Prohibits the Secretary from recovering past Medicare overpayments by offsetting future payments to a health care provider or while a provider is appealing a determination that an overpayment has been made or the amount of such an overpayment.
Title II: Appeals Process Reforms - Revises requirements for the post-payment audit process, particularly the recoupment of overpayments.
Requires the Secretary to permit any health care provider to appeal any determination of the Secretary under Medicare on behalf of a deceased beneficiary where no substitute party is available.
Title III: Education Components - Amends SSA title XVIII to provide for education programs for physicians, providers of services, and suppliers.
Requires fiscal intermediaries and carriers to do their utmost to provide health care providers with one, straight, and correct answer regarding Medicare billing and cost reporting questions, as well as their true first and last names.
Requires the Secretary to establish a process for providers to request assistance in writing (advisory opinions) from fiscal intermediaries or carriers in addressing questionable Medicare coverage, billing, documentation, coding and cost reporting procedures.
Title IV: Sustainable Growth Rate Reforms - Requires the inclusion of regulatory costs in the estimate of the sustainable growth rate for all physicians' services for a fiscal year.
Title V: Studies and Reports - Requires the Comptroller General to audit and report to Congress on: (1) Health Care Financing Administration compliance with statutes administered by it and with administrative procedure and other requirements under Federal civil service law; and (2) the statistical validity, necessity, and effects of random sample audits, as well as the percentage of claims found to be improper from these audits.
Requires the Comptroller General to study and report to Congress on whether policies or enforcement efforts against health care providers have reduced access to care for Medicare beneficiaries.
[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 3131 Introduced in Senate (IS)]
106th CONGRESS
2d Session
S. 3131
To amend title XVIII of the Social Security Act to ensure that the
Secretary of Health and Human Services provides appropriate guidance to
physicians and other health care providers that are attempting to
properly submit claims under the Medicare Program and to ensure that
the Secretary targets truly fraudulent activity for enforcement of
Medicare billing regulations, rather than inadvertent billing errors.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 28 (legislative day, September 22), 2000
Mr. Murkowski (for himself and Mr. Abraham) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to ensure that the
Secretary of Health and Human Services provides appropriate guidance to
physicians and other health care providers that are attempting to
properly submit claims under the Medicare Program and to ensure that
the Secretary targets truly fraudulent activity for enforcement of
Medicare billing regulations, rather than inadvertant billing errors.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare Billing
and Education Act of 2000''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
TITLE I--REGULATORY REFORM
Sec. 101. Prospective application of certain regulations.
Sec. 102. Requirements for judicial and regulatory challenges of
regulations.
Sec. 103. Prohibition of recovering past overpayments by certain means.
Sec. 104. Prohibition of recovering past overpayments if appeal
pending.
TITLE II--APPEALS PROCESS REFORMS
Sec. 201. Reform of post-payment audit process.
Sec. 202. Definitions relating to protections for physicians,
suppliers, and providers of services.
Sec. 203. Right to appeal on behalf of deceased beneficiaries.
TITLE III--EDUCATION COMPONENTS
Sec. 301. Designated funding levels for provider education.
Sec. 302. Advisory opinions.
TITLE IV--SUSTAINABLE GROWTH RATE REFORMS
Sec. 401. Inclusion of regulatory costs in the calculation of the
sustainable growth rate.
TITLE V--STUDIES AND REPORTS
Sec. 501. GAO audit and report on compliance with certain statutory
administrative procedure requirements.
Sec. 502. GAO study and report on provider participation.
Sec. 503. GAO audit of random sample audits.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Physicians, providers of services, and suppliers of
medical equipment and supplies that participate in the Medicare
Program under title XVIII of the Social Security Act must
contend with over 100,000 pages of complex Medicare
regulations, most of which are unknowable to the average health
care provider.
(2) Many physicians are choosing to discontinue
participation in the Medicare Program to avoid becoming the
target of an overzealous Government investigation regarding
compliance with the extensive regulations governing the
submission and payment of Medicare claims.
(3) Health Care Financing Administration contractors send
post-payment review letters to physicians that require the
physician to submit to additional substantial Government
interference with the practice of the physician in order to
preserve the physician's right to due process.
