Social Security Fraud and Error Prevention Act of 2015
Amends title II (Old Age, Survivors and Disability Insurance) of the Social Security Act (SSAct) to appropriate from the Social Security Trust Funds to the Social Security Administration for each fiscal year beginning FY2016 amounts for specified fraud and error prevention activities. Prescribes a formula for the calculation of such amounts, which include fines and civil monetary penalties recovered.
Directs the Commissioner of Social Security to: (1) report to Congress and the Office of Management and Budget (OMB) a plan for conducting fraud and error prevention activities; (2) take any necessary actions to ensure that cooperative disability investigations (CDI) units have been established for each of the 50 states, the District of Columbia, and the territories; (3) conduct quality reviews in certain cases with respect to decisions in connection with the application for benefits under this title and SSAct title XVI (Supplemental Security Income) (SSI), in a sufficient number to ensure compliance with laws, regulations, and other guidance issued by the Commissioner; (4) report annually to Congress the total number of cases selected for such quality review, the number of such cases in which a decision is remanded, and the number of such cases in which a decision is modified or reversed; and (5) report annually to Congress on the number of work-related continuing disability reviews conducted.
Allows the Commissioner to submit a combined annual report to specified congressional committees of certain information relating to disability benefits.
Increases civil and criminal penalties for specified persons in positions of trust in certain cases of fraud, and requires inflation adjustments every four years for certain civil penalties.
Prohibits the Commissioner, in making any determination with respect to whether an individual is or continues to be under a disability, from considering (except for good cause) any evidence furnished by a physician or other health care provider who has been barred from practice, has been assessed a penalty for the submission of false evidence, or is excluded from participation in any federal health care program..
Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to repeal program integrity adjustments after FY2014 to budget authority for continuing disability reviews and redeterminations.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1419 Introduced in House (IH)]
114th CONGRESS
1st Session
H. R. 1419
To amend title II of the Social Security Act to improve the Social
Security Administration's ability to fight fraud, prevent errors, and
protect the Social Security Trust Fund, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 18, 2015
Mr. Becerra (for himself, Mr. Levin, Mr. Doggett, Mr. Larson of
Connecticut, Mr. Blumenauer, Mr. Rangel, Mr. Lewis, Mr. Thompson of
California, Mr. Crowley, Mr. Danny K. Davis of Illinois, Ms. Linda T.
Saanchez of California, Mr. Cummings, Mr. Cartwright, Ms. Schakowsky,
Ms. Matsui, and Mr. Pierluisi) introduced the following bill; which was
referred to the Committee on Ways and Means, and in addition to the
Committee on the Budget, 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 amend title II of the Social Security Act to improve the Social
Security Administration's ability to fight fraud, prevent errors, and
protect the Social Security Trust Fund, 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 ``Social Security Fraud and Error
Prevention Act of 2015''.
SEC. 2. FRAUD AND ERROR PREVENTION.
(a) In General.--Section 201 of the Social Security Act (42 U.S.C.
401 et seq.) is amended by striking subsection (n) and inserting the
following:
``(n) Fraud and Error Prevention.--
``(1) Subject to paragraph (4) and as authorized by
subparagraph (g)(1), there is hereby appropriated from any one
or all of the Trust Funds to the Social Security Administration
for each fiscal year beginning with fiscal year 2016 for fraud
and error prevention activities described in paragraph (3), in
addition to any other amounts otherwise appropriated for such
fiscal year, an amount equal to the sum of--
``(A) the applicable dollar amount (determined
under paragraph (2)), plus
``(B) an amount equal to the sum of any fines or
other monetary penalties recovered in the previous
fiscal year pursuant to sections 208(a), 1129(a), 1140
(to the extent that such penalties are imposed for
misuse or misrepresentation of words, letters, symbols,
or emblems relating to the Social Security
Administration), and 1632(a).
``(2) The applicable dollar amount determined under this
clause is--
``(A) for fiscal year 2016, $1,750,000,000;
``(B) for each of fiscal years 2017 through 2021,
$1,800,000,000; and
``(C) for each fiscal year thereafter,
$1,800,000,000 multiplied by the ratio (not less than
1) of--
``(i) the Consumer Price Index for Urban
Wager Earners and Clerical Workers (CPI-W, as
published by the Bureau of Labor Statistics of
the Department of Labor) for the 1st full
calendar year preceding such fiscal year, to
``(ii) the CPI-W for 2019.
``(3) The Commissioner of Social Security may use funds
appropriated under paragraph (1) for the following purposes:
``(A) Medical continuing disability reviews
conducted pursuant to section 221(i) and section
1614(a)(3)(H).
