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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6378 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 6378

  To reduce waste, fraud, and abuse under the Medicare, Medicaid, and 
                 CHIP programs, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 29, 2010

  Mr. Roskam introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
   Ways and Means and the Judiciary, 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 reduce waste, fraud, and abuse under the Medicare, Medicaid, and 
                 CHIP programs, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Fighting Fraud and 
Abuse to Save Taxpayers' Dollars Act'' or the ``FAST Act''.
    (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. Tracking excluded providers across State lines.
Sec. 4. Access for private sector and governmental entities.
Sec. 5. Liability of Medicare administrative contractors for claims 
                            submitted by excluded providers.
Sec. 6. Limiting the discharge of debts in bankruptcy proceedings in 
                            cases where a health care provider or a 
                            supplier engages in fraudulent activity.
Sec. 7. Prevention of waste, fraud, and abuse in the Medicaid and CHIP 
                            programs.
Sec. 8. Illegal distribution of a Medicare, Medicaid, or CHIP 
                            beneficiary identification or billing 
                            privileges.
Sec. 9. Pilot program for the use of universal product numbers on claim 
                            forms for reimbursement under the Medicare 
                            program.
Sec. 10. Prohibition of inclusion of Social Security account numbers on 
                            Medicare cards.
Sec. 11. Implementation.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The Medicare program loses an estimated $60,000,000,000 
        annually to wasted and fraudulent payments.
            (2) The Medicaid program also suffers from rampant fraud. 
        As the Office of the Inspector General of the Department of 
        Health and Human Services noted in 2009, in an analysis of the 
        only source of nationwide Medicaid claims and beneficiary 
        eligibility information, the Medicaid Statistical Information 
        System, the Federal Government does not have ``timely, 
        accurate, or comprehensive information for fraud, waste, and 
        abuse detection'' in the Medicaid program.
            (3) Absent comprehensive estimates, the Medicaid program's 
        improper payment rate may be the most objective measure of 
        taxpayer dollars lost to fraud. The national average improper 
        payment rate ranges between 8.7 percent and 10.5 percent, but 
        many States have much higher improper payment rates.
            (4) The new Federal health reform law substantially expands 
        the Medicaid program, significantly changes the Medicare 
        program, creates new mandates and regulations, and will send 
        hundreds of billions of dollars to insurance companies.
            (5) It is the duty of public officials and public servants 
        in Congress and the Administration to protect the American 
        public's taxpayer dollars. Congress and the Administration must 
        continue to aggressively combat waste, fraud, and abuse in 
        public health care programs.
            (6) The Inspector General of the Department of Health and 
        Human Services has stated that ``swift and effective detection 
        of and response to waste, fraud, and abuse remain an essential 
        program integrity strategy''. Furthermore, the Inspector 
        General noted that ``effective use of Medicare and Medicaid 
        data is critical to the success of the Government's efforts to 
        reduce waste, fraud, and abuse''.
            (7) The loss of taxpayer dollars due to waste and fraud 
        under the Medicare and Medicaid programs not only threatens the 
        financial viability of those programs, it erodes the public 
        trust. American taxpayers should not be expected to tolerate 
        rampant waste, fraud, and abuse in publicly funded health care 
        programs.
            (8) Congress supports the commitment of the Office of the 
        Inspector General of the Department of Health and Human 
        Services to ``enhancing existing data analysis and mining 
        capabilities and employing advanced techniques such as 
        predictive analytics and social network analysis, to counter 
        new and existing fraud schemes''.
            (9) Congress supports the use of predictive modeling and 
        other smart technologies that can transform the current ``pay 
        and chase'' payment cultures under the Medicare and Medicaid 
        programs and prevent taxpayer dollars from being lost to waste, 
        fraud, and abuse.

SEC. 3. TRACKING EXCLUDED PROVIDERS ACROSS STATE LINES.

