beneficiary is the Social Security number of
the beneficiary, the beneficiary's spouse, or another individual.</text>
</clause><clause id="ID8bb27596ee8d455982b9807e004e4f9d"><enum>(iii)</enum><header>Use of
partial account number</header><text>The Secretary of Health and Human
Services, in consultation with the Commissioner of Social Security, may provide
for the use of a partial Social Security account number on a Medicare
identification card if the Secretary determines that such use does not allow an
unacceptable risk of fraudulent use.</text>
</clause></subparagraph></paragraph><paragraph id="id1B445E99659B48B594A912DB839B525F"><enum>(2)</enum><header>Communications
provided to beneficiaries</header><text>Not later than 4 years after the date
of enactment of this Act, the Secretary of Health and Human Services shall
prohibit the display of a Medicare beneficiary’s Social Security account number
on written or electronic communication provided to the beneficiary unless the
Secretary, in consultation with the Commissioner of Social Security, determines
that inclusion of Social Security account numbers on such communications is
essential for the operation of the Medicare program.</text>
</paragraph></subsection><subsection id="idD36C7784DE97480DA555426A40AB632B"><enum>(c)</enum><header>Medicare
beneficiary defined</header><text>In this section, the term <term>Medicare
beneficiary</term> means an individual who is 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.</text>
</subsection><subsection id="H681EEE47D16846BE8225AF41DBF3203"><enum>(d)</enum><header>Conforming
amendments</header>
<paragraph id="idE2B4143D73714E7496B15F626BC55126"><enum>(1)</enum><header>Reference in
the Social Security Act</header><text>Section 205(c)(2)(C) of the Social
Security Act (42 U.S.C. 405(c)(2)(C)) is amended—</text>
<subparagraph id="id8C6FFC588C0F4796979D89B4AF9F2C08"><enum>(A)</enum><text>by moving clause
(x), as added by section 1414(a)(2) of the Patient Protection and Affordable
Care Act (Public Law 111–148), 6 ems to the left;</text>
</subparagraph><subparagraph id="id057F1A6ADF894E829EB1400979EDB18B"><enum>(B)</enum><text>by redesignating
clause (x), as added by section 2(a)(1) of the Social Security Number
Protection Act of 2010 (42 U.S.C. 1305 note), as clause (xii); and</text>
</subparagraph><subparagraph id="id9896E285B5504104860C08CE1DD4E933"><enum>(C)</enum><text>by adding after
clause (xii), as redesignated by subparagraph (B), the following new
clause:</text>
<quoted-block id="HD673FF97D42A4A49B77724B498240085" style="OLC">
<subsection id="H7A131A0B07A2430000B1BA231022D8F2"><enum>(xiii)</enum><text display-inline="yes-display-inline">Subject to section 203 of the
<short-title>Medicare and Medicaid Fighting Fraud and
Abuse to Save Taxpayers’ Dollars Act</short-title>, social security account
numbers shall not be displayed on Medicare identification cards or on
communications provided to Medicare
beneficiaries.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="idAEF1C48D822541E5948E1DE2B380E7B1"><enum>(2)</enum><header>Access to
information</header><text>Section 205(r) of the Social Security Act (405 U.S.C.
405(r)) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id2065483BC80C4277A8869A0EA6DD894E" style="OLC">
<paragraph id="ID7e95d3510c5941e6be9cf8496bc09bad" indent="up1"><enum>(10)</enum><text>To prevent and identify fraudulent
activity, the Commissioner shall upon the request of the Attorney General or
upon the request of the Secretary of Health and Human Services enter into a
reimbursable agreement with the Attorney General or the Secretary to provide
information collected under paragraph (1) if—</text>
<subparagraph id="id97FDACCDFE074C999D6E8782C6FF0EC1"><enum>(A)</enum><text>the requirements of subparagraphs (A)
and (B) of paragraph (3) are met; and</text>
</subparagraph><subparagraph id="id76209C8326144498B19D09E8060B322D"><enum>(B)</enum><text>such agreement includes appropriate
provisions to protect the confidentiality of information provided by the
Commissioner under such
agreement.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="ID4ad158bc787a4d32997c714151796b32"><enum>(e)</enum><header>Pilot
program</header>
<paragraph id="id9D8D729D90A04747A2CB8CBDE956250D"><enum>(1)</enum><header>Establishment</header><text>The
Secretary shall establish a pilot program utilizing smart card technology to
evaluate—</text>
<subparagraph id="ID28e966e9eb464ef7b78199e896efdf86"><enum>(A)</enum><text>the applicability
of smart card technology to the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.), including the applicability of
such technology to Medicare beneficiaries or Medicare providers; and</text>
</subparagraph><subparagraph id="ID3f2857fecf7f4b62b2ffb5dd0d0f2d91"><enum>(B)</enum><text>whether such
cards would be effective in preventing fraud under the Medicare program.</text>
</subparagraph></paragraph><paragraph id="ID3b5e33bb81924b3a86fc5d2d1e8d4d30"><enum>(2)</enum><header>Implementation</header>
<subparagraph id="IDb07560c3053942bdab55de9c0efec761"><enum>(A)</enum><header>Initial
implementation</header><text>The Secretary shall implement the pilot program
under this subsection not later than 1 year after the date of enactment of this
Act.</text>
</subparagraph><subparagraph id="IDc487eed633034e7faec09a22cdf2112b"><enum>(B)</enum><header>Scope and
duration</header><text>The Secretary shall conduct the pilot program—</text>
<clause id="id390F6511652A4446ADC63B022B62A275"><enum>(i)</enum><text>in
not less than 2 States; and</text>
</clause><clause id="idC91C567BC3B2493992C0057EDFF780E6"><enum>(ii)</enum><text>for a period of
not less than 180 days or more than 2 years.</text>
</clause></subparagraph></paragraph><paragraph id="ID3d2bfee6c98245bd9ab53a748aeaebc7"><enum>(3)</enum><header>Report</header><text>Not
later than 12 months after the completion of the pilot program under this
subsection, the Secretary shall submit to the appropriate committees of
Congress and make available to the public a report that includes the
following:</text>
<subparagraph id="ID9e2df53a71b4415a9a7da83ea3ce4b6d"><enum>(A)</enum><text>A summary of the
pilot program and findings, including—</text>
<clause id="IDa0bd80407e38436099fbfe966f4ff483"><enum>(i)</enum><text>the
costs or savings to the Medicare program as a result of the implementation of
the pilot program;</text>
</clause><clause id="ID65bb1dd1ab97420aac8beaf37eef2a0f"><enum>(ii)</enum><text>whether the use
of smart card technology resulted in improvements in the quality of care
provided to Medicare beneficiaries under the pilot program; and</text>
</clause><clause id="IDbfe318b1447444df9c84d53bd29a52bc"><enum>(iii)</enum><text>whether such
technology was useful in preventing or detecting fraud, waste, and abuse in the
Medicare program.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID9c1a67d491c943f39237ce33818ebbe0"><enum>(B)</enum><text>Recommendations
regarding whether the use of smart card technology should be expanded under the
Medicare program.</text>
</subparagraph></paragraph><paragraph id="ID223a2a1fbc2c4b15badaf23c9924493c"><enum>(4)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph id="id316F75DD81C3466695CB30CD64D10773"><enum>(A)</enum><header>Medicare
beneficiary</header><text>The term <term>Medicare beneficiary</term> means an
individual entitled to, or enrolled for, benefits under part A of title XVIII
of the Social Security Act (42 U.S.C. 1395c et seq.) or enrolled for benefits
under part B of such title (42 U.S.C. 1395j et seq.).</text>
</subparagraph><subparagraph id="id6A7206A9D16941579C03528D726C7F63"><enum>(B)</enum><header>Medicare
provider</header><text>The term <term>Medicare provider</term> includes a
provider of services (as defined in section 1861(u) of the Social Security Act