(4) When a Health Care Financing Administration contractor
sends a post-payment review letter to a physician, that
contractor often has no telephone or face-to-face communication
with the physician, provider of services, or supplier.
(5) The Health Care Financing Administration targets
billing errors as though health care providers have committed
fraudulent acts, but has not adequately educated physicians,
providers of services, and suppliers regarding Medicare billing
requirements.
(6) The Office of the Inspector General of the Department
of Health and Human Services found that 75 percent of surveyed
physicians had never received any educational materials from a
Health Care Financing Administration contractor concerning the
equipment and supply ordering process.
SEC. 3. DEFINITIONS.
In this Act:
(1) Applicable authority.--The term ``applicable
authority'' has the meaning given such term in section
1861(uu)(1) of the Social Security Act (as added by section
202).
(2) Carrier.--The term ``carrier'' means a carrier (as
defined in section 1842(f) of the Social Security Act (42
U.S.C. 1395u(f))) with a contract under title XVIII of such Act
to administer benefits under part B of such title.
(3) Extrapolation.--The term ``extrapolation'' has the
meaning given such term in section 1861(uu)(2) of the Social
Security Act (as added by section 202).
(4) Fiscal intermediary.--The term ``fiscal intermediary''
means a fiscal intermediary (as defined in section 1816(a) of
the Social Security Act (42 U.S.C. 1395h(a))) with an agreement
under section 1816 of such Act to administer benefits under
part A or B of such title.
(5) Health care provider.--The term ``health care
provider'' has the meaning given the term ``eligible provider''
in section 1897(a)(2) of the Social Security Act (as added by
section 301).
(6) Medicare program.--The term ``Medicare Program'' means
the health benefits program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(7) Prepayment review.--The term ``prepayment review'' has
the meaning given such term in section 1861(uu)(3) of the
Social Security Act (as added by section 202).
(8) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
TITLE I--REGULATORY REFORM
SEC. 101. PROSPECTIVE APPLICATION OF CERTAIN REGULATIONS.
Section 1871(a) of the Social Security Act (42 U.S.C. 1395hh(a)) is
amended by adding at the end the following new paragraph:
``(3) Any regulation described under paragraph (2) may not
take effect earlier than the date on which such regulation
becomes a final regulation. Any regulation described under such
paragraph that applies to an agency action, including any
agency determination, shall only apply as that regulation is in
effect at the time that agency action is taken.''.
SEC. 102. REQUIREMENTS FOR JUDICIAL AND REGULATORY CHALLENGES OF
REGULATIONS.
(a) Right To Challenge Constitutionality and Statutory Authority of
HCFA Regulations.--Section 1872 of the Social Security Act (42 U.S.C.
1395ii) is amended to read as follows:
``application of certain provisions of title ii
``Sec. 1872. The provisions of sections 206 and 216(j), and of
subsections (a), (d), (e), (h), (i), (j), (k), and (l) of section 205,
shall also apply with respect to this title to the same extent as they
are applicable with respect to title II, except that--
``(1) in applying such provisions with respect to this
title, any reference therein to the Commissioner of Social
Security or the Social Security Administration shall be
considered a reference to the Secretary or the Department of
Health and Human Services, respectively; and
``(2) section 205(h) shall not apply with respect to any
action brought against the Secretary under section 1331 or 1346
of title 28, United States Code, regardless of whether such
action is unrelated to a specific determination of the
Secretary, that challenges--
``(A) the constitutionality of substantive or
interpretive rules of general applicability issued by
the Secretary;
``(B) the Secretary's statutory authority to
promulgate such substantive or interpretive rules of
general applicability; or
``(C) a finding of good cause under subparagraph
(B) of the sentence following section 553(b)(3) of
title 5, United States Code, if used in the
promulgation of substantive or interpretive rules of
general applicability issued by the Secretary.''.