    (a) Greater Coordination.--In order to ensure that providers of 
services and suppliers that have operated in one State and are excluded 
from participation in the Medicare program are unable to begin 
operation and participation in other Federal health care programs in 
another State, the Secretary shall provide for increased coordination 
between the following:
            (1) The Administrator of the Centers for Medicare & 
        Medicaid Services.
            (2) Regional offices of the Centers for Medicare & Medicaid 
        Services.
            (3) Medicare administrative contractors, fiscal 
        intermediaries, and carriers.
            (4) State health agencies, State plans under title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.), State plans 
        under title XXI of such Act (42 U.S.C. 1397aa et seq.), and 
        entities that contract with such agencies and plans, as 
        directed by the Secretary.
            (5) The Federation of State Medical Boards.
    (b) Improved Information Systems.--
            (1) In general.--The Secretary shall improve information 
        systems to allow greater integration between databases under 
        the Medicare program so that--
                    (A) Medicare administrative contractors, fiscal 
                intermediaries, and carriers have immediate access to 
                information identifying providers and suppliers 
                excluded from participation in the Medicare program, 
                the Medicaid program under title XIX of the Social 
                Security Act, the State Children's Health Insurance 
                Program under title XXI of such Act, and other Federal 
                health care programs; and
                    (B) such information can be shared on a real-time 
                basis, in accordance with protocols established under 
                subsection (g)(2)--
                            (i) across Federal health care programs and 
                        agencies, including between the Department of 
                        Health and Human Services, the Social Security 
                        Administration, the Department of Veterans 
                        Affairs, the Department of Defense, the 
                        Department of Justice, and the Office of 
                        Personnel Management; and
                            (ii) with State health agencies, State 
                        plans under title XIX of the Social Security 
                        Act (42 U.S.C. 1396 et seq.), State child 
                        health plans under title XXI of such Act (42 
                        U.S.C. 1397aa et seq.), and entities that 
                        contract with such agencies and plans, as 
                        directed by the Secretary.
            (2) Sharing of information in addition to heat efforts.--
        The information shared under paragraph (1) shall be in addition 
        to, and shall not replace, activities of the Health Care Fraud 
        Prevention and Enforcement Action Team (HEAT) established by 
        the Attorney General and the Department of Health and Human 
        Services.
            (3) Appropriate coordination.--In implementing this 
        subsection, the Secretary shall provide for the maximum 
        appropriate coordination with the process established under 
        section 6401(b)(2) of the Patient Protection and Affordable 
        Care Act (Public Law 111-148).
    (c) ``One PI'' Database for Medicare, Medicaid, and CHIP.--
            (1) In general.--The Secretary shall--
                    (A) continue to upload Medicare claims, provider, 
                and beneficiary data into the Integrated Data 
                Repository under section 1128J(a)(1) of the Social 
                Security Act, as added by section 6402(a) of the 
                Patient Protection and Affordable Care Act until such 
                time as the Secretary determines that the Integrated 
                Data Repository is completed; and
                    (B) fully implement the waste, fraud, and abuse 
                detection solution of the Centers for Medicare & 
                Medicaid Services, called the ``One PI project'' (in 
                this subsection referred to as the ``project'') by not 
                later than January 1, 2013.
            (2) Access.--The Secretary, in consultation with Inspector 
        General of the Department of Health and Human Services, may 
        allow stakeholders who combat, or could assist in combating, 
        waste, fraud, and abuse under Federal health care programs to 
        have access to the One PI system established under the project. 
        Such stakeholders may include the Director of the Federal 
        Bureau of Investigation, the Comptroller General of the United 
        States, Medicare administrative contractors, fiscal 
        intermediaries, and carriers.
    (d) Federal and State Agency Access to National Practitioner Data 
Bank.--For purposes of enhancing data sharing in order to identify 
programmatic weaknesses and improving the timeliness of analysis and 
actions to prevent waste, fraud, and abuse, relevant Federal and State 
agencies, including the Department of Health and Human Services, the 
Department of Justice, State departments of health, State Medicaid 
plans under title XIX of the Social Security Act, State child health 
plans under title XXI of such Act, and State Medicaid fraud control 
units (as described in section 1903(q) of the Social Security Act (42 
U.S.C. 1396b(q))), shall have real-time access to the National 
Practitioner Data Bank, as directed by the Secretary. The Secretary 
may, in consultation with the Inspector General of the Department of 
Health and Human Services, give such real-time access to State 
attorneys general and State and local law enforcement agencies.
    (e) Access to Claims and Payment Databases.--Section 1128J(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 striking ``databases.--For purposes'' and inserting 