(42 U.S.C. 1395x(u))) and a supplier (as defined in section 1861(d) of such Act
(42 U.S.C. 1395x(d))).</text>
</subparagraph><subparagraph id="id107646EB5A744857A95D4DF9DEEDF558"><enum>(C)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</subparagraph><subparagraph id="idA2232E6D03B74CB8ACD93FA02ED236A1"><enum>(D)</enum><header>Smart
card</header><text>The term <term>smart card</term> means identification used
by a Medicare beneficiary or a Medicare provider that includes anti-fraud
attributes. Such a card—</text>
<clause id="ID9e6c07d5b24a457bb0639e89a944d308"><enum>(i)</enum><text>may
rely on existing commercial data transfer networks or on a network of
proprietary card readers or databases; and</text>
</clause><clause id="ID1584f2371ea0493aa1c7f02adc0f4313"><enum>(ii)</enum><text>may
include—</text>
<subclause id="IDbaac3ceba4b845c5967b6db057858a4b"><enum>(I)</enum><text>cards using
technology adapted from the financial services industry;</text>
</subclause><subclause id="IDb3ae76e7000b4ace8eaad715419e32c9"><enum>(II)</enum><text>cards containing
individual biometric identification, provided that such identification is
encrypted and not contained in any central database;</text>
</subclause><subclause id="ID7fffc755d93948f6bd23715630c148c3"><enum>(III)</enum><text>cards adapting
technology and processes utilized in the TRICARE program under chapter 55 of
title 10, United States Code, or by the Veterans Administration; or</text>
</subclause><subclause id="idA0EB64DEEA754298BCEF0A71E0AD59A7"><enum>(IV)</enum><text>such other
technology as the Secretary determines appropriate.</text>
</subclause></clause></subparagraph></paragraph></subsection></section><section id="id9264F6864A3B4CAC846B11EF0984581E"><enum>204.</enum><header>Requiring
prepayment review of all claims for durable medical equipment at high risk of
waste, fraud, and abuse</header><text display-inline="no-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="id56992DB910AF4FAD8DA10FA6A5375701" style="OLC">
<paragraph id="id3E199B5C001E40C1A5A4DBCBC0DBF7F6"><enum>(22)</enum><header>Prepayment
review for durable medical equipment at high risk of fraud</header><text>Not
later than 270 days after the date of enactment of the
<short-title>Medicare and Medicaid Fighting Fraud and
Abuse to Save Taxpayers’ Dollars Act</short-title>, the Secretary, in
consultation with the Inspector General of the Department of Health and Human
Services, shall establish policies and procedures for prepayment review, which
may include pre-certification, for all claims for reimbursement under this
title for durable medical equipment at high risk of waste, fraud, and abuse, as
determined by the Secretary, including power
wheelchairs.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="id8ED63D28BD374B6F9654154B597D179C"><enum>205.</enum><header>Strengthening
Medicaid Program integrity through flexibility</header><text display-inline="no-display-inline">Section 1936 of the Social Security Act (42
U.S.C. 1396u–6) is amended—</text>
<paragraph id="id95ED6F4FDB954BDC876A13CCA4178971"><enum>(1)</enum><text>in subsection
(a), by inserting <quote>, or otherwise,</quote> after <quote>entities</quote>;
and</text>
</paragraph><paragraph id="idE02B766D47024D7ABF8053EB41924B6F"><enum>(2)</enum><text>in subsection
(e)—</text>
<subparagraph id="id92329B276517460293B1194D11CC6DAB"><enum>(A)</enum><text>in paragraph (1),
in the matter preceding subparagraph (A), by inserting <quote>(including the
costs of equipment, salaries and benefits, and travel and training)</quote>
after <quote>Program under this section</quote>; and</text>
</subparagraph><subparagraph id="id3877FFAA519945AA8CEF2AB479FE4B98"><enum>(B)</enum><text>in paragraph (3),
by striking <quote>by 100</quote> and inserting <quote>by 100, or such number
as determined necessary by the Secretary to carry out the
Program,</quote>.</text>
</subparagraph></paragraph></section><enum>III</enum><header>Improving data
sharing across agencies and programs</header>
<section id="ID089eb366bd69488ab362e1a538e16682"><enum>301.</enum><header>Improving data
sharing across agencies and programs</header>
<subsection id="id4AD81523043A471C8FA92FF71E796424"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">In order to ensure
that the Secretary, Medicare program safeguard contractors and other oversight
contractors (as defined in subsection (g)(4)), the Inspector General of the
Department of Health and Human Services, the Attorney General, and State and
local law enforcement are able to operate with greater coordination to curb
fraud and improper payments, the Secretary, the Inspector General of the
Department of Health and Human Services, and the Attorney General shall provide
for increased coordination and data sharing as described in the succeeding
subsections.</text>
</subsection><subsection id="ID3381eb91d4604ac5bea9211839ef5151"><enum>(b)</enum><header>Improving data
sharing internally and with CMS contractors</header>
<paragraph id="id27B982A9024C49B7B9CEC82A78034DC3"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish policies and procedures to
ensure that claims and other data, including the data described in paragraph
(3), is accessible to Medicare program safeguard contractors and other
oversight contractors not less frequently than on a daily basis.</text>
</paragraph><paragraph id="IDf39264e94d60493ea79fc947f71eaa77"><enum>(2)</enum><header>Analysis of
data</header><text>The Secretary shall require Medicare program safeguard
contractors and other oversight contractors to analyze the data accessed under
paragraph (1) on an ongoing basis for purposes of conducting pre- and
post-payment reviews under the Medicare program.</text>
</paragraph><paragraph id="id8CBF6AC92E4E41C2868D52A3A2CED9E9"><enum>(3)</enum><header>Data
described</header><text>The following data is described in this
paragraph:</text>
<subparagraph id="id811B6F67AC5B4672B06D59202E1A3B7D"><enum>(A)</enum><text>Claims payment,
claims denial, and other claims data under the Medicare program from the common
working file and the Medicare national claims history database.</text>
</subparagraph><subparagraph id="id3857721C00864D37BB97D76E69C77AAD"><enum>(B)</enum><text>Data on providers
of services and suppliers under the Medicare program, including data from the
Medicare Provider Enrollment, Chain, and Ownership System (PECOS) of the
Centers for Medicare & Medicaid Services.</text>
</subparagraph><subparagraph id="id5A8FD10251B84155ABA097094BECDAC1"><enum>(C)</enum><text>Medicare
beneficiary data, including data from the Enrollment DataBase of the Centers
for Medicare & Medicaid Services.</text>
</subparagraph></paragraph></subsection><subsection id="IDf4dd84a74b6b43dfbb88e092cd466d1f"><enum>(c)</enum><header>Provider
database reviews and verification</header>
<paragraph id="id4651C45B926A496C90D484489D6126F4"><enum>(1)</enum><header>In
general</header>
<subparagraph id="id91C6AC3624894D02B125BF51C047B320"><enum>(A)</enum><header>Review and
update of Medicare provider databases</header><text>The Secretary shall
establish policies and procedures, which may include contractors, to review and
update on a daily basis Medicare provider databases, including the review and
update of the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
of the Centers for Medicare & Medicaid Services against death data of the
Social Security Administration, for accuracy and completeness. Such policies
and procedures shall also include data matches on a daily basis, as determined
appropriate by the Secretary, against other databases as determined appropriate
by the Secretary, including the database of the Drug Enforcement Agency of
persons registered to manufacture, distribute, or dispense a controlled
substance under part C of title II of the Controlled Substances Act (21 U.S.C.