(b) Construction of Hearing Rights Relating to Determinations by
the Secretary Regarding Agreements With Providers of Services.--Section
1866(h) of the Social Security Act (42 U.S.C. 1395cc(h)) is amended by
adding at the end the following new paragraph:
``(3) For purposes of applying paragraph (1), an institution or
agency dissatisfied with a determination by the Secretary described in
such paragraph shall be entitled to a hearing thereon regardless of
whether--
``(A) such determination has been made by the Secretary or
by a State pursuant to an agreement entered into with the
Secretary under section 1864; or
``(B) the Secretary has imposed or may impose a remedy,
penalty, or other sanction on the institution or agency in
connection with such determination.''.
SEC. 103. PROHIBITION OF RECOVERING PAST OVERPAYMENTS BY CERTAIN MEANS.
(a) In General.--Except as provided in subsection (b) and
notwithstanding sections 1815(a), 1842(b), and 1861(v)(1)(A)(ii) of the
Social Security Act (42 U.S.C. 1395g(a), 1395u(a), and
1395x(v)(1)(A)(ii)), or any other provision of law, for purposes of
applying sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, and 1893
of such Act (42 U.S.C. 1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 1395gg,
and 1395ddd), the Secretary may not offset any future payment to a
health care provider to recoup a previously made overpayment, but
instead shall establish a repayment plan to recoup such an overpayment.
(b) Exception.--This section shall not apply to cases in which the
Secretary finds evidence of fraud or similar fault on the part of such
provider.
SEC. 104. PROHIBITION OF RECOVERING PAST OVERPAYMENTS IF APPEAL
PENDING.
(a) Notwithstanding any provision of law, for purposes of applying
sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, and 1893 of the
Social Security Act (42 U.S.C. 1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii),
1395gg, and 1395ddd), the Secretary may not take any action (or
authorize any other person, including any fiscal intermediary, carrier,
and contractor under section 1893 of such Act (42 U.S.C. 1395ddd)) to
recoup an overpayment during the period in which a health care provider
is appealing a determination that such an overpayment has been made or
the amount of the overpayment.
(b) Exception.--This section shall not apply to cases in which the
Secretary finds evidence of fraud or similar fault on the part of such
provider.
TITLE II--APPEALS PROCESS REFORMS
SEC. 201. REFORM OF POST-PAYMENT AUDIT PROCESS.
(a) Communications to Physicians.--Section 1842 of the Social
Security Act (42 U.S.C. 1395u) is amended by adding at the end the
following new subsection:
``(u)(1)(A) Except as provided in paragraph (2), in carrying out
its contract under subsection (b)(3), with respect to physicians'
services, the carrier shall provide for the recoupment of overpayments
in the manner described in the succeeding subparagraphs if--
``(i) the carrier or a contractor under section 1893 has
not requested any relevant record or file; and
``(ii) the case has not been referred to the Department of
Justice or the Office of Inspector General.
``(B)(i) During the 1-year period beginning on the date on which a
physician receives an overpayment, the physician may return the
overpayment to the carrier making such overpayment without any penalty.
``(ii) If a physician returns an overpayment under clause (i),
neither the carrier nor the contractor under section 1893 may begin an
investigation or target such physician based on any claim associated
with the amount the physician has repaid.
``(C) The carrier or a contractor under section 1893 may not recoup
or offset payment amounts based on extrapolation (as defined in section
1861(uu)(2)) if the physician has not been the subject of a post-
payment audit.
``(D) As part of any written consent settlement communication, the
carrier or a contractor under section 1893 shall clearly state that the
physician may submit additional information (including evidence other
than medical records) to dispute the overpayment amount without waiving
any administrative remedy or right to appeal the amount of the
overpayment.
``(E) As part of the administrative appeals process for any amount
in controversy, a physician may directly appeal any adverse
determination of the carrier or a contractor under section 1893 to an
administrative law judge.
``(F)(i) Each consent settlement communication from the carrier or
a contractor under section 1893 shall clearly state that prepayment
review (as defined in section 1861(uu)(3)) may be imposed where the
physician submits an actual or projected repayment to the carrier or a
contractor under section 1893. Any prepayment review shall cease if the
physician demonstrates to the carrier that the physician has properly
submitted clean claims (as defined in section 1816(c)(2)(B)(i)).
``(ii) Prepayment review may not be applied as a result of an
action under section 201(a), 301(b), or 302.
