Medicare Fraud Enforcement and Prevention Act of 2010 - Amends title XI of the Social Security Act (SSA) to increase criminal penalties for both felony and misdemeanor fraud under SSA titles XVIII (Medicare) and XIX (Medicaid).
Adds a new offense of distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges with the intent to defraud.
Applies civil monetary penalties to: (1) conspiracy to make false statements or commit other specified offenses with respect to Medicare or Medicaid claims; and (2) knowing creation or use of false records or statements with respect to the transmission of money or property to a federal health care program. Extends the statute of limitations from six to 10 years after presentation of a claim.
Amends SSA title XVIII (Medicare), as amended by the Patient Protection and Affordable Care Act (PPACA), to revise screening requirements.
Amends SSA title XI, as amended by PPACA, to require the access to claims and payment data granted to Inspector General of the Department of Health and Human Services (HHS) and the Attorney General to include access to real time claims and payment data.
Requires the HHS Inspector General to implement mechanisms for the sharing of information about suspected fraud relating to the federal health care programs under Medicare, Medicaid, and SSA title XXI (Children's Health Insurance Program) (CHIP) with other appropriate law enforcement officials.
Directs the HHS Secretary to carry out a five-year pilot program that implements biometric technology to ensure that individuals entitled to benefits under Medicare part A or enrolled under Medicare part B are physically present at the time and place of receipt of certain items and services for which payment may be made.
Requires the Comptroller General to study and report to Congress on Medicare administrative contractors, including Recovery Audit Contractors.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5044 Introduced in House (IH)]
111th CONGRESS
2d Session
H. R. 5044
To provide for enhanced penalties to combat Medicare and Medicaid
fraud, a Medicare data-mining system and biometric technology pilot
program, and a GAO study on Medicare administrative contractors.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 15, 2010
Mr. Klein of Florida (for himself and 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 provide for enhanced penalties to combat Medicare and Medicaid
fraud, a Medicare data-mining system and biometric technology pilot
program, and a GAO study on Medicare administrative contractors.
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 2010''.
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 such Act (42
U.S.C. 1320a-7b) is amended by adding at the end the following new
subsection:
``(g) Whoever knowingly, intentionally, and with the intent to
defraud purchases, sells, or distributes, or arranges for the purchase,
sale, or distribution of two or more Medicare or Medicaid beneficiary
identification numbers or billing privileges under title XVIII or title
XIX shall be imprisoned for not more than three 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. 42 U.S.C. 1395y), as added by section
6402(h) of the Patient Protection and Affordable Care Act (Public Law
111-148), is amended by striking ``may'' and inserting ``shall''.
(d) Civil Monetary Penalties for False Statements or Delaying
Inspections.--Paragraph (9) of section 1128A(a) of the Social Security
Act (42 U.S.C. 1320a-7a(a)), as added by section 6408(a) of the Patient
Protection and Affordable Care Act (Public Law 111-148), is amended by
inserting ``or to timely provide information in response to a request
authorized by section 1128J(b),'' after ``regulations),''.
SEC. 4. ENHANCED SCREENING, MEDICARE DATA-MINING SYSTEM; BIOMETRIC
TECHNOLOGY PILOT PROGRAM.
(a) Enhanced Screening.--Section 1866(j)(2)(B)(ii) of the Social
Security Act (42 U.S.C. 1395cc(j)), as inserted by section 6401(a)(3)
of the Patient Protection and Affordable Care Act (Public Law 111-148),
is amended by striking ``may'' and inserting ``shall''.
(b) Access to Real Time Claims and Payment Data.--
Section1128J(a)(2) of the Social Security Act, as added by section
6402(a) of the Patient Protection and Affordable Care Act (Public Law
111-148), is amended--
(1) by inserting ``including real time claims and payment
data,'' after ``access to claims and payment data''; and
(2) by adding at the end the following sentence: ``In
carrying out this section, the Inspector General of the
Department of Health and Human Services, in consultation with
the Attorney General, shall implement mechanisms for the
sharing of information about suspected fraud relating to the
Federal health care programs under titles XVIII, XIX, and XXI
with other appropriate law enforcement officials.''.
(c) Biometric Technology Pilot Program.--
(1) In general.--By not later than one year after the date
of the enactment of this Act, the Secretary of Health and Human
Services shall carry out a 5-year pilot program that implements
biometric technology to ensure that individuals entitled to
benefits under part A of title XVIII of the Social Security Act
or enrolled under part B of such title are physically present
at the time and place of receipt of certain items and services
(specified by the Secretary) for which payment may be made
under such title. Under such pilot program the Secretary may
provide for financial incentives to encourage voluntary
participation of providers of services (as defined in section
1861(u) of such Act) and suppliers (as defined in section
1861(d) of such Act).
(2) Reports.--The Secretary of Health and Human Services
shall, for each of the third, fourth, and fifth years of the
pilot program under paragraph (1), submit to Congress a report
on the effectiveness of the pilot program in reducing the
occurrence of waste, fraud, and abuse in the Medicare program
under title XVIII of the Social Security Act.
(3) Authorization of appropriations.--For purpose of
carrying out paragraph (1), there is authorized to be
appropriated such sums as may be necessary.
SEC. 5. GAO STUDY AND REPORT.
(a) Study.--The Comptroller General of the United States shall
conduct a study on Medicare administrative contractors under section
1874A of the Social Security Act, including Recovery Audit Contractors,
regarding the following areas:
(1) Training and expertise in identifying fraud, including
the education levels of the key individuals tasked to identify
or refer potential cases of fraud, and whether the Centers for
Medicare & Medicaid Services should be providing more training
to contractors, or require contractors to hire experts with
greater medical training.
(2) Acquisition and implementation of data mining software
among Medicare administrative contractors, if applicable, and
the ability or availability of such software to provide real-
time data mining capabilities.
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall complete the study under this section and submit a report to
Congress regarding the findings of the study and recommendations for
legislation and administrative action.
<all>
Introduced in House
Introduced in House
Referred to House Energy and Commerce
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.
Referred to House Ways and Means
Referred to the Subcommittee on Health.
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