821 et seq.), State medical licensing data, databases of suspended or debarred
Federal contractors, including the Excluded Parties List System of the General
Services Administration, the Debt Check program of the Department of the
Treasury, a list of incarcerated individuals from the Department of Justice and
each State’s Department of Corrections, and the List of Excluded
Individuals/Entities of the Office of Inspector General of the Department of
Health and Human Services.</text>
</subparagraph><subparagraph id="id170EC09C469549839411DAFE2A91CE40"><enum>(B)</enum><header>Consultation</header><text>The
policies and procedures under subparagraph (A) shall require the Secretary to
periodically consult with external organizations, including the Federation of
State Medical Boards, to determine data sources and screening tools best suited
to detect fraudulent applications for enrollment under section 1866(j) of the
Social Security Act (42 U.S.C. 1395cc(j)) submitted by providers of medical or
other items or services and suppliers under the Medicare program.</text>
</subparagraph><subparagraph id="idEC7E6B871CF04522A48BE417E9FDD70B"><enum>(C)</enum><header>Data
matching</header>
<clause id="idB02498C472F54A038A1A86F3692925D3"><enum>(i)</enum><header>In
general</header><text>The policies and procedures under subparagraph (A) may
include entering into agreements with the Commissioner of Social Security
pursuant to section 205(r) of the Social Security Act (42 U.S.C. 405(r)) to
match data against the death information maintained by the Commissioner, and
matching against the database of the Drug Enforcement Agency of persons
registered to manufacture, distribute, or dispense a controlled substance under
part C of title II of the Controlled Substances Act (21 U.S.C. 821 et seq.),
and other Federal databases, as determined appropriate by the Secretary.</text>
</clause><clause id="idC188B54B23CF4006ADC99BE42FE80590"><enum>(ii)</enum><header>Confidentiality
of data obtained</header><text>The Secretary shall take any actions required by
an agreement described in clause (i) or any other agreement with the
Commissioner of Social Security to obtain data from the Commissioner for
purposes of this section to maintain the confidentiality of data obtained from
the Commissioner and to assure that the data is used solely for the purposes of
this section.</text>
</clause></subparagraph><subparagraph id="IDcc99ebeda0604e41a1cc84e044551205"><enum>(D)</enum><header>Ongoing
analysis</header><text>The Secretary shall use analytic software for the
conduct of ongoing analysis of Medicare provider databases described in
subparagraph (A) to verify and update data supplied by providers of services
and suppliers under the Medicare program. The Secretary may use commercial
database sources for purposes of verifying such data.</text>
</subparagraph></paragraph><paragraph id="ID47c739fb6bfd45fb93e72b771f3a123a"><enum>(2)</enum><header>Access to
national directory of new hires</header><text>Section 453(j) of the Social
Security Act (42 U.S.C. 653(j)) is amended by adding at the end the following
new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id3289F05807884F49AD383D82E3B8B1A3" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="IDB713347A696444D1B44CB37A77C9AEE8"><enum>(12)</enum><header display-inline="yes-display-inline">Provision of new hire information to the
centers for medicare & medicaid services and applicable State health
subsidy programs</header><text display-inline="yes-display-inline">The National
Directory of New Hires shall provide the Administrator of the Centers for
Medicare & Medicaid Services and, for purposes of carrying out section
1413(c)(3)(A)(ii) of Public Law 111–148, each applicable State health subsidy
program (as defined in section 1413(e) of such Public Law) with all information
in the National Directory.</text>
</paragraph><after-quoted-block></after-quoted-block></quoted-block>
</paragraph><paragraph id="idF3048B1DCC5E441885058997DAE530E8"><enum>(3)</enum><header>Access to list
of convicted individuals</header><text>The Attorney General shall provide the
Secretary of Health and Human Services access to a list of convicted
individuals for use in preventing waste, fraud, and abuse under the Medicare
and Medicaid programs.</text>
</paragraph></subsection><subsection id="ID25c976d177224b3f9ec6e9f2dcf9c9cf"><enum>(d)</enum><header>Beneficiary
database review and verification</header>
<paragraph id="ID1d5d736057704dae8a995e5029c56e5f"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish policies and procedures,
which may include contractors, to review and update on a daily basis Medicare
beneficiary databases, including the Enrollment DataBase of the Centers for
Medicare & Medicaid Services, for accuracy and completeness. Such policies
and procedures shall include data matches against death data of the Social
Security Administration and also on a daily basis, as determined appropriate by
the Secretary, other Federal databases as determined appropriate by the
Secretary, including a list of incarcerated individuals from the Department of
Justice and each State’s Department of Corrections.</text>
</paragraph><paragraph id="IDd60883765c5549188a4318b3a13d43fe"><enum>(2)</enum><header>Ongoing
analysis</header><text>The Secretary shall use analytic software for the
conduct of ongoing analysis of Medicare beneficiary databases described in
paragraph (1) to verify and update data supplied by providers of services and
suppliers under the Medicare program. The Secretary may use commercial database
sources for purposes of verifying such data.</text>
</paragraph></subsection><subsection id="IDf9398324351c4c3b95cb44b0f5433781"><enum>(e)</enum><header>Continued
efforts on integrated data repository and one PI project; expanded access by
agencies</header>
<paragraph id="idCE97C0CB19B54E39A5305F550F03FE92"><enum>(1)</enum><header>Continued
efforts on integrated data repository and one PI project</header>
<subparagraph id="idEA0160A6AB0746A498D6C10AC41F51F8"><enum>(A)</enum><header>In
general</header><text>The Secretary shall—</text>
<clause id="idAD1C88EED4E646F2BBE272AA12285ED5"><enum>(i)</enum><text>continue to
incorporate Medicare claims and payment, provider, and beneficiary data into
the Integrated Data Repository under section 1128J(a)(1) of the Social Security
Act, as added by section 6402(a) of the Patient Protection and Affordable Care
Act; and</text>
</clause><clause id="idE9794B7A01994A21B684CEB87040A150"><enum>(ii)</enum><text>fully implement
the waste, fraud, and abuse detection solution of the Centers for Medicare
& Medicaid Services, called the <quote>One PI project</quote>.</text>