        ``databases.--
                    ``(A) Access for the conduct of law enforcement and 
                oversight activities.--For purposes'';
            (2) in subparagraph (A), as added by paragraph (1), by 
        inserting ``, including the Integrated Data Repository under 
        paragraph (1)'' before the period at the end; and
            (3) by adding at the end the following new subparagraph:
                    ``(B) Access to reduce waste, fraud, and abuse.--
                For purposes of reducing waste, fraud, and abuse, and 
                to the extent consistent with applicable information, 
                privacy, security, and disclosure laws, including the 
                regulations promulgated under the Health Insurance 
                Portability and Accountability Act of 1996 and section 
                552a of title 5, United States Code, and subject to any 
                information systems security requirements under such 
                laws or otherwise required by the Secretary, the 
                Secretary, in consultation with the Inspector General 
                of the Department of Health and Human Services, may 
                allow State Medicaid fraud control units and State and 
                local law enforcement officials to have access to 
                claims and payment data of the Department of Health and 
                Human Services and its contractors related to titles 
                XVIII, XIX, and XXI, including the Integrated Data 
                Repository under paragraph (1).''.
    (f) Ensuring Data Is Uploaded to the IDR on a Daily Basis.--Section 
1128J(a)(1) 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 by adding at the end the following new subparagraph:
                    ``(C) Uploading of medicare claims data on a daily 
                basis.--All Medicare claims data shall be uploaded into 
                the Integrated Data Repository on a daily basis.''.
    (g) Real-Time Access to Data.--
            (1) In general.--The Secretary shall ensure that any data 
        provided to an entity or individual under the provisions of or 
        amendments made by this section is provided to such entity or 
        individual on a real-time basis, in accordance with protocols 
        established by the Secretary under paragraph (2). The Secretary 
        shall consult with the Inspector General of the Department of 
        Health and Human Services prior to implementing this 
        subsection.
            (2) Protocols.--
                    (A) In general.--The Secretary shall establish 
                protocols to ensure the secure transfer and storage of 
                any data provided to another entity or individual under 
                the provisions of or amendments made by this section.
                    (B) Consideration of hhs oig recommendations.--In 
                establishing protocols under subparagraph (A), the 
                Secretary shall take into account recommendations 
                submitted to the Secretary by the Inspector General of 
                the Department of Health and Human Services with 
                respect to the secure transfer and storage of such 
                data.
    (h) GAO Study and Report on Use of Federation of State Medical 
Boards To Strengthen Enrollment Integrity Processes.--
            (1) Study.--The Comptroller General of the United States 
        shall, in consultation with the Federation of State Medical 
        Boards, conduct a study on whether and, if so, to what degree, 
        such Federation may be useful to the Secretary in further 
        strengthening the integrity of processes for enrolling 
        providers of services and suppliers under Federal health care 
        programs.
            (2) Report.--Not later than 1 year after the date of 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report containing the results 
        of the study conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Comptroller General determines appropriate.
    (i) Definitions.--In this section:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Centers for Medicare & Medicaid Services.
            (2) CHIP.--The term ``CHIP'' means the State Children's 
        Health Insurance Program under title XXI of the Social Security 
        Act (42 U.S.C. 1397aa et seq.).
            (3) Federal health care program.--The term ``Federal health 
        care program'' has the meaning given such term in section 
        1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)).
            (4) HHS OIG.--The term ``HHS OIG'' means the Inspector 
        General of the Department of Health and Human Services.
            (5) Medicare administrative contractors, fiscal 
        intermediaries, and carriers.--The term ``Medicare 
        administrative contractors, fiscal intermediaries, and 
        carriers'' includes zone program integrity contractors, program 
        safeguard or integrity contractors, recovery audit contractors 
        under section 1893(h) of the Social Security Act (42 U.S.C. 
        1395ddd(h)), and special investigative units at Medicare 
        contractors (as defined in section 1889(g) of the Social 
        Security Act (42 U.S.C. 1395zz(g))).
            (6) Medicare program.--The term ``Medicare program'' means 
        the program under title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.).
            (7) Provider of services.--The term ``provider of 
        services'' has the meaning given such term in section 1861(u) 
        of the Social Security Act (42 U.S.C. 1395x(u)).
            (8) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (9) State.--The term ``State'' includes the District of 
        Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, 
        Guam, and American Samoa.
            (10) Supplier.--The term ``supplier'' has the meaning given 
        such term in section 1861(d) of the Social Security Act (42 
        U.S.C. 1395x(d)).

