[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 418 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 418

 To reduce Medicare waste, fraud, and abuse by providing for enhanced 
 penalties to combat Medicare and Medicaid fraud, for a Medicare data-
 mining system, for a study on applying biometric technology, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 25, 2013

 Ms. Ros-Lehtinen introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Committee 
 on Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To reduce Medicare waste, fraud, and abuse by providing for enhanced 
 penalties to combat Medicare and Medicaid fraud, for a Medicare data-
 mining system, for a study on applying biometric technology, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Fraud Enforcement and 
Prevention Act of 2013''.

SEC. 2. 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 the Social 
Security Act (42 U.S.C. 1320a-7b) is amended by adding at the end the 
following new subsection:
    ``(h) Whoever knowingly purchases, sells, or unlawfully 
distributes, or arranges for the purchase, sale, or unlawful 
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.

SEC. 3. 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) 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)) is amended by inserting ``or to timely 
provide information in response to a request authorized by section 
1128J(b),'' after ``regulations),''.

SEC. 4. ENHANCED SCREENING, MEDICARE DATA-MINING SYSTEM; BIOMETRIC 
              TECHNOLOGY STUDY.

    (a) Enhanced Screening.--Section 1866(j)(2)(B)(ii) of the Social 
Security Act (42 U.S.C. 1395cc(j)(2)(B)(ii)) 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 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) Study on Use of Biometric Technology.--
            (1) In general.--The Secretary of Health and Human Services 
        shall provide for a study that analyzes the feasibility and 
        benefits in reducing waste, fraud, and abuse of carrying out a 
        program (in this subsection referred to as a ``biometric 
        technology 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. Such 
        a program 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) Report.--Not later than 6 months after the date of the 
        enactment of this Act, the Secretary shall submit to the 
        Congress a report on the study conducted under paragraph (1). 
        Such report shall include an analysis of the likely 
        effectiveness of a biometric technology program on reducing 
        waste, fraud, and abuse under the Medicare program and may 
        include recommendations with regard to whether such a program, 
        on a pilot or other basis, should be implemented.
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