</clause></subparagraph><subparagraph id="ID33db84da40a5493a947c1302e1926538"><enum>(B)</enum><header>Updating of IDR
on daily basis</header><text>The Secretary shall establish policies and
procedures to ensure that the Integrated Data Repository is updated with
Medicare claims payment data and data from the Medicare provider databases
described in subsection (c)(1) and Medicare beneficiary databases described in
subsection (d)(1), including the common working file, on a daily basis.</text>
</subparagraph><subparagraph id="id1690212009434145BE29DDF3026179B7"><enum>(C)</enum><header>Access to
IDR</header><text>The Secretary shall ensure that Medicare program safeguard
contractors and other oversight contractors have access to the full range of
data contained in the Integrated Data Repository and related analytic tools by
not later than September 30, 2012. Such access shall include both real-time
portal access and other means in accordance with protocols established by the
Secretary.</text>
</subparagraph><subparagraph id="ID074ac7e79b2a4f9e9b4c09a96367f3f6"><enum>(D)</enum><header>Law enforcement
access</header><text>The Secretary shall ensure that Federal and other
appropriate law enforcement agencies, including the Inspector General of the
Department of Health and Human Services and the Attorney General, have access
to the full range of data contained in the Integrated Data Repository and
related analytic tools by not later than September 30, 2012. Such access shall
include both real-time portal access and other means in accordance with
protocols established by the Secretary.</text>
</subparagraph><subparagraph id="IDaff0039deb1d4ef196dad89eeeab048f"><enum>(E)</enum><header>Date certain
for inclusion of prepayment claims data</header><text>The Secretary shall
ensure that the Integrated Data Repository includes access to prepayment claims
data by not later than September 30, 2012.</text>
</subparagraph><subparagraph id="ID7aec98cb781d42d69ac211b8a1c347c4"><enum>(F)</enum><header>Date certain
for inclusion of medicaid program data</header><text>The Secretary shall ensure
that the Integrated Data Repository includes access to or incorporates Medicaid
program data by not later than September 30, 2014 (or, if States are unable to
provide certain data to the Secretary by such date, a substantial amount of the
Medicaid program data that is available as of such date).</text>
</subparagraph></paragraph><paragraph id="ID3fed40e79de34bb6bb9e2da6a6c2ee87"><enum>(2)</enum><header>Expanded
database access to appropriate state entities</header>
<subparagraph id="id3B69AC0DD6484FE4B8AD0A2CA72506D3"><enum>(A)</enum><header>Access to
Integrated data repository</header><text>For purposes of enhancing data sharing
in order to identify programmatic weaknesses and improving the timeliness of
analysis and actions to prevent waste, fraud, and abuse, relevant State
agencies, including the State Medicaid plans under title XIX of the Social
Security Act, State child health plans under title XXI of such Act, and State
Medicaid fraud control units (as described in section 1903(q) of the Social
Security Act (42 U.S.C. 1396b(q))), shall have access to the full range of data
contained in the Integrated Data Repository, including the One PI system
established under the One PI project, as directed by the Secretary, by not
later than September 30, 2013. The Secretary may, in consultation with the
Inspector General of the Department of Health and Human Services, give such
access to State attorneys general and State law enforcement agencies.</text>
</subparagraph><subparagraph id="ID5be4d2343c0543e4b87463505dcf70c6"><enum>(B)</enum><header>Conforming
amendments</header><text>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—</text>
<clause id="ID38615c063f2d4a5bad74ccb61ae75285"><enum>(i)</enum><text>by
striking <quote><header-in-text level="paragraph" style="OLC">DATABASES</header-in-text>.—</quote> and inserting
<quote><header-in-text level="paragraph" style="OLC">DATABASES</header-in-text>.—</quote></text>
<quoted-block display-inline="no-display-inline" id="id85C6A26EE4EA4BB889454DE4BA34DB52" style="OLC">
<subparagraph id="ID12eef17a94384546a484a904f8393087"><enum>(A)</enum><header>Access for the
conduct of law enforcement and oversight activities</header><text>For
purposes</text>
</subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
</clause><clause id="IDb82452ebf0ac422b9dc663e7639d2435"><enum>(ii)</enum><text>in
subparagraph (A), as added by subclause (I), by inserting <quote>, including,
in accordance with section 301(e)(1)(D) of the
<short-title>Medicare and Medicaid Fighting Fraud and
Abuse to Save Taxpayers’ Dollars Act</short-title>, the Integrated Data
Repository under paragraph (1)</quote> before the period at the end; and</text>
</clause><clause id="IDa50c927068cb4bb5b014ae7174b83f54"><enum>(iii)</enum><text>by adding at
the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idCF1DFED822ED44D485AB28CE9EC68F0C" style="OLC">
<subparagraph id="ID29a411fea40b490ca9c6350824cae18a"><enum>(B)</enum><header>Access to
reduce waste, fraud, and abuse</header><text>For purposes of reducing waste,
fraud, and abuse, 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 Secretary, in consultation with the Inspector General of the
Department of Health and Human Services, shall allow appropriate State agency
access to claims and payment data of the Department of Health and Human
Services and its contractors related to titles XVIII, XIX, and XXI, including,
in accordance with section 301(e)(2)(A) of the
<short-title>Medicare and Medicaid Fighting Fraud and
Abuse to Save Taxpayers’ Dollars Act</short-title>, the Integrated Data
Repository under paragraph
(1).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></subsection><subsection id="ID2ede0a12f5a544a79f61c586fc31a67b"><enum>(f)</enum><header>General
protocols and security</header>
<paragraph id="ID32ba84af2c1444d0b47a2444746b374a"><enum>(1)</enum><header>In
general</header><text>The Secretary shall ensure that any data provided to an
entity or individual under the provisions of or amendments made by this section
is provided to such entity or individual in accordance with protocols
established by the Secretary under paragraph (2). The Secretary shall consult
with the Inspector General of the Department of Health and Human Services prior
to implementing this subsection.</text>
</paragraph><paragraph id="IDc1b2349aa18c41c6932a3b6e3475e7e1"><enum>(2)</enum><header>Protocols</header>
<subparagraph id="IDf3251e922aa14d6a8e6a39cd13bb3e57"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish protocols to ensure the
secure transfer and storage of any data provided to another entity or
individual under the provisions of or amendments made by this section.</text>