SEC. 4. ACCESS FOR PRIVATE SECTOR AND GOVERNMENTAL ENTITIES.

    (a) In General.--Title XI of the Social Security Act (42 U.S.C. 
1301 et seq.), as amended by section 6402(a) of the Patient Protection 
and Affordable Care Act (Public Law 111-148), is amended by inserting 
after section 1128J the following new section:

        ``expanded access to the national practitioner data bank

    ``Sec. 1128K.  (a) Expanded Access.--
            ``(1) In general.--The information in the National 
        Practitioner Data Bank established pursuant to the Health Care 
        Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.) may 
        be made available on a real-time basis, in accordance with 
        protocols established by the Secretary under subsection (b), 
        to--
                    ``(A) Federal and State government agencies and 
                health plans, commercial health plans, and any health 
                care provider, supplier, or practitioner entering an 
                employment or contractual relationship with an 
                individual or entity who has been subject to a final 
                adverse action in the past 10 years, where the contract 
                involves the furnishing of items or services reimbursed 
                by one or more Federal health care programs (regardless 
                of whether the individual or entity is paid by the 
                programs directly, or whether the items or services are 
                reimbursed directly or indirectly through the claims of 
                a direct provider); and
                    ``(B) utilization and quality control peer review 
                organizations and accreditation entities as defined by 
                the Secretary, including but not limited to 
                organizations described in part B of this title and in 
                section 1154(a)(4)(C).
            ``(2) No effect on access under other applicable law; 
        appropriate coordination.--Nothing in this section shall affect 
        the availability of information in the National Practitioner 
        Data Bank under other applicable law, including the 
        availability of such information to entities or individuals 
        under part B of the Health Care Quality Improvement Act of 1986 
        (42 U.S.C. 11131 et seq.). In implementing this section, the 
        Secretary shall provide for the maximum appropriate 
        coordination with such part.
    ``(b) Protocols.--The Secretary shall establish protocols to ensure 
the secure transfer and storage of data made available under this 
section. In establishing such protocols the Secretary shall take into 
account recommendations submitted to the Secretary by the Inspector 
General of the Department of Health and Human Services and the National 
Association of Insurance Commissioners with respect to the secure 
transfer and storage of such data, the establishment or approval of a 
fee structure under subsection (c), and the establishment of user 
access protocols.
    ``(c) Fees for Disclosure.--
            ``(1) In general.--
                    ``(A) Fees.--Subject to paragraph (2), the 
                Secretary may establish or approve reasonable fees for 
                the disclosure of information under this section, 
                including with respect to requests by Federal agencies 
                or other entities, such as fiscal intermediaries and 
                carriers, acting under contract on behalf of such 
                agencies.
                    ``(B) Establishment or approval of fee amounts.--In 
                establishing or approving the amount of such fees, the 
                Secretary shall ensure that the total amount of the 
                fees to be collected is equal to the total costs of 
                processing the requests for disclosure and of providing 
                such information. Such fees shall be available to the 
                Secretary to cover such costs.
                    ``(C) For-profit entities.--The Secretary may allow 
                for-profit entities to receive data under this section 
                for a fee that is comparable to the fee charged to a 
                Federal agency or other entity under subparagraph (A) 
                with respect to a similar request.
            ``(2) Free access to certain data.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of the Fighting Fraud and Abuse to 
                Save Taxpayers' Dollars Act, for purposes of 
                identifying additional strategies and tools to combat 
                waste, fraud, and abuse, the Secretary--
                            ``(i) shall establish protocols to ensure 
                        the secure transmission of data under this 
                        section; and
                            ``(ii) may ensure nonprofit academic, 
                        policy, and research institutions have access 
                        to data from the National Practitioner Data 
                        Bank.
                    ``(B) Access free of charge.--Data shall be 
                provided under subparagraph (A)(ii) free of charge to 
                academic, policy, and research institutions.
                    ``(C) Requirement.--Any academic, policy, or 
                research institution that is provided data under 
                subparagraph (A)(ii) shall, as a condition of receiving 
                such data, be required to share with the Secretary any 
                findings using such data to combat waste, fraud, and 
                abuse (in a form and manner of the academic, policy, or 
                research institution's choosing).
    ``(d) Establishment of Appeals Process.--
            ``(1) In general.--The Secretary shall establish a 
        transparent and responsive appeals process under which a 
        provider of services or supplier may have their name removed 
        from the National Practitioner Data Bank. Under such process, 
        appeals shall be conducted in a timely manner (not more than 90 
        days after the earlier of the date of the listing in the 
        National Practitioner Data Bank or the issuance of any penalty 
        involved) in order to minimize the time that providers of 
        services or suppliers who successfully appeal are excluded from 
        participation under the programs under titles XVIII and XIX.
            ``(2) Consultation.--The Secretary shall consult with major 
        colleges of medical practice in the United States, commercial 
        health plans, the Inspector General of the Department of Health 
        and Human Services, the National Association of Insurance 
        Commissioners, and the Federation of State Medical Boards in 
        establishing the appeals process under paragraph (1).
    ``(e) Definitions.--In this section:
            ``(1) Commercial health plan.--The term `commercial health 
        plan' means health insurance coverage (as defined in section 
        2791 of the Public Health Service Act and including group 
        health plans).
            ``(2) Final adverse action.--The term `final adverse 
        action' means one or more of the following actions:
                    ``(A) A Medicare-imposed revocation of any Medicare 
                billing privileges.
                    ``(B) Suspension or revocation of a license to 
                provide health care by any State licensing authority.
                    ``(C) A conviction of a Federal or State felony 
                offense within the last 10 years preceding enrollment, 
                revalidation, or re-enrollment.
                    ``(D) An exclusion or debarment from participation 
                in a Federal or State health care program.''.
    (b) Criminal Penalty for Misuse of Information Disclosed.--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 knowingly uses information disclosed from the 
        National Practitioner Data Bank under section 1128K for a 
        purpose other than those authorized under that section shall be 
        imprisoned for not more than 3 years or fined under title 18, 
        United States Code, or both.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 5. LIABILITY OF MEDICARE ADMINISTRATIVE CONTRACTORS FOR CLAIMS 
              SUBMITTED BY EXCLUDED PROVIDERS.