``(B) SSI redeterminations conducted pursuant to
section 1611(c).
``(C) Work-related continuing disability reviews
conducted pursuant to section 223(f).
``(D) Establishment, support, or expansion of
cooperative disability investigations (CDI) units.
``(E) Pre-effectuation reviews conducted pursuant
to section 221(c) and section 1633(e).
``(F) Quality reviews of decisions made by an
administrative law judge under this title or title XVI
in accordance with section 221(n).
``(G) Recovery of overpayments under sections 204
and 1631(b).
``(H) Recovery of civil monetary penalties imposed
under sections 1129 and 1140.
``(I) Supporting prosecution of felonies under
section 208.
``(4) Funds appropriated under paragraph (1) for a fiscal
year shall not be available for obligation until the report
required to be submitted under paragraph (5) 60 days prior to
the beginning of such fiscal year has been submitted.
``(5) Not later than 60 days prior to the beginning of each
fiscal year after 2015, the Commissioner of Social Security
shall submit a report to the Committee on Ways and Means of the
House of Representatives, the Committee on Finance of the
Senate, and the Office and Management and Budget that includes
the following:
``(A) A plan for conducting the fraud and error
prevention activities described in paragraph (3) in
such fiscal year, including--
``(i) an itemized statement of the dollar
amounts expected to be spent on each such
activity during such fiscal year;
``(ii) an itemized statement of the
estimated long-term savings to the Trust Funds
and the Treasury expected to be obtained as a
result of each such activity, and a statement
of the estimated total value of benefits paid
under this title solely as a result of such
activities;
``(iii) performance targets for each such
activity; and
``(iv) a certification from the Chief
Actuary of the Social Security Administration
that the plan will improve the actuarial status
of the Trust Funds.
``(B) An assessment of the fraud and error
prevention activities described in paragraph (3)
conducted in the previous fiscal year, including--
``(i) an itemized statement of the dollar
amounts spent on each such activity during such
fiscal year;
``(ii) an itemized statement of the
estimated long-term savings to the Trust Funds
and the Treasury obtained as a result of each
such activity, and a statement of the estimated
total value of benefits paid under this title
solely as a result of such activities;
``(iii) an assessment of the extent to
which performance targets set in the applicable
plan for such fiscal year were met;
``(iv) an explanation and a corrective
action plan for any failure to meet such
performance targets;
``(v) an assessment of whether funds made
available under paragraph (1) for such fiscal
year were adequate to protect the Trust Funds
from fraud and errors, an explanation of any
such funds that remained unobligated at the end
of the fiscal year, and recommendations for
needed adjustments to future funding in order
to protect the Trust Funds from fraud and
errors and any additional cost-effective
strategies for improving the actuarial status
of the Trust Funds; and
``(6) Of the discretionary amounts made available for
`Social Security Administration--Limitation on Administrative
Expenses' for each fiscal year beginning with fiscal year 2016,
the amount obligated for the activities described in paragraph
(3) shall be not less than the sum of--
``(A) $273,000,000; plus
``(B) the amount obligated from funds made
available for `Social Security Administration--
Limitation on Administrative Expenses' for fiscal year
2014 for the activities described in subparagraphs (C)
through (I) of paragraph (3).''.
(b) Office of Inspector General.--Section 201 of the Social
Security Act (42 U.S.C. 401 et seq.), as amended by subsection (a), is
further amended by adding at the end the following:
``(o) Office of Inspector General Fraud Investigations.--
``(1) As authorized by subparagraph (g)(1), there is hereby
appropriated from any one or all of the Trust Funds to the
Office of Inspector General of the Social Security
Administration for each fiscal year beginning with fiscal year
2016 for the Office of Investigations, in addition to any other
amounts otherwise appropriated for such fiscal year, an amount
equal to the applicable dollar amount (determined under
paragraph (2)).
``(2) The applicable dollar amount determined under this
clause is--
``(A) for fiscal year 2016, $60,000,000;
``(B) for each fiscal year thereafter, $60,000,000
multiplied by the ratio (not less than 1) of--
``(i) the Consumer Price Index for Urban
Wager Earners and Clerical Workers (CPI-W, as
published by the Bureau of Labor Statistics of
the Department of Labor) for the 1st full
calendar year preceding such fiscal year, to
``(ii) the CPI-W for 2014.''.
SEC. 3. EXPANSION OF COOPERATIVE DISABILITY INVESTIGATIONS UNITS.
Not later than October 1, 2018, the Commissioner of Social Security
shall take any necessary actions to ensure that cooperative disability
investigations (CDI) units have been established to provide coverage
for each of the 50 States, the District of Columbia, Puerto Rico, Guam,
the Northern Mariana Islands, the Virgin Islands, and American Samoa.