</subparagraph><subparagraph id="ID6c09725152df40dfba52c11bb2c034eb"><enum>(B)</enum><header>Consideration
of recommendations of the Inspector General of the Department of Health and
Human Services</header><text>In establishing protocols under subparagraph (A),
the Secretary shall take into account recommendations submitted to the
Secretary by the Inspector General of the Department of Health and Human
Services with respect to the secure transfer and storage of such data.</text>
</subparagraph></paragraph></subsection><subsection id="ID030d390417804c21ab5532314f638ccf"><enum>(g)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="IDdfe1c697ac6d45039dd0c3b6e58d413d"><enum>(1)</enum><header>Federal health
care program</header><text>The term <term>Federal health care program</term>
has the meaning given such term in section 1128B(f) of the Social Security Act
(42 U.S.C. 1320a–7b(f)).</text>
</paragraph><paragraph id="idF6D6EB8931AD4BE4A36CB68C63E771FB"><enum>(2)</enum><header>Medicaid
program</header><text>The term <term>Medicaid program</term> means the program
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).</text>
</paragraph><paragraph id="IDe2cf5dce735d4a858699dd5dbc327f42"><enum>(3)</enum><header>Medicare
program</header><text>The term <term>Medicare program</term> means the program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).</text>
</paragraph><paragraph id="IDf634d298fd4946b2abbe67076e659bb9"><enum>(4)</enum><header>Medicare
program safeguard contractors and other oversight contractors</header><text>The
term <term>Medicare program safeguard contractors and other oversight
contractors</term> includes zone program integrity contractors, program
safeguard or integrity contractors, recovery audit contractors under section
1893(h) of the Social Security Act (42 U.S.C. 1395ddd(h)), special
investigative units at Medicare contractors (as defined in section 1889(g) of
the Social Security Act (42 U.S.C. 1395zz(g))), and any other oversight
contractors designated by the Secretary.</text>
</paragraph><paragraph id="IDcea4fdcc5d3d41edadade5b90b521ae5"><enum>(5)</enum><header>Provider of
services</header><text>The term <term>provider of services</term> has the
meaning given such term in section 1861(u) of the Social Security Act (42
U.S.C. 1395x(u)).</text>
</paragraph><paragraph id="IDa8dd870e7d85459281a0c8c6a2b8d6c9"><enum>(6)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph id="ID994d0d50472747d986957b15242159fe"><enum>(7)</enum><header>State</header><text>The
term <term>State</term> includes the District of Columbia, the Commonwealth of
Puerto Rico, the Virgin Islands, Guam, and American Samoa.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID1e10345575014071b3929def999efbde"><enum>(8)</enum><header>Supplier</header><text>The
term <term>supplier</term> has the meaning given such term in section 1861(d)
of the Social Security Act (42 U.S.C. 1395x(d)).</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id3D82AFF692524A04A64758F4C60D60F6"><enum>302.</enum><header>Expanding
automated prepayment review of Medicare claims</header>
<subsection commented="no" display-inline="no-display-inline" id="idA3EB84BFBE1B494390A1BD242D2DFB24"><enum>(a)</enum><header>Automated
prepayment review</header>
<paragraph commented="no" display-inline="no-display-inline" id="id54B3C69F2F494462A87050E8364D74D6"><enum>(1)</enum><header>In
general</header><text>Subject to subsection (b), the Secretary shall establish
automated prepayment review of all Medicare claims under parts A and B of title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) by not later than
September 30, 2012.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id00807808ACD94EEC92803B0C014DC0F3"><enum>(2)</enum><header>Implementation</header><text>The
provisions of this section shall be implemented in conjunction with, and as
part of, any predictive modeling and other analytics technologies implemented
under section 4241 of the Small Business Jobs Act of 2010 (42 U.S.C. 1320a–7n),
except that any requirement under such section 4241 that conflicts with a
requirement under this section shall not apply to this section.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id16D3493E6761440E8173AAF086D4010D"><enum>(b)</enum><header>Elements</header><text>Such
automated prepayment review shall include the following:</text>
<paragraph commented="no" display-inline="no-display-inline" id="id5B805C09A1FF4013926421E6E1A84C8B"><enum>(1)</enum><header>Program
integrity system</header>
<subparagraph commented="no" display-inline="no-display-inline" id="id8779260FA6DA49B4B86A069D87E70903"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (D), a program integrity system
under which relevant claims under such parts A and B are compared in order
to—</text>
<clause commented="no" display-inline="no-display-inline" id="idF558C4A309A54A2D86623C63C2207369"><enum>(i)</enum><text>identify errors
or fraud under the Medicare program, including—</text>
<subclause commented="no" display-inline="no-display-inline" id="id6C220C9B9E464F2C8B531A4F2AD9F653"><enum>(I)</enum><text>duplicate claims
for items or services; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="id131EDEF4BA5D42449BA936CB303500C5"><enum>(II)</enum><text>claims where
payment of benefits under one such part is only available if such payment is
not available under another such part; and</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="id1ADD95958BB84612A9B6C1A77AF8C6D4"><enum>(ii)</enum><text>obtain such
other information or conduct such other analysis as the Secretary determines is
useful for program integrity purposes.</text>
</clause></subparagraph><subparagraph id="ID65aaafc31f5a400a95a7091a050380eb"><enum>(B)</enum><header>Implementation</header><text>Not
later than September 30, 2013, the Secretary shall ensure that all relevant
daily claims data under such parts A and B are compared as part of such program
integrity system.</text>
</subparagraph><subparagraph id="id94807A34AC464703827A12AD3FC4F781"><enum>(C)</enum><header>Plan for
inclusion of part D claims data</header><text>Not later than September 30,
2013, the Secretary shall establish a plan for including Medicare claims under
part D of such title XVIII (42 U.S.C. 1395w–101 et seq.) for use in comparisons
under such program integrity system.</text>
</subparagraph><subparagraph id="id167A3A6153164F728A9E7B20B2E9FF11"><enum>(D)</enum><header>No impact on
prompt payment requirements</header><text>In no case shall the program
integrity system under this paragraph have any impact on prompt payment
requirements under such parts A and B, including such requirements under
sections 1816(c)(2) and 1842(c)(2) of the Social Security Act (42 U.S.C.