    (a) Reimbursement to the Secretary for Amounts Paid to Excluded 
Providers.--Section 1874A(b) of the Social Security Act (42 U.S.C. 
1395kk(b)) is amended by adding at the end the following new paragraph:
            ``(6) Reimbursements to secretary for amounts paid to 
        excluded providers.--
                    ``(A) Limitation.--
                            ``(i) In general.--Except as provided in 
                        clause (ii), the Secretary shall not enter into 
                        a contract with a Medicare administrative 
                        contractor under this section unless the 
                        contractor agrees to reimburse the Secretary 
                        for any amounts paid by the contractor for with 
                        respect to any item or service (other than an 
                        emergency item or service, not including items 
                        or services furnished in an emergency room of a 
                        hospital) which is furnished--
                                    ``(I) by an individual or entity 
                                during the period when such individual 
                                or entity is excluded pursuant to 
                                section 1128, 1128A, 1156 or 1842(j)(2) 
                                from participation in the program under 
                                this title; or
                                    ``(II) at the medical direction or 
                                on the prescription of a physician 
                                during the period when he is excluded 
                                pursuant to section 1128, 1128A, 1156, 
                                or 1842(j)(2) from participation in the 
                                program under this title and when the 
                                person furnishing such item or service 
                                knew or had reason to know of the 
                                exclusion (after a reasonable time 
                                period after reasonable notice has been 
                                furnished to the person).
                            ``(ii) Exception.--Where a Medicare 
                        administrative contractor pays a claim for 
                        payment for items or services furnished by an 
                        individual or entity excluded from 
                        participation in the programs under this title, 
                        pursuant to section 1128, 1128A, 1156, or l866, 
                        and such Medicare administrative contractor did 
                        not know or have reason to know that such 
                        individual or entity was so excluded, then, to 
                        the extent permitted by this title, and 
                        notwithstanding such exclusion, the contractor 
                        shall not be required to reimburse the 
                        Secretary under clause (i) for any amounts paid 
                        with respect to such items or services. In each 
                        such case the Secretary shall notify the 
                        contractor of the exclusion of the individual 
                        or entity furnishing the items or services. A 
                        Medicare administrative contractor shall not 
                        make payment for items or services furnished by 
                        an excluded individual or entity to a 
                        beneficiary after a reasonable time (as 
                        determined by the Secretary in regulations) 
                        after the Secretary has notified the contractor 
                        of the exclusion of that individual or entity.
                    ``(B) Requirement to review claims.--A Medicare 
                administrative contractor shall review claims submitted 
                to the contractor for payment for services under this 
                title in order to ensure that such services were not 
                furnished by an individual or entity during any period 
                for which the individual or entity is excluded from 
                such participation (as described in subparagraph 
                (A)).''.
    (b) Report on Effectiveness and Development of Scorecard and 
Measurable Performance Metrics for Medicare Contractors.--
            (1) Report.--
                    (A) In general.--Not later than 12 months after the 
                date of enactment of this Act, the Secretary of Health 
                and Human Services shall submit to Congress a report on 
                the overall effectiveness and potential of Medicare 
                contractors.
                    (B) Contents of report.--The report submitted under 
                subparagraph (A) shall include the Secretary's 
                recommendations for the development of measurable 
                performance metrics and a scorecard for Medicare 
                contractors (or, in the case of Medicare administrative 
                contractors, updated and revised measurable performance 
                metrics and a revised scorecard), together with 
                recommendations for such legislation and administrative 
                action as the Secretary determines appropriate.
            (2) Consultation.--The Secretary shall consult with 
        Medicare contractors, the Inspector General of the Department 
        of Health and Human Services, private sector waste, fraud, and 
        abuse experts, and entities with experience combating and 
        preventing waste, fraud, and abuse, including through the 
        review of Medicare claims, in preparing the report submitted 
        under paragraph (1).
            (3) Medicare contractors defined.--In this subsection, the 
        term ``Medicare contractor'' means any of the following:
                    (A) A Medicare administrative contractor under 
                section 1874A of the Social Security Act.
                    (B) A Medicare Program Safeguard Contractor.
                    (C) A Zone Program Integrity Contractor.
                    (D) A Medicare Drug Integrity Contractor.
    (c) Effective Date.--
            (1) In general.--The amendments made by subsection (a) 
        shall apply to claims for reimbursement submitted on or after 
        the date of enactment of this Act.
            (2) Contract modification.--The Secretary of Health and 
        Human Services shall take such steps as may be necessary to 
        modify contracts entered into, renewed, or extended prior to 
        the date of enactment of this Act to conform such contracts to 
        the provisions of and amendments made by this section.

SEC. 6. LIMITING THE DISCHARGE OF DEBTS IN BANKRUPTCY PROCEEDINGS IN 
              CASES WHERE A HEALTH CARE PROVIDER OR A SUPPLIER ENGAGES 
              IN FRAUDULENT ACTIVITY.