SEC. 4. CODIFICATION OF REQUIREMENT TO CONDUCT QUALITY REVIEWS.
Section 221 of the Social Security Act is amended by adding at the
end the following:
``(n)(1) The Commissioner of Social Security shall conduct quality
reviews in accordance with section 969 of part 404 of title 20, Code of
Federal Regulations, in cases described in section 970(a) of such part
(as such sections were in effect on January 1, 2015) with respect to
decisions in connection with applications for benefits under this title
and title XVI, in a sufficient number to ensure compliance with laws,
regulations, and other guidance issued by the Commissioner of Social
Security.
``(2) The Commissioner of Social Security shall annually submit to
the Committee on Ways and Means of the House of Representatives and the
Committee on Finance of the Senate a report that includes--
``(A) the total number of cases selected for a quality
review as described in paragraph (1);
``(B) the number of such cases in which a decision is
remanded; and
``(C) the number of such cases in which a decision is
modified or reversed.''.
SEC. 5. REPORT ON WORK-RELATED CONTINUING DISABILITY REVIEWS.
Section 223 of the Social Security Act is amended by adding at the
end the following:
``(k) Report on Work-Related Continuing Disability Reviews.--The
Commissioner of Social Security shall annually submit to the Committee
on Ways and Means of the House of Representatives and the Committee on
Finance of the Senate a report on the number of work-related continuing
disability reviews conducted pursuant to subsection (f). Such report
shall include--
``(1) the total number of reports of earnings received by
the Commissioner in the previous calendar year from individuals
receiving benefits on account of disability under this title or
title XVI;
``(2) the number of such reports that resulted in a
determination by the Commissioner to conduct a work-related
continuing disability review with respect to the beneficiary to
whom such report pertains, and the basis on which such
determinations were made;
``(3) in the case of a beneficiary selected for a work-
related continuing disability review on the basis of a report
of earnings--
``(A) the average number of days between the
submission of the report and the initiation of the
review, and the average number of days between the
initiation and the completion of the review;
``(B) the number of such reviews completed during
such calendar year, and the number of such reviews that
result in a suspension or termination of benefits;
``(C) the number of such reviews that had not been
completed as of the end of such calendar year;
``(4) the total savings to the Trust Funds and the Treasury
generated from benefits terminated as a result of such reviews;
and
``(5) with respect to individuals for whom a work-related
continuing disability review was completed during such calendar
year--
``(A) the number who participated in the Ticket to
Work program under section 1148 during such calendar
year;
``(B) the number who used any program work
incentives during such calendar year; and
``(C) the number who received vocational
rehabilitation services during such calendar year with
respect to which which the Commissioner of Social
Security reimbursed a State agency under section
222(d).''.
SEC. 6. COORDINATION OF REPORTS RELATING TO DISABILITY BENEFITS.
Section 221(i)(3) of the Social Security Act (42 U.S.C. 421(i)(3))
is amended by adding at the end the following: ``To the extent the
Commissioner of Social Security determines to be necessary for maximum
efficiency, the Commissioner may submit a combined report consisting of
the information required to be submitted under this paragraph,
subsection (c)(3)(C), subsection (n)(2), section 201(n)(5), and section
223(k).''.
SEC. 7. INCREASED PENALTIES IN CERTAIN CASES OF FRAUD.
(a) Conspiracy To Commit Social Security Fraud.--Section 208(a) of
the Social Security Act (42 U.S.C. 408(a)) is amended--
(1) in paragraph (7)(C), by striking ``or'' at the end;
(2) in paragraph (8), by adding ``or'' at the end; and
(3) by inserting after paragraph (8) the following:
``(9) conspires to commit any offense described in any of
paragraphs (1) through (4),''.
(b) Increased Criminal Penalties for Certain Individuals in
Positions of Trust.--Section 208(a) of such Act (42 U.S.C. 408(a)), as
amended by subsection (a), is further amended by striking the period at
the end and inserting ``, except that in the case of a person who
receives a fee or other income for services performed in connection
with any determination with respect to benefits under this title, or
who is a physician or other health care provider who submits medical
evidence in connection with any such determination, such person shall
be guilty of a felony and upon conviction thereof shall be fined under
title 18, United States Code, or imprisoned for not more than ten
years, or both.''.
(c) Increased Civil Monetary Penalties for Certain Individuals in
Positions of Trust.--Section 1129(a)(1) of such Act (42 U.S.C. 1320a-
8(a)(1)) is amended, in the matter following subparagraph (C), by
inserting after ``withholding disclosure of such fact'' the following:
``, except that in the case of such a person who receives a fee or
other income for services performed in connection with any such
determination or who is a physician or other health care provider who
submits medical evidence in connection with any such determination, the
amount of such penalty shall be not more than $7,500''.