1395h(c)(2); 1395u(c)(2)).</text>
</subparagraph></paragraph><paragraph id="ID2338fe9fef394689b24d16f7842c6fe9"><enum>(2)</enum><header>Automated
risk-based provider verification</header>
<subparagraph id="idDAB65B857A8040FCB4A4E22550E6B1F7"><enum>(A)</enum><header>In
general</header><text>An automated risk-based verification system for the
purpose of verification and analysis of providers of services and suppliers
under the Medicare program on an ongoing basis, including during the period
between the enrollment of the provider of services or supplier under section
1866(j) of the Social Security Act (42 U.S.C. 1395cc(j)) and the revalidation
(or any subsequent revalidation) of such provider of services or supplier under
such section. Subject to subparagraph (C), such system shall include criminal
background checks for providers of services and suppliers who the Secretary
determines present a high risk of waste, fraud, and abuse.</text>
</subparagraph><subparagraph id="idC5E9DB86F3334A578AD1894C4F1A496E"><enum>(B)</enum><header>Implementation</header><text>The
Secretary shall establish the system under subparagraph (A) not later than
September 30, 2013.</text>
</subparagraph><subparagraph id="id91C0D32B2CD848D3B8D6890D9A86DA2E"><enum>(C)</enum><header>No duplication
of screening under enrollment process</header><text>The system under
subparagraph (A) shall be in addition to and shall not duplicate any screening,
including any criminal background check, conducted under section 1866(j)(2) of
the Social Security Act (42 U.S.C. 1395cc(j)(2)).</text>
</subparagraph><subparagraph id="id0D7D2BDB33824F0A9E16A5EE0444646A"><enum>(D)</enum><header>Prohibition on
disclosure of risk-based data and analysis</header><text>The Secretary shall
not disclose to the public any data collected or analysis conducted under the
automated risk-based verification system under subparagraph (A).</text>
</subparagraph></paragraph><paragraph id="ID512b6a1132674afaa84b413a22433bea"><enum>(3)</enum><header>Tracking
rejected claims</header>
<subparagraph id="idB31C65CA57FA4BC686CDC5E64AC8DDF1"><enum>(A)</enum><header>In
general</header><text>For the purpose of identifying and analyzing potentially
fraudulent and otherwise inappropriate claims under the Medicare program, a
process for identifying and tracking, including by provider of services or
supplier, claims for payment under the Medicare program that were rejected or
denied under the automated edit process of a medicare administrative contractor
under section 1874A of the Social Security Act (42 U.S.C. 1395kk).</text>
</subparagraph><subparagraph id="id33E33EB795094DE187B508150980E4F3"><enum>(B)</enum><header>Implementation</header><text>The
Secretary shall establish the process under subparagraph (A) not later than
September 30, 2013.</text>
</subparagraph></paragraph></subsection><subsection id="id47AE1A6AADF34CC297DFA664F31487E8"><enum>(c)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="id5E1890108C914071B1C71CB740BDDE11"><enum>(1)</enum><header>Medicare
program</header><text>The term <term>Medicare program</term> means the program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).</text>
</paragraph><paragraph id="idCCCFC378E7B34D8782E32C02A46DF838"><enum>(2)</enum><header>Automated
prepayment review</header><text>The term <term>automated prepayment
review</term> means screening using automated data analysis and intelligent
analysis prior to making payment. Such term does not include prepayment medical
review.</text>
</paragraph><paragraph id="idE003988A2AC644079C78A16E117ECA15"><enum>(3)</enum><header>Provider of
services</header><text>The term <term>provider of services</term> has the
meaning given that term in section 1861(u) of such Act (42 U.S.C.
1395ww(u)).</text>
</paragraph><paragraph id="idE24245EC2B414C63A669E284F155FD35"><enum>(4)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph id="id0076BEA2277A4FE5B6228F6BA3CF2FA6"><enum>(5)</enum><header>Supplier</header><text>The
term <term>supplier</term> has the meaning given such term in section 1861(d)
of such Act (42 U.S.C. 1395ww(d)).</text>
</paragraph></subsection></section><section id="ID4e86f6eda0144ac4962550bdec38496a"><enum>303.</enum><header>Improving the
sharing of data between the Federal Government and State Medicaid
programs</header>
<subsection id="id4C60B766B69343C9B6A4C00D16823A19"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <term>Secretary</term>) shall establish a plan to
encourage and facilitate the inclusion of States in the Medicare-Medicaid Data
Match Program (commonly referred to as the <term>Medi-Medi Program</term>)
under section 1893(g) of the Social Security Act (42 U.S.C. 1395ddd(g)).</text>
</subsection><subsection id="ID591495a440b64d0baa1180232a3ce9b8"><enum>(b)</enum><header>Program
revisions To improve Medi-Medi Data Match Program participation by
States</header><text>Section 1893(g)(1)(A) of the Social Security Act (42
U.S.C. 1395ddd(g)(1)(A)) is amended—</text>
<paragraph id="ID5c81c108deb241639897e6e17f1b2ada"><enum>(1)</enum><text>in the matter
preceding clause (i), by inserting <quote>or otherwise</quote> after
<quote>eligible entities</quote>;</text>
</paragraph><paragraph id="ID67e123ec5fda444091dca778165a10bb"><enum>(2)</enum><text>in clause
(i)—</text>
<subparagraph id="ID3abbd50b18774d559f4ae13d0f065f78"><enum>(A)</enum><text>by inserting
<quote>to review claims data</quote> after <quote>algorithms</quote>;
and</text>
</subparagraph><subparagraph id="IDa46e4d39e5f7492980e24e8e8b793183"><enum>(B)</enum><text>by striking
<quote>service, time, or patient</quote> and inserting <quote>provider,
service, time, or patient</quote>;</text>
</subparagraph></paragraph><paragraph id="ID458aa588377443e39dffe3c757d44dfa"><enum>(3)</enum><text>in clause
(ii)—</text>
<subparagraph id="idEDC463C1764C4EB5B4293F91799A7077"><enum>(A)</enum><text>by inserting
<quote>to investigate and recover amounts with respect to suspect
claims</quote> after <quote>appropriate actions</quote>; and</text>
</subparagraph><subparagraph id="id0AB0724F5DC846029683BF958468A40F"><enum>(B)</enum><text>by striking
<quote>; and</quote> and inserting a semicolon;</text>
</subparagraph></paragraph><paragraph id="id0C90D9FC540E41B18F2A6912F6EB59B4"><enum>(4)</enum><text>in clause (iii),
by striking the period and inserting <quote>; and</quote>; and</text>
</paragraph><paragraph id="ID7bcc8f4037a1421a822fd96d487c0bf7"><enum>(5)</enum><text>by adding at end
the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="id3FE8E2918C0549CEA9EABDBA5B66541A" style="OLC">
<clause id="idDA363B59088445F09A3766E4622A0AAD"><enum>(iv)</enum><text>furthering the
Secretary’s design, development, installation, or enhancement of an automated
data system architecture—</text>
<subclause id="id338D443F179547EFB9F46069C7859011"><enum>(I)</enum><text>to collect,
integrate, and assess data for purposes of program integrity, program
oversight, and administration, including the Medi-Medi Program; and</text>
</subclause><subclause id="idC4ACAAC1A04D4B7B98E08616ECDAFDCD"><enum>(II)</enum><text>that improves
the coordination of requests for data from
States.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="idDCEC8807BB754352A971215A8DEC6576"><enum>(c)</enum><header>Providing
states with data on improper payments made for items or services provided to
dual eligible individuals</header>
<paragraph id="id52FD31D98EE54E8D9E6975BA28602D02"><enum>(1)</enum><header>In
general</header><text>The Secretary shall develop and implement a plan that
allows each State agency responsible for administering a State plan for medical
assistance under title XIX of the Social Security Act access to relevant data
on improper or erroneous payments made under the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for health care items
or services provided to dual eligible individuals.</text>
</paragraph><paragraph id="id4D5D9F5AD402439E8D8BD2DE8336D753"><enum>(2)</enum><header>Dual eligible
individual defined</header><text>In this section, the term <term>dual eligible
individual</term> means an individual who is entitled to, or enrolled for,
benefits under part A of title XVIII of the Social Security Act (42 U.S.C.