    (a) In General.--
            (1) Civil monetary penalties.--Section 1128A(a) of the 
        Social Security Act (42 U.S.C. 1320a-7a(a)) is amended by 
        adding at the end the following: ``Notwithstanding any other 
        provision of law, amounts made payable under this section are 
        not dischargeable under section 727, 944, 1141, 1228, or 1328 
        of title 11, United States Code, or any other provision of such 
        title.''.
            (2) Recovery of overpayment to providers of services under 
        part a.--Section 1815(d) of the Social Security Act (42 U.S.C. 
        1395g(d)) is amended--
                    (A) by inserting ``(1)'' after ``(d)''; and
                    (B) by adding at the end the following:
            ``(2) Notwithstanding any other provision of law, amounts 
        due to the Secretary under this section are not dischargeable 
        under section 727, 944, 1141, 1228, or 1328 of title 11, United 
        States Code, or any other provision of such title if the 
        overpayment was the result of fraudulent activity, as may be 
        defined by the Secretary.''.
            (3) Recovery of overpayment of benefits under part b.--
        Section 1833(j) of the Social Security Act (42 U.S.C. 1395l(j)) 
        is amended--
                    (A) by inserting ``(1)'' after ``(j)''; and
                    (B) by adding at the end the following:
            ``(2) Notwithstanding any other provision of law, amounts 
        due to the Secretary under this section are not dischargeable 
        under section 727, 944, 1141, 1228, or 1328 of title 11, United 
        States Code, or any other provision of such title if the 
        overpayment was the result of fraudulent activity, as may be 
        defined by the Secretary.''.
            (4) Collection of past-due obligations arising from breach 
        of scholarship and loan contract.--Section 1892(a) of the 
        Social Security Act (42 U.S.C. 1395ccc(a)) is amended by adding 
        at the end the following:
            ``(5) Notwithstanding any other provision of law, amounts 
        due to the Secretary under this section are not dischargeable 
        under section 727, 944, 1141, 1228, or 1328 of title 11, United 
        States Code, or any other provision of such title.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to bankruptcy petitions filed after the date of enactment of this 
Act.

SEC. 7. PREVENTION OF WASTE, FRAUD, AND ABUSE IN THE MEDICAID AND CHIP 
              PROGRAMS.

    (a) Detection of Fraudulent Identification Numbers Within the 
Medicaid and CHIP Programs.--
            (1) Medicaid.--Section 1903(i) of the Social Security Act 
        (42 U.S.C. 1396b(i)), as amended by section 2001(a)(2)(B) of 
        the Patient Protection and Affordable Care Act (Public Law 111-
        148), is amended--
                    (A) in paragraph (25), by striking ``or'' at the 
                end;
                    (B) in paragraph (26), by striking the period and 
                inserting ``; or''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(27) with respect to amounts expended for an item or 
        service for which medical assistance is provided under the 
        State plan or under a waiver of such plan unless the claim for 
        payment for such item or service contains--
                    ``(A) a valid beneficiary identification number 
                that, for purposes of the individual who received such 
                item or service, has been determined by the State 
                agency to correspond to an individual who is eligible 
                to receive benefits under the State plan or waiver; and
                    ``(B) a valid National Provider Identifier that, 
                for purposes of the provider that furnished such item 
                or service, has been determined by the State agency to 
                correspond to a participating provider that is eligible 
                to receive payment for furnishing such item or service 
                under the State plan or waiver.''.
            (2) CHIP.--Section 2107(e)(1)(I) of the Social Security Act 
        (42 U.S.C. 1397gg(e)(1)(I)) is amended by striking ``and (17)'' 
        and inserting ``(17), and (27)''.
    (b) Screening Requirements for Managed Care Entities.--
            (1) In general.--Section 1902 of the Social Security Act 
        (42 U.S.C. 1396a) is amended--
                    (A) by redesignating the second subsection (ii), as 
                added by section 6401(b)(1)(B) of the Patient 
                Protection and Affordable Care Act, as subsection (kk) 
                of such section; and
                    (B) in subsection (kk), as so redesignated--
                            (i) by redesignating paragraph (8) as 
                        paragraph (9); and
                            (ii) by inserting after paragraph (7) the 
                        following new paragraph:
            ``(8) Managed care entities.--The State establishes 
        procedures to ensure that any managed care entity (as defined 
        in section 1932(a)(1)(B)) under contract with the State 
        complies with all applicable requirements under this 
        subsection.''.
            (2) Medicaid managed care organizations.--Section 
        1903(m)(2)(A) of the Social Security Act (42 U.S.C. 
        1396b(m)(2)(A)) is amended--
                    (A) in clause (xii), by striking ``and'' at the 
                end;
                    (B) in clause (xiii), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following new clause:
                            ``(xiv) such contract requires that the 
                        entity comply with any applicable screening, 
                        oversight, and reporting requirements under 
                        section 1902(kk).''.
            (3) Managed care entities.--Section 1932(d) of the Social 
        Security Act (42 U.S.C. 1396u-2(d)) is amended by adding at the 
        end the following new paragraph:
            ``(5) Compliance with screening, oversight, and reporting 
        requirements.--A managed care entity shall comply with any 
        applicable screening, oversight, and reporting requirements 
        under section 1902(kk).''.
    (c) Required Database Checks.--Clause (i) of section 1866(j)(2)(B) 
of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) is amended to 
read as follows:
                            ``(i) shall include--
                                    ``(I) a licensure check, which may 
                                include such checks across States; and
                                    ``(II) for purposes of the Medicaid 
                                program under title XIX--
                                            ``(aa) database checks 
                                        (including such checks across 
                                        States), which shall include--

