A bill to provide for enhanced penalties to combat Medicare and Medicaid fraud, a Medicare data-mining system, and a Beneficiary Verification Pilot Program, and for other purposes.

Summary: Medicare and Medicaid 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 one 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 XI, as amended by the Patient Protection and Affordable Care Act, with respect to the access to claims and payment data granted to the Inspector General of the Department of Health and Human Services (HHS). Requires the 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 implement a five-year Beneficiary Verification Pilot Program to verify, with respect to Medicare claims, that the beneficiary for which the claim was made was actually furnished the claimed item or service.

Requires the Comptroller General to study and report to Congress on Medicare administrative contractors, including Recovery Audit Contractors.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare and Medicaid 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 one 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) In General.--Section 1128A(a) of the Social Security Act (42 
U.S.C. 1320a-7a(a)) is amended--
            (1) 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)),'';
            (2) 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;'';
            (3) in the first sentence--
                    (A) by striking ``or in cases under paragraph (9)'' 
                and inserting ``in cases under paragraph (9)''; and
                    (B) 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
            (4) 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.''.
    (b) Timeframe.--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''.
    (c) Definitions.--Section 1128A(i) of the Social Security Act (42 
U.S.C. 1320a-7a(i)) is amended--
            (1) 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.'';
            (2) 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.'';
            (3) in paragraph (7)--
                    (A) by striking ``term `should know' means'' and 
                inserting ``terms `knowing', `knowingly', and `should 
                know' mean'';
                    (B) by redesignating subparagraphs (A) and (B) as 
                subparagraphs (B) and (C), respectively;
                    (C) by inserting before subparagraph (B), as 
                redesignated by clause (ii), the following new 
                subparagraph:
                    ``(A) has actual knowledge of the information;''; 
                and
                    (D) in the matter following subparagraph (C), as 
                redesignated by clause (ii)--
                            (i) by inserting ``require'' after ``and''; 
                        and
                            (ii) by striking ``is required''; and
            (4) 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.''.

SEC. 4. MEDICARE DATA-MINING SYSTEM; BENEFICIARY VERIFICATION PILOT 
              PROGRAM.

    (a) Access to 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 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.''.
    (b) Beneficiary Verification Pilot Program.--
            (1) In general.--By not later than 1 year after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services (in this subsection referred to as the ``Secretary'') 
        shall implement a 5-year pilot program (to be know as the 
        ``Beneficiary Verification Pilot Program'') under which the 
        Secretary shall establish a process to verify, with respect to 
        claims for reimbursement under title XVIII of the Social 
        Security Act for items and services (as specified by the 
        Secretary) furnished to Medicare beneficiaries, that the 
        beneficiary for which the claim was made was actually furnished 
        such item or service. Such process may include communicating, 
        by phone or other means, directly with the beneficiary in order 
        to conduct such verification.
            (2) Reports.--The Secretary shall, for each of the third, 
        fourth, and fifth years of the Beneficiary Verification Pilot 
        Program under this section, 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 the Beneficiary Verification Pilot Program under 
        this subsection, 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.