(d) References to Social Security and Medicare in Electronic
Communications.--
(1) In general.--Section 1140(a)(1) of the Social Security
act (42 U.S.C. 1320b-10(a)(1)) is amended by inserting
``(including any electronic or Internet-related
communication)'' after ``or other communication''.
(2) Treatment as separate violations.--Section 1140(b) of
such Act (42 U.S.C. 1320b-10(b)) is amended by adding at the
end the following: ``In the case of any items referred to in
subsection (a)(1) consisting of an electronic or Internet-
related communication, each dissemination, viewing, or
accessing of the electronic or Internet-related communication
which contains one or more words, letters, symbols, or emblems
in violation of subsection (a) shall represent a separate
violation.''.
(e) Inflation Adjustment of Certain Civil Monetary Penalties.--
Title XI of the Social Security Act is amended by inserting after
section 1129B the following:
``SEC. 1129C. CIVIL MONETARY PENALTY INFLATION ADJUSTMENT.
``(a) Adjustment by Regulation.--The Commissioner of Social
Security shall, not later than 180 days after the date of enactment of
the Social Security Fraud and Error Prevention Act of 2015, and at
least once every 4 years thereafter--
``(1) by regulation adjust the maximum amount of each civil
monetary penalty by the inflation adjustment described under
subsection (b); and
``(2) publish each such regulation in the Federal Register.
``(b) Amount of Adjustment.--The inflation adjustment under
subsection (a) shall be determined by increasing the maximum amount of
each civil monetary penalty by the cost-of-living adjustment. Any
increase determined under this subsection shall be rounded to the
nearest--
``(1) multiple of $1,000 in the case of penalties greater
than $1,000 but less than or equal to $10,000; and
``(2) multiple of $5,000 in the case of penalties greater
than $10,000 but less than or equal to $100,000.
``(c) Definitions.--For purposes of this section--
``(1) the term `civil monetary penalty' means--
``(A) a penalty imposed by paragraph (1) or (3) of
section 1129(a); and
``(B) a penalty imposed by paragraph (1) or (2) of
section 1140(b).
``(2) the term `cost-of-living adjustment' means the
percentage (if any) for each civil monetary penalty by which--
``(A) the Consumer Price Index for Urban Wager
Earners and Clerical Workers (CPI-W, as published by
the Bureau of Labor Statistics of the Department of
Labor) for the month of June of the calendar year
preceding the adjustment, exceeds
``(B) the CPI-W for the month of June of the
calendar year in which the amount of such civil
monetary penalty was last set or adjusted pursuant to
law.
``(d) Application of Increase.--Any increase under this Act in a
civil monetary penalty shall apply only to violations which occur after
the date the increase takes effect.''.
SEC. 8. EXCLUSION OF CERTAIN MEDICAL EVIDENCE IN DISABILITY CASES.
(a) In General.--Section 223(d)(5) of the Social Security Act (42
U.S.C. 423(d)(5)) is amended by adding at the end the following:
``(C) In making any determination with respect to whether an
individual is under a disability or continues to be under a disability,
the Commissioner of Social Security may not consider, except for good
cause as determined by the Commissioner, any evidence furnished by a
physician or other health care provider who--
``(i) has been barred from practice in any State;
``(ii) has been assessed a penalty under section 1129 for
the submission of false evidence; or
``(iii) is excluded (at the time of such determination)
from participation in any Federal health care program under
section 1128.''.
(b) Regulations.--Not later than 1 year after the date of the
enactment of this Act, the Commissioner of Social Security shall issue
regulations to carry out the amendment made by subsection (a).
(c) Effective Date.--The amendment made by subsection (a) shall
apply with respect to determinations of disability made on or after the
date that is 1 year after the date of enactment of this Act.
SEC. 9. REPEAL OF PROGRAM INTEGRITY ADJUSTMENTS TO DISCRETIONARY
SPENDING LIMITS.
Section 251(b)(2)(B)(i) of the Balanced Budget and Emergency
Deficit Control Act of 1985 is amended--
(1) in subclause (II), by adding ``and'' at the end;
(2) in subclause (III), by striking the semicolon at the
end and inserting a period; and
(3) by striking subclauses (IV) through (X).
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E356-357)
Referred to the Committee on Ways and Means, and in addition to the Committee on the Budget, 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 the Committee on Ways and Means, and in addition to the Committee on the Budget, 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 the Committee on Ways and Means, and in addition to the Committee on the Budget, 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 the Subcommittee on Social Security.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line