``(2) If a carrier or a contractor under section 1893 identifies
(before or during post-payment review activities) that a physician has
submitted a claim with a coding, documentation, or billing
inconsistency, before sending any written communication to such
physician, the carrier or a contractor under section 1893 shall contact
the physician by telephone or in person at the physician's place of
business during regular business hours and shall--
``(i) identify the billing anomaly;
``(ii) inform the physician of how to address the anomaly;
and
``(iii) describe the type of coding or documentation that
is required for the claim.''.
(b) Effective Date.--The amendments made by this section shall take
effect 60 days after the date of enactment of this Act.
SEC. 202. DEFINITIONS RELATING TO PROTECTIONS FOR PHYSICIANS,
SUPPLIERS, AND PROVIDERS OF SERVICES.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395 et seq.) is amended by adding at the end the following new
subsection:
``Definitions Relating to Protections for Physicians, Suppliers, and
Providers of Services
``(uu) For purposes of provisions of this title relating to
protections for physicians, suppliers of medical equipment and
supplies, and providers of services:
``(1) Applicable authority.--The term `applicable
authority' means the carrier, contractor under section 1893, or
fiscal intermediary that is responsible for making any
determination regarding a payment for any item or service under
the Medicare Program under this title.
``(2) Extrapolation.--The term `extrapolation' means the
application of an overpayment dollar amount to a larger
grouping of physician claims than those in the audited sample
to calculate a projected overpayment figure.
``(3) Prepayment review.--The term `prepayment review'
means the carriers' and fiscal intermediaries' practice of
withholding claim reimbursements from eligible providers even
if the claims have been properly submitted and reflect medical
services provided.''.
SEC. 203. RIGHT TO APPEAL ON BEHALF OF DECEASED BENEFICIARIES.
Notwithstanding section 1870 of the Social Security Act (42 U.S.C.
1395gg) or any other provision of law, the Secretary shall permit any
health care provider to appeal any determination of the Secretary under
the Medicare Program on behalf of a deceased beneficiary where no
substitute party is available.
TITLE III--EDUCATION COMPONENTS
SEC. 301. DESIGNATED FUNDING LEVELS FOR PROVIDER EDUCATION.
(a) Education Programs for Physicians, Providers of Services, and
Suppliers.--Title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) is amended by adding at the end the following new section:
``education programs for physicians, providers of services, and
suppliers
``Sec. 1897. (a) Definitions.--In this section:
``(1) Education programs.--The term `education programs'
means programs undertaken in conjunction with Federal, State,
and local medical societies, specialty societies, other
providers, and the Federal, State, and local associations of
such providers that--
``(A) focus on current billing, coding, cost
reporting, and documentation laws, regulations, fiscal
intermediary and carrier manual instructions;
``(B) place special emphasis on billing, coding,
cost reporting, and documentation errors that the
Secretary has found occur with the highest frequency;
and
``(C) emphasize remedies for these improper
billing, coding, cost reporting, and documentation
practices.
``(2) Eligible providers.--The term `eligible provider'
means a physician (as defined in section 1861(r)), a provider
of services (as defined in section 1861(u)), or a supplier of
medical equipment and supplies (as defined in section
1834(j)(5)).
``(b) Conduct of Education Programs.--
``(1) In general.--Carriers and fiscal intermediaries shall
conduct education programs for any eligible provider that
submits a claim under paragraph (2)(A).
``(2) Eligible provider education.--
``(A) Submission of claims and records.--Any
eligible provider may voluntarily submit any present or
prior claim or medical record to the applicable
authority (as defined in section 1861(uu)(1)) to
determine whether the billing, coding, and
documentation associated with the claim is appropriate.
``(B) Prohibition of extrapolation.--No claim
submitted under subparagraph (A) is subject to any type
of extrapolation (as defined in section 1861(uu)(2)).
``(c) Safe Harbor.--No submission of a claim or record under this
section shall result in the carrier or a contractor under section 1893
beginning an investigation or targeting an individual or entity based
on any claim or record submitted under such subparagraph.
``(3) Treatment of improper claims.--If the carrier or
fiscal intermediary finds a claim to be improper, the eligible
provider shall have the following options:
``(A) Correction of problems.--To correct the
documentation, coding, or billing problem to
appropriately substantiate the claim and either--
``(i) remit the actual overpayment; or
``(ii) receive the appropriate additional
payment from the carrier or fiscal
intermediary.