                                                    ``(AA) the Medicaid 
                                                Statistical Information 
                                                System (as described in 
                                                section 1903(r)(1)(F)); 
                                                and

                                                    ``(BB) any relevant 
                                                medical databases that 
                                                are maintained by the 
                                                State agencies, as 
                                                determined by the 
                                                Secretary in 
                                                consultation with the 
                                                directors of the State 
                                                agencies; and

                                            ``(bb) coordination of 
                                        excluded provider lists between 
                                        the Secretary and the State 
                                        agency, including exchanges of 
                                        data regarding excluding 
                                        providers between Federal and 
                                        State databases; and''.
    (d) Technical Corrections.--Section 1902 of the Social Security Act 
(42 U.S.C. 1396a), as amended by subsection (b)(1), is further 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (23), by striking ``subsection 
                (ii)(4)'' and inserting ``subsection (kk)(4)''; and
                    (B) in paragraph (77), by striking ``subsection 
                (ii)'' and inserting ``subsection (kk)''; and
            (2) in subsection (kk), by striking ``section 1886'' each 
        place it appears and inserting ``section 1866''.

SEC. 8. 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)), as amended by section 4(b), is amended by adding at the end the 
following:
            ``(5) Whoever knowingly, intentionally, and with the intent 
        to defraud purchases, sells or distributes, or arranges for the 
        purchase, sale, or distribution of a Medicare, Medicaid, or 
        CHIP beneficiary identification number or billing privileges 
        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. 9. PILOT PROGRAM FOR THE USE OF UNIVERSAL PRODUCT NUMBERS ON CLAIM 
              FORMS FOR REIMBURSEMENT UNDER THE MEDICARE PROGRAM.

    (a) Establishment.--
            (1) In general.--Not later than January 1, 2013, the 
        Secretary shall establish a pilot program under which claims 
        for reimbursement under the Medicare program for UPN covered 
        items contain the universal product number of the UPN covered 
        item.
            (2) Duration.--The pilot program under this section shall 
        be conducted for a 2-year period.
            (3) Consideration of gao recommendations.--The Secretary 
        shall take into account the recommendations of the Comptroller 
        General of the United States in establishing the pilot program 
        under this section.
    (b) Development and Implementation of Procedures.--
            (1) Information included in upn.--The Secretary, in 
        consultation with manufacturers and entities with appropriate 
        expertise, shall determine the relevant descriptive information 
        appropriate for inclusion in a universal product number for a 
        UPN covered item under the pilot program.
            (2) Review of procedure.--The Secretary, in consultation 
        with interested parties (which shall, at a minimum, include the 
        Inspector General of the Department of Health and Human 
        Services and private sector and health industry experts), shall 
        use information obtained under the pilot program through the 
        use of universal product numbers on claims for reimbursement 
        under the Medicare program to periodically review the UPN 
        covered items billed under the Health Care Financing 
        Administration Common Procedure Coding System and adjust such 
        coding system to ensure that functionally equivalent UPN 
        covered items are billed and reimbursed under the same codes.
    (c) GAO Reports to Congress on Effectiveness of Implementation of 
Pilot Program.--
            (1) Initial report.--Not later than 6 months after the 
        implementation of the pilot program under this section, the 
        Comptroller General of the United States shall submit to 
        Congress a report on the effectiveness of such implementation.
            (2) Final report.--Not later than 18 months after the 
        completion of the pilot program under this section, the 
        Comptroller General of the United States shall submit to 
        Congress a report on the effectiveness of the pilot program, 
        together with recommendations regarding the use of universal 
        product numbers and the use of data obtained from the use of 
        such numbers, and recommendations for such legislation and 
        administrative action as the Comptroller General determines 
        appropriate.
    (d) Use of Available Funding.--The Secretary shall use amounts 
available in the Centers for Medicare & Medicaid Services Program 
Management Account or in the Health Care Fraud and Abuse Control 
Account under section 1817(k) of the Social Security Act (42 U.S.C. 
1395i(k)) to carry out the pilot program under this section.
    (e) Definitions.--In this section:
            (1) Medicare program.--The term ``Medicare program'' means 
        the program under title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (3) Universal product number.--The term ``universal product 
        number'' means a number that is--
                    (A) affixed by the manufacturer to each individual 
                UPN covered item that uniquely identifies the item at 
                each packaging level; and
                    (B) based on commercially acceptable identification 
                standards such as, but not limited to, standards 
                established by the Uniform Code Council--International 
                Article Numbering System or the Health Industry 
                Business Communication Council.
            (4) UPN covered item.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the term ``UPN covered item'' means--
                            (i) a covered item as that term is defined 
                        in section 1834(a)(13) of the Social Security 
                        Act (42 U.S.C. 1395m(a)(13));
                            (ii) an item described in paragraph (8) or 
                        (9) of section 1861(s) of such Act (42 U.S.C. 
                        1395x);
                            (iii) an item described in paragraph (5) of 
                        such section 1861(s); and
                            (iv) any other item for which payment is 
                        made under this title that the Secretary 
                        determines to be appropriate.
                    (B) Exclusion.--The term ``UPN covered item'' does 
                not include a customized item for which payment is made 
                under this title.