1395c et seq.), or enrolled for benefits under part B of title XVIII of such
Act (42 U.S.C. 1395j et seq.), and is eligible for medical assistance under a
State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) or under a
waiver of such plan.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id86140AF510E245BFB5679FE8168995A4"><enum>304.</enum><header>Improving
claims processing and detection of fraud within the Medicaid and CHIP
programs</header>
<subsection id="IDbb20c82d7aea4ca59f02daca9dfc10d4"><enum>(a)</enum><header>Medicaid</header><text>Section
1903(i) of the Social Security Act (42 U.S.C. 1396b(i)), as amended by section
2001(a)(2)(B) of the Patient Protection and Affordable Care Act (Public Law
111–148), is amended—</text>
<paragraph id="ID5a6d544af17e4a5abf4b773b4847a1c9"><enum>(1)</enum><text>in paragraph
(25), by striking <quote>or</quote> at the end;</text>
</paragraph><paragraph id="IDd7303e6ac53c4bee9270b08f609415ad"><enum>(2)</enum><text>in paragraph
(26), by striking the period and inserting <quote>; or</quote>; and</text>
</paragraph><paragraph id="IDe395e2b290bc4630ac49c23e9e27bf23"><enum>(3)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id0F81DDA05718431DA2294880E1D42DC6" style="OLC">
<paragraph id="IDd7136516391d4d2487d947e1bb1b7871"><enum>(27)</enum><text>with respect to
amounts expended for an item or service for which medical assistance is
provided under the State plan or under a waiver of such plan unless the claim
for payment for such item or service contains—</text>
<subparagraph id="ID05639b27b1b14060892823054c219d38"><enum>(A)</enum><text>a valid
beneficiary identification number that, for purposes of the individual who
received such item or service, has been determined by the State agency to
correspond to an individual who is eligible to receive benefits under the State
plan or waiver; and</text>
</subparagraph><subparagraph id="ID50532b9e5c784c699e11a740ac97db14"><enum>(B)</enum><text>a valid provider
identifier that, for purposes of the provider that furnished such item or
service, has been determined by the State agency to correspond to a
participating provider that is eligible to receive payment for furnishing such
item or service under the State plan or
waiver.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="ID571fd83377d84e6696393e1b8b6fcd50"><enum>(b)</enum><header>Chip</header><text>Section
2107(e)(1)(I) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(I)) is amended
by striking <quote>and (17)</quote> and inserting <quote>(17), and
(27)</quote>.</text>
</subsection></section><section id="ID1ba1dc1e81e64378ae03b789d8c7f6b1"><enum>305.</enum><header>Reports</header>
<subsection id="id9EB6C24759EE432886D722B2CC10102B"><enum>(a)</enum><header>Report to
congress on plan for implementation</header>
<paragraph id="idC16DF24F9F27449CB9270E695D79EDBA"><enum>(1)</enum><header>Report</header>
<subparagraph id="id101C6E6671064C3D864860D3C5E54033"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than 270
days after the date of enactment of this Act, the Secretary of Health and Human
Services, in consultation with the Commissioner of Social Security and the
Attorney General, shall submit to Congress a report containing a plan for
implementing the provisions of and amendments made by sections 301 through 304,
including, with respect to the implementation of section 303, the plan
described in subparagraph (B).</text>
</subparagraph><subparagraph id="id56ED626D17264934AD37C7F0745F0B07"><enum>(B)</enum><header>Plan for
increasing recovery of overpayments</header><text>The report submitted under
subparagraph (A) shall include a plan, developed by the Secretary of Health and
Human Services, in consultation with the inspector General of the Department of
Health and Human Services, to increase the recovery of overpayments for health
care items or services provided to dual eligible individuals (as defined in
section 303(c)(2)).</text>
</subparagraph></paragraph><paragraph id="idBB6095CE9C554313B7431E3CE0BD1190"><enum>(2)</enum><header>Inclusion in
annual health care fraud and abuse control account report</header><text display-inline="yes-display-inline">Section 1817(k)(5) of the Social Security
Act (42 U.S.C. 1395i(k)(5)) is amended—</text>
<subparagraph id="id3FBE3F47C9CC4A7D9F30023A1B9AACB7"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (A), by striking
<quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="idDA4604BD6BDA4E6FB65F66EDFE16DD4E"><enum>(B)</enum><text display-inline="yes-display-inline">in subparagraph (B), by striking the period
at the end and inserting <quote>; and</quote>; and</text>
</subparagraph><subparagraph id="idADD42F2AAB3247F798717ACC2DCB9A22"><enum>(C)</enum><text display-inline="yes-display-inline">by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="id37FCD93A153C4AB2BCFCF0354B6D1655" style="OLC">
<subparagraph id="id749393F7F51D48DD888A9B5A560B70A2"><enum>(C)</enum><text display-inline="yes-display-inline">effective beginning with the report
submitted January 1 following the date the report under section 306(a)(1) of
the <short-title>Medicare and Medicaid Fighting Fraud and
Abuse to Save Taxpayers’ Dollars Act</short-title> is submitted, any updates to
the plan included in the report under such section 306(a)(1), including any
potential challenges to meeting the deadlines for implementation of the
provisions of and amendments made by sections 301 through 304 of such
Act.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="id45AFC5BDAF4F44699DBB6D48C463401E"><enum>(b)</enum><header>Report to
congress on interagency cooperation and data sharing</header><text>Not later
than 180 days after the date of enactment of this Act, the Secretary of Health
and Human Services, in consultation with the Administrator of the Veterans
Administration, the Secretary of Defense, the Director of the Office of
Personnel Management, and the head of any other relevant Federal agency that
administers a Federal health care program, shall submit to Congress a report on
the potential of data sharing, including the sharing or data checking of
Medicare provider and Medicare beneficiary databases, to prevent and detect
potential fraud and improper payments under the Medicare program.</text>
</subsection></section><enum>IV</enum><header>Improving CMS
contractor performance</header>
<section id="idF52532BF395E4426B29A60D35EFD0BF9"><enum>401.</enum><header>Establishing
Medicare administrative contractor error reduction incentives</header>
<subsection id="id80F40A19AD0145858EA0B14A419A8DAE"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section
1874A(b)(1)(D) of the Social Security Act (42 U.S.C. 1395kk(b)(1)(D)) is
amended—</text>
<paragraph id="id25475D9F3F404DFC873E850CEBA78FF9"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote><header-in-text level="subparagraph" style="OLC">quality</header-in-text>.—The
Secretary</quote> and inserting “<header-in-text level="subparagraph" style="OLC">quality</header-in-text>.—</text>
<quoted-block display-inline="no-display-inline" id="idD82DD1A2FD8C4D9F94390D5189B03D70" style="OLC">
<clause id="id55368F215075406392C7A584E43B3205"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to clauses