``(B) Repayment.--To repay the actual overpayment
amount if the service was not covered under the
Medicare Program under this title or if adequate
documentation does not exist.
``(4) Prohibition of eligible provider tracking.--The
applicable authorities may not use the record of attendance of
any eligible provider at an education program conducted under
this section or the inquiry regarding claims under paragraph
(2)(A) to select, identify, or track such eligible provider for
the purpose of conducting any type of audit or prepayment
review.''.
(b) Funding of Education Programs.--
(1) Medicare integrity program.--Section 1893(b)(4) of the
Social Security Act (42 U.S.C. 1395ddd(b)(4)) is amended by
adding at the end the following new sentence: ``No less than 10
percent of the program funds shall be devoted to the education
programs for eligible providers under section 1897.''.
(2) Carriers.--Section 1842(b)(3)(H) of the Social Security
Act (42 U.S.C. 1395u(b)(3)(H)) is amended by adding at the end
the following new clause:
``(iii) No less than 2 percent of carrier
funds shall be devoted to the education
programs for eligible providers under section
1897.''.
(3) Fiscal intermediaries.--Section 1816(b)(1) of the
Social Security Act (42 U.S.C. 1395h(b)(1)) is amended--
(A) in subparagraph (A), by striking ``and'' at the
end;
(B) in subparagraph (B), by striking ``; and'' and
inserting a comma; and
(C) by adding at the end the following new
subparagraph:
``(C) that such agency or organization is using no
less than 1 percent of its funding for education
programs for eligible providers under section 1897.''.
(c) Effective Date.--The amendments made by this section shall take
effect 60 days after the date of enactment of this Act.
SEC. 302. ADVISORY OPINIONS.
(a) Straight Answers.--
(1) In general.--Fiscal intermediaries and carriers shall
do their utmost to provide health care providers with one,
straight and correct answer regarding billing and cost
reporting questions under the Medicare Program, and will, when
requested, give their true first and last names to providers.
(2) Written requests.--
(A) In general.--The Secretary shall establish a
process under which a health care provider may request,
in writing from a fiscal intermediary or carrier,
assistance in addressing questionable coverage,
billing, documentation, coding and cost reporting
procedures under the Medicare Program and then the
fiscal intermediary or carrier shall respond in writing
within 30 business days with the correct billing or
procedural answer.
(B) Use of Written Statement.--
(i) In general.--Subject to clause (ii), a
written statement under paragraph (1) may be
used as proof against a future payment audit or
overpayment determination under the Medicare
Program.
(ii) Extrapolation prohibition.--Subject to
clause (iii), no claim submitted under this
section shall be subject to extrapolation.
(iii) Limitation on application.--Clauses
(i) and (ii) shall not apply to cases of
fraudulent billing.
(C) Safe harbor.--If a physician requests an
advisory opinion under this subsection, neither the
fiscal intermediary, the carrier, nor a contractor
under section 1893 of the Social Security Act (42
U.S.C. 1395ddd) may begin an investigation or target
such physician based on any claim cited in the request.
(b) Extension of Existing Advisory Opinion Provisions of Law.--
Section 1128D(b) of the Social Security Act (42 U.S.C. 1320a-7d(b)) is
amended--
(1) in paragraph (4), by adding at the end the following
new subparagraph:
``(C) Safe harbor.--If a party requests an advisory
opinion under this subsection, neither the fiscal
intermediary, the carrier, nor a contractor under
section 1893 may begin an investigation or target such
party based on any claim cited in the request.''; and
(2) in paragraph (6), by striking, `` and before the date
which is 4 years after such date of enactment''.
TITLE IV--SUSTAINABLE GROWTH RATE REFORMS
SEC. 401. INCLUSION OF REGULATORY COSTS IN THE CALCULATION OF THE
SUSTAINABLE GROWTH RATE.
