Preventing and Reducing Improper Medicare and Medicaid Expenditures to Restore Integrity to Benefits Act of 2015
This bill amends title XIX (Medicaid) of the Social Security Act to make several changes related to the prevention of Medicaid fraud.
With respect to the Medicaid Integrity Program (MIP), the bill: (1) specifies that program appropriations may cover costs of equipment, travel, training, and salaries and benefits; and (2) allows the Department of Health and Human Services (HHS) flexibility in determining the number of additional staff necessary to carry out the program. (MIP is a federal program aimed at preventing and reducing provider fraud, waste, and abuse in the Medicaid program.)
Under current law, HHS may contract with Medicare administrative contractors (MACs), which are private insurers that process Medicare claims within specified geographic jurisdictions. The bill requires HHS to provide specified incentives for MACs to reduce improper payment error rates within their jurisdictions.
The bill establishes criminal penalties of up to 10 years imprisonment and up to $500,000 in fines for illegally purchasing or distributing Medicare, Medicaid, or Children's Health Insurance Program (CHIP) beneficiary identification or billing privileges.
The bill increases the scope of the Medicare-Medicaid Data Match Program (Medi-Medi Program), an existing program through which contractors and participating governmental agencies collaboratively analyze Medicare and Medicaid billing trends. HHS must establish a plan to encourage states to participate in the Medi-Medi Program.
HHS shall develop and implement a plan to allow states to access relevant data on improper or fraudulent payments made under the Medicare program on behalf of individuals dually eligible for both Medicare and Medicaid.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3718 Introduced in House (IH)]
<DOC>
114th CONGRESS
1st Session
H. R. 3718
To amend titles XVIII and XIX of the Social Security Act to curb waste,
fraud, and abuse in the Medicare and Medicaid programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 8, 2015
Mr. Roskam (for himself and Mr. Carney) 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 amend titles XVIII and XIX of the Social Security Act to curb waste,
fraud, and abuse in the Medicare and Medicaid programs.
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 ``Preventing and Reducing Improper
Medicare and Medicaid Expenditures to Restore Integrity to Benefits Act
of 2015''.
SEC. 2. STRENGTHENING MEDICAID PROGRAM INTEGRITY THROUGH FLEXIBILITY.
Section 1936 of the Social Security Act (42 U.S.C. 1396u-6) is
amended--
(1) in subsection (a), by inserting ``, or otherwise,''
after ``entities''; and
(2) in subsection (e)--
(A) in paragraph (1), in the matter preceding
subparagraph (A), by inserting ``(including the costs
of equipment, salaries and benefits, and travel and
training)'' after ``Program under this section''; and
(B) in paragraph (3), by striking ``by 100'' and
inserting ``by 100, or such number as determined
necessary by the Secretary to carry out the Program,''.
SEC. 3. ESTABLISHING MEDICARE ADMINISTRATIVE CONTRACTOR ERROR REDUCTION
INCENTIVES.
(a) In General.--Section 1874A(b)(1)(D) of the Social Security Act
(42 U.S.C. 1395kk-1(b)(1)(D)) is amended--
(1) by striking ``quality.--The Secretary'' and inserting
``quality.--
``(i) In general.--Subject to clauses (ii)
and (iii), the Secretary''; and
(2) by inserting after clause (i), as added by paragraph
(1), the following new clauses:
``(ii) Improper payment rate reduction
incentives.--The Secretary shall provide
incentives for medicare administrative
contractors to reduce the improper payment
error rates in their jurisdictions.
``(iii) Incentives.--The incentives
provided for under clause (ii)--
``(I) may include a sliding scale
of award fee payments and additional
incentives to medicare administrative
contractors that either reduce the
improper payment rates in their
jurisdictions to certain thresholds, as
determined by the Secretary, or
accomplish tasks, as determined by the
Secretary, that further improve payment
accuracy; and
``(II) may include substantial
reductions in award fee payments under
cost-plus-award-fee contracts, for
medicare administrative contractors
that reach an upper end improper
payment rate threshold or other
threshold as determined by the
Secretary, or fail to accomplish tasks,
as determined by the Secretary, that
further improve payment accuracy.''.
(b) Effective Date.--
(1) In general.--The amendments made by subsection (a)
shall apply to contracts entered into or renewed on or after
the date that is 3 years after the date of enactment of this
Act.
(2) Application to existing contracts.--In the case of
contracts in existence on or after the date of the enactment of
this Act and that are not subject to the effective date under
paragraph (1), the Secretary of Health and Human Services
shall, when appropriate and practicable, seek to apply the
incentives provided for in the amendments made by subsection
(a) through contract modifications.
SEC. 4. STRENGTHENING PENALTIES FOR THE ILLEGAL DISTRIBUTION OF A
MEDICARE, MEDICAID, OR CHIP BENEFICIARY IDENTIFICATION OR
BILLING PRIVILEGES.
Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b))
is amended by adding at the end the following:
``(4) Whoever without lawful authority knowingly and
willfully purchases, sells or distributes, or arranges for the
purchase, sale, or distribution of a beneficiary identification
number or unique health identifier for a health care provider
under title XVIII, title XIX, or title XXI 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.''.
SEC. 5. IMPROVING THE SHARING OF DATA BETWEEN THE FEDERAL GOVERNMENT
AND STATE MEDICAID PROGRAMS.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish a plan
to encourage and facilitate the participation of States in the
Medicare-Medicaid Data Match Program (commonly referred to as the
``Medi-Medi Program'') under section 1893(g) of the Social Security Act
(42 U.S.C. 1395ddd(g)).
(b) Program Revisions To Improve Medi-Medi Data Match Program
Participation by States.--Section 1893(g)(1)(A) of the Social Security
Act (42 U.S.C. 1395ddd(g)(1)(A)) is amended--
(1) in the matter preceding clause (i), by inserting ``or
otherwise'' after ``eligible entities'';
(2) in clause (i)--
(A) by inserting ``to review claims data'' after
``algorithms''; and
(B) by striking ``service, time, or patient'' and
inserting ``provider, service, time, or patient'';
(3) in clause (ii)--
(A) by inserting ``to investigate and recover
amounts with respect to suspect claims'' after
``appropriate actions''; and
(B) by striking ``; and'' and inserting a
semicolon;
(4) in clause (iii), by striking the period and inserting
``; and''; and
(5) by adding at the end the following new clause:
``(iv) furthering the Secretary's design,
development, installation, or enhancement of an
automated data system architecture--
``(I) to collect, integrate, and
assess data for purposes of program
integrity, program oversight, and
administration, including the Medi-Medi
Program; and
``(II) that improves the
coordination of requests for data from
States.''.
(c) Providing States With Data on Improper Payments Made for Items
or Services Provided to Dual Eligible Individuals.--
(1) In general.--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 fraudulent 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.
(2) Dual eligible individual defined.--In this section, the
term ``dual eligible individual'' 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.
SEC. 6. REPORT ON IMPLEMENTATION.
Not later than 18 months after the date of the enactment of this
Act, the Secretary of Health and Human Services shall submit to
Congress a report on the implementation of the provisions of, and the
amendments made by--
(1) this Act; and
(2) sections 506 and 507 of the Medicare Access and CHIP
Reauthorization Act of 2015 (Public Law 114-10).
<all>
Introduced in House
Introduced in House
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 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 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 the Subcommittee on Health.
Referred to the Subcommittee on Health.
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