(ii) and (iii), the Secretary</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="id5F8F7A65FDC34051AAF1BFD8CF6059BB"><enum>(2)</enum><text display-inline="yes-display-inline">by inserting after clause (i), as added by
paragraph (1), the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="id9AEE0A0B02604B168D4BA2C0A21609A5" style="OLC">
<clause id="id25C69916D6D24F88B84F735027A2AB99"><enum>(ii)</enum><header>Improper
payment error rate reduction incentive plan</header><text>The Secretary shall
establish a plan to provide incentives for medicare administrative contractors
to reduce the improper payment error rates in their jurisdictions.</text>
</clause><clause id="id94F031D501454EC6BE609572A981FEA7"><enum>(iii)</enum><header>Contents of
plan</header><text>The plan established under clause (ii)—</text>
<subclause id="id7CC995F3E5B84B78A87E97BA4EDEE314"><enum>(I)</enum><text>may include a
sliding scale of bonus payments and additional incentives to medicare
administrative contractors that reduce the improper payment error rates in
their jurisdictions to certain benchmark levels; and</text>
</subclause><subclause id="id0C7962A266614025B943573E00C087AD"><enum>(II)</enum><text>shall include
penalties, including substantial reductions in award fee payments under award
fee contracts, for any medicare administrative contractor that reaches an upper
end error threshold or other threshold as determined by the
Secretary.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idF2FED3CAAED6418E9F074AD4BA95E637"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to contracts
entered into on or after the date that is 12 months after the date of enactment
of this Act and to current contracts through modification when
practicable.</text>
</subsection></section><section id="id02D86AAB57FF4923AC22207E17733609"><enum>402.</enum><header>Separating
provider enrollment and screening from Medicare administrative
contractors</header>
<subsection id="id7D142F627B6C4EE1864D1103B8CE9F7B"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1866(j)(1) of
the Social Security Act (42 U.S.C. 1395cc(j)(1)) is amended by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="id6B5195EE9EBE4910BF937423393D759A" style="OLC">
<subparagraph id="idFA6BB2E1FC56482681E1196029B2C269"><enum>(D)</enum><header>Implementation</header><text display-inline="yes-display-inline">The enrollment process established under
subparagraph (A) and the provider screening under paragraph (2) shall be
carried out under one or more contracts with entities. Such contracts shall be
separate from any contract to serve as a medicare administrative contractor
under section
1874A.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id6F6600C2C0454A6D954CC44DD55F172D"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to
contracts entered into on or after the date that is 24 months after the date of
enactment of this Act and to current contracts through modification when
practicable.</text>
</subsection></section><section id="IDf170620dbc174944a59337d57b1ab1e7"><enum>403.</enum><header>Developing
measurable performance metrics for Medicare contractors</header>
<subsection id="IDe9d04bf2119f4f9bbe099cc9f154d16b"><enum>(a)</enum><header>Report</header><text>Not
later than 12 months after the date of enactment of this Act, the Secretary of
Health and Human Services (in this section referred to as the
<term>Secretary</term>) shall submit to Congress a report containing measurable
metrics for improving Medicare contractor performance, including Medicare
administrative contractors under section 1874A of the Social Security Act (42
U.S.C. 1395kk), program safeguard contractors and other similar contractors,
Medicare Drug Integrity Contractors, qualified independent contractors with a
contract under section 1869(c) of the Social Security Act (42 U.S.C.
1395ff(c)), and other contractors that perform administrative or oversight
functions under the Medicare program under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.).</text>
</subsection><subsection id="ID3c205cf07b084a59875b1f368c0829a8"><enum>(b)</enum><header>Contents of
report</header><text>The report submitted under subsection (a) shall include
the Secretary’s recommendations for the development of measurable performance
metrics for Medicare contractors (or updated and revised measurable performance
metrics), together with recommendations for such legislation and administrative
action as the Secretary considers appropriate.</text>
</subsection><subsection id="ID060b0fe675f1475fb5885164a6590831"><enum>(c)</enum><header>Relationship to
Government Performance and Results Act</header><text>The metrics submitted in
the report under subsection (a) may include performance goals or performance
indicators established under the provisions of and amendments made by the GPRA
Modernization Act of 2010 (Public Law 111–352).</text>
</subsection><subsection id="ID22b3a6b8fc1b4965b81254a93c644864"><enum>(d)</enum><header>Review by the
comptroller general</header><text>Not later than 270 days after the date on
which the report is submitted under subsection (a), the Comptroller General of
the United States shall submit to Congress a report containing a review of the
report submitted under such subsection.</text>
</subsection></section><enum>V</enum><header>Other
provisions</header>
<section id="IDd564432678de4d8e8ca35d6a50fd9096"><enum>501.</enum><header>Strengthening
penalties for the illegal distribution of a Medicare, Medicaid, or CHIP
beneficiary identification or billing privileges</header><text display-inline="no-display-inline">Section 1128B(b) of the Social Security Act
(42 U.S.C. 1320a–7b(b)) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="idD40A49E69953401D9C145CC5CD65F48A" style="OLC">
<paragraph id="ID33612082cdb54225b34e6a7efbae0e98"><enum>(4)</enum><text>Whoever
knowingly, intentionally, and with the intent to defraud purchases, sells or
distributes, or arranges for the purchase, sale, or distribution of a Medicare,
Medicaid, or CHIP beneficiary identification number or billing privileges under
title XVIII, title XIX, or title XXI, including a provider identifier, shall be
imprisoned for not more than 10 years or fined not more than $500,000
($1,000,000 in the case of a corporation), or
both.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="id3605DC10FC274D358F10CFAB291BC03B"><enum>502.</enum><header>Providing
implementation funding</header>
<subsection id="idFA7E9F59CC334FBDA14058DAF72EDE4D"><enum>(a)</enum><header>In
general</header><text>For purposes of carrying out the provisions of and
amendments made by this Act, in addition to funds otherwise available, there
are appropriated to the Secretary of Health and Human Services for the Centers
for Medicare & Medicaid Services Program Management Account, from amounts
in the general fund of the Treasury not otherwise appropriated, $75,000,000 for
the period of fiscal years 2012 through 2016. Amounts appropriated under the
preceding sentence shall remain available until expended.</text>
</subsection><subsection id="id7B1FE7DCBC5A4C5C883C29D16AA59A09"><enum>(b)</enum><header>Revision to the
Medicare Improvement Fund</header><text display-inline="yes-display-inline">Section 1898(b)(1)(B) of the Social
Security Act (42 U.S.C. 1395iii(b)(1)(B)) is amended by striking
<quote>$275,000,000</quote> and inserting <quote>$200,000,000</quote>.</text>
</subsection></section>