(a) In General.--Section 1848(f)(2) of the Social Security Act (42
U.S.C. 1395w-4(f)(2)) is amended--
(1) by redesignating subparagraphs (A) through (D) as
clauses (i) through (iv), respectively;
(2) by striking ``Specification of growth rate.--The
sustainable growth rate'' and inserting ``Specification of
growth rate.--
``(A) In general.--The sustainable growth rate'';
and
(3) by adding at the end the following new subparagraphs:
``(B) Inclusion of sgr regulatory costs.--The
Secretary shall include in the estimate established
under clause (iv)--
``(i) the costs for each physicians'
service resulting from any regulation
implemented by the Secretary during the year
for which the sustainable growth rate is
estimated, including those regulations that may
be implemented during such year; and
``(ii) the costs described in subparagraph
(C).
``(C) Inclusion of other regulatory costs.--The
costs described in this subparagraph are any per
procedure costs incurred by each physicians' practice
in complying with each regulation promulgated by the
Secretary, regardless of whether such regulation
affects the fee schedule established under subsection
(b)(1).
``(D) Inclusion of costs in regulatory impact
analyses.--With respect to any regulation promulgated
on or after January 1, 2001, that may impose a
regulatory cost described in subparagraph (B)(i) or (C)
on a physician, the Secretary shall include in the
regulatory impact analysis accompanying such regulation
an estimate of any such cost.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to any estimate made by the Secretary of Health and
Human Services on or after the date of enactment of this Act.
TITLE V--STUDIES AND REPORTS
SEC. 501. GAO AUDIT AND REPORT ON COMPLIANCE WITH CERTAIN STATUTORY
ADMINISTRATIVE PROCEDURE REQUIREMENTS.
(a) Audit.--The Comptroller General of the United States shall
conduct an audit of the compliance of the Health Care Financing
Administration and all regulations promulgated by the Department of
Health and Human Resources under statutes administered by the Health
Care Financing Administration with--
(1) the provisions of such statutes;
(2) subchapter II of chapter 5 of title 5, United States
Code (including section 553 of such title); and
(3) chapter 6 of title 5, United States Code.
(b) Report.--Not later than 18 months after the date of enactment
of this Act, the Comptroller General shall submit to Congress a report
on the audit conducted under subsection (a), together with such
recommendations for legislative and administrative action as the
Comptroller General determines appropriate.
SEC. 502. GAO STUDY AND REPORT ON PROVIDER PARTICIPATION.
(a) Study.--The Comptroller General of the United States shall
conduct a study on provider participation in the Medicare Program to
determine whether policies or enforcement efforts against health care
providers have reduced access to care for Medicare beneficiaries. Such
study shall include a determination of the total cost to physician,
supplier, and provider practices of compliance with Medicare laws and
regulations, the number of physician, supplier, and provider audits,
the actual overpayments assessed in consent settlements, and the
attendant projected overpayments communicated to physicians, suppliers,
and providers as part of the consent settlement process.
(b) Report.--Not later than 18 months after the date of enactment
of this Act, the Comptroller General shall submit to Congress a report
on the study conducted under subsection (a), together with such
recommendations for legislative and administrative action as the
Comptroller General determines appropriate.
SEC. 503. GAO AUDIT OF RANDOM SAMPLE AUDITS.
(a) Audit.--The Comptroller General of the United States shall
conduct an audit to determine--
(1) the statistical validity of random sample audits
conducted under the Medicare Program before the date of the
enactment of this Act;
(2) the necessity of such audits for purposes of
administering sections 1815(a), 1842(a), and 1861(v)(1)(A)(ii)
of the Social Security Act (42 U.S.C. 1395g(a), 1395u(a), and
1395x(v)(1)(A)(ii));
(3) the effects of the application of such audits to health
care providers under sections 1842(b), 1866(a)(1)(B)(ii), 1870,
and 1893 of such Act (42 U.S.C. 1395u(a), 1395cc(a)(1)(B)(ii),
1395gg, and 1395ddd); and
(4) the percentage of claims found to be improper from
these audits, as well as the proportion of the extrapolated
overpayment amounts to the overpayment amounts found from the
analysis of the original sample.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit to Congress
a report on the audit conducted under subsection (a), together with
such recommendations for legislative and administrative action as the
Comptroller General determines appropriate.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S9469-9470)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S9470-9472)
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