SEC. 10. PROHIBITION OF INCLUSION OF SOCIAL SECURITY ACCOUNT NUMBERS ON 
              MEDICARE CARDS.

    (a) In General.--Section 205(c)(2)(C) of the Social Security Act 
(42 U.S.C. 405(c)(2)(C)), as amended by section 1414(a)(2) of the 
Patient Protection and Affordable Care Act (Public Law 111-148), is 
amended by adding at the end the following new clause:
    ``(xi) The Secretary of Health and Human Services, in consultation 
with the Commissioner of Social Security, shall establish cost-
effective procedures to ensure that a Social Security account number 
(or any derivative thereof) is not displayed, coded, or embedded on the 
Medicare card issued to an individual who is entitled to benefits under 
part A of title XVIII or enrolled under part B of title XVIII and that 
any other identifier displayed on such card is easily identifiable as 
not being the Social Security account number (or a derivative 
thereof).''.
    (b) Effective Date.--
            (1) In general.--The amendment made by subsection (a) shall 
        apply with respect to Medicare cards issued on and after an 
        effective date specified by the Secretary of Health and Human 
        Services, but in no case shall such effective date be later 
        than the date that is 24 months after the date adequate funding 
        is provided pursuant to subsection (d)(2).
            (2) Reissuance.--Subject to subsection (d)(2), in the case 
        of individuals who have been issued such cards before such 
        date, the Secretary of Health and Human Services--
                    (A) shall provide for the reissuance for such 
                individuals of such a card that complies with such 
                amendment not later than 3 years after the effective 
                date specified under paragraph (1); and
                    (B) may permit such individuals to apply for the 
                reissuance of such a card that complies with such 
                amendment before the date of reissuance otherwise 
                provided under subparagraph (A) in such exceptional 
                circumstances as the Secretary may specify.
    (c) Outreach Program.--Subject to subsection (d)(2), the Secretary 
of Health and Human Services, in consultation with the Commissioner of 
Social Security, shall conduct an outreach program to Medicare 
beneficiaries and providers about the new Medicare card provided under 
this section.
    (d) Report to Congress and Limitations on Effective Date.--
            (1) Report.--Not later than 90 days after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services, acting through the Administrator of the Centers for 
        Medicare & Medicaid Services and in consultation with the 
        Commissioner of Social Security, shall submit to Congress a 
        report that includes detailed options regarding the 
        implementation of this section, including line-item estimates 
        of and justifications for the costs associated with such 
        options and estimates of timeframes for each stage of 
        implementation. In recommending such options, the Secretary 
        shall take into consideration, among other factors, cost-
        effectiveness and beneficiary outreach and education.
            (2) Limitation; modification of deadlines.--With respect to 
        the amendment made by subsection (a), and the requirements of 
        subsections (b) and (c)--
                    (A) such amendment and requirements shall not apply 
                until adequate funding is transferred pursuant to 
                section 11(b) to implement the provisions of this 
                section, as determined by Congress; and
                    (B) any deadlines otherwise established under this 
                section for such amendment and requirements are 
                contingent upon the receipt of adequate funding (as 
                determined in subparagraph (A)) for such 
                implementation.
        The previous sentence shall not affect the timely submission of 
        the report required under paragraph (1).

SEC. 11. IMPLEMENTATION.

    (a) Empowering the HHS OIG and GAO.--Except as otherwise provided, 
to the extent practicable, the Secretary of Health and Human Services 
(in this section referred to as the ``Secretary'') shall--
            (1) carry out the provisions of and amendments made by this 
        Act in consultation with the Inspector General of the 
        Department of Health and Human Services; and
            (2) take into consideration the findings and 
        recommendations of the Comptroller General of the United States 
        in carrying out such provisions and amendments.
    (b) Funding.--The Secretary shall provide for the transfer, from 
the Health Care Fraud and Abuse Control Account under section 1817(k) 
of the Social Security Act (42 U.S.C. 1395i(k)), to the Centers for 
Medicare & Medicaid Services Program Management Account, of such sums, 
provided such sums are fully offset, as the Secretary determines are 
for necessary administrative expenses associated with carrying out the 
provisions of and amendments made by this Act (other than section 9). 
Amounts transferred under the preceding sentence shall remain available 
until expended.
    (c) Savings.--Any reduction in outlays under the Medicare program 
under title XVIII of the Social Security Act under the provisions of, 
and amendments made by, this Act may only be utilized to offset outlays 
under part A of such title.
                                 <all>
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