I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Fighting Fraud and Abuse to Save Taxpayers’ Dollars 

6 Act’’ or the ‘‘FAST Act’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 


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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. 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The Medicare program loses an estimated 

4 $60,000,000,000 annually to wasted and fraudulent 

5 payments. 

6 (2) The Medicaid program also suffers from 

7 rampant fraud. As the Office of the Inspector Gen8 eral of the Department of Health and Human Serv9 ices noted in 2009, in an analysis of the only source 

10 of nationwide Medicaid claims and beneficiary eligi11 bility information, the Medicaid Statistical Informa12 tion System, the Federal Government does not have 

13 ‘‘timely, accurate, or comprehensive information for 

14 fraud, waste, and abuse detection’’ in the Medicaid 

15 program. 

16 (3) Absent comprehensive estimates, the Med17 icaid program’s improper payment rate may be the 

18 most objective measure of taxpayer dollars lost to 


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1 fraud. The national average improper payment rate 

2 ranges between 8.7 percent and 10.5 percent, but 

3 many States have much higher improper payment 

4 rates. 

5 (4) The new Federal health reform law substan6 tially expands the Medicaid program, significantly 

7 changes the Medicare program, creates new man8 dates and regulations, and will send hundreds of bil9 lions of dollars to insurance companies. 

10 (5) It is the duty of public officials and public 

11 servants in Congress and the Administration to pro12 tect the American public’s taxpayer dollars. Con13 gress and the Administration must continue to ag14 gressively combat waste, fraud, and abuse in public 

15 health care programs. 

16 (6) The Inspector General of the Department of 

17 Health and Human Services has stated that ‘‘swift 

18 and effective detection of and response to waste, 

19 fraud, and abuse remain an essential program integ20 rity strategy’’. Furthermore, the Inspector General 

21 noted that ‘‘effective use of Medicare and Medicaid 

22 data is critical to the success of the Government’s 

23 efforts to reduce waste, fraud, and abuse’’. 

24 (7) The loss of taxpayer dollars due to waste 

25 and fraud under the Medicare and Medicaid proVerDate Mar 15 2010 02:02 Oct 15, 2010 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6378.IH H6378

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1 grams not only threatens the financial viability of 

2 those programs, it erodes the public trust. American 

3 taxpayers should not be expected to tolerate ramp4 ant waste, fraud, and abuse in publicly funded 

5 health care programs. 

6 (8) Congress supports the commitment of the 

7 Office of the Inspector General of the Department of 

8 Health and Human Services to ‘‘enhancing existing 

9 data analysis and mining capabilities and employing 

10 advanced techniques such as predictive analytics and 

11 social network analysis, to counter new and existing 

12 fraud schemes’’. 

13 (9) Congress supports the use of predictive 

14 modeling and other smart technologies that can 

15 transform the current ‘‘pay and chase’’ payment cul16 tures under the Medicare and Medicaid programs 

17 and prevent taxpayer dollars from being lost to 

18 waste, fraud, and abuse. 

19 SEC. 3. TRACKING EXCLUDED PROVIDERS ACROSS STATE 

20 LINES. 

21 (a) GREATER COORDINATION.—In order to ensure 

22 that providers of services and suppliers that have operated 

23 in one State and are excluded from participation in the 

24 Medicare program are unable to begin operation and par25 ticipation in other Federal health care programs in anVerDate Mar 15 2010 02:02 Oct 15, 2010 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6378.IH H6378

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1 other State, the Secretary shall provide for increased co2 ordination between the following: 

3 (1) The Administrator of the Centers for Medi4 care & Medicaid Services. 

5 (2) Regional offices of the Centers for Medicare 

6 & Medicaid Services. 

7 (3) Medicare administrative contractors, fiscal 

8 intermediaries, and carriers. 

9 (4) State health agencies, State plans under 

10 title XIX of the Social Security Act (42 U.S.C. 1396 

11 et seq.), State plans under title XXI of such Act (42 

12 U.S.C. 1397aa et seq.), and entities that contract 

13 with such agencies and plans, as directed by the 

14 Secretary. 

15 (5) The Federation of State Medical Boards. 

16 (b) IMPROVED INFORMATION SYSTEMS.— 

17 (1) IN GENERAL.—The Secretary shall improve 

18 information systems to allow greater integration be19 tween databases under the Medicare program so 

20 that— 

21 (A) Medicare administrative contractors, 

22 fiscal intermediaries, and carriers have imme23 diate access to information identifying providers 

24 and suppliers excluded from participation in the 

25 Medicare program, the Medicaid program under 


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1 title XIX of the Social Security Act, the State 

2 Children’s Health Insurance Program under 

3 title XXI of such Act, and other Federal health 

4 care programs; and 

5 (B) such information can be shared on a 

6 real-time basis, in accordance with protocols es7 tablished under subsection (g)(2)— 

8 (i) across Federal health care pro9 grams and agencies, including between the 

10 Department of Health and Human Serv11 ices, the Social Security Administration, 

12 the Department of Veterans Affairs, the 

13 Department of Defense, the Department of 

14 Justice, and the Office of Personnel Man15 agement; and 

16 (ii) with State health agencies, State 

17 plans under title XIX of the Social Secu18 rity Act (42 U.S.C. 1396 et seq.), State 

19 child health plans under title XXI of such 

20 Act (42 U.S.C. 1397aa et seq.), and enti21 ties that contract with such agencies and 

22 plans, as directed by the Secretary. 

23 (2) SHARING OF INFORMATION IN ADDITION TO

24 HEAT EFFORTS.—The information shared under 

25 paragraph (1) shall be in addition to, and shall not 


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1 replace, activities of the Health Care Fraud Preven2 tion and Enforcement Action Team (HEAT) estab3 lished by the Attorney General and the Department 

4 of Health and Human Services. 

5 (3) APPROPRIATE COORDINATION.—In imple6 menting this subsection, the Secretary shall provide 

7 for the maximum appropriate coordination with the 

8 process established under section 6401(b)(2) of the 

9 Patient Protection and Affordable Care Act (Public 

10 Law 111–148). 

11 (c) ‘‘ONE PI’’ DATABASE FOR MEDICARE, MEDICAID, 

12 AND CHIP.— 

13 (1) IN GENERAL.—The Secretary shall— 

14 (A) continue to upload Medicare claims, 

15 provider, and beneficiary data into the Inte16 grated Data Repository under section 

17 1128J(a)(1) of the Social Security Act, as 

18 added by section 6402(a) of the Patient Protec19 tion and Affordable Care Act until such time as 

20 the Secretary determines that the Integrated 

21 Data Repository is completed; and 

22 (B) fully implement the waste, fraud, and 

23 abuse detection solution of the Centers for 

24 Medicare & Medicaid Services, called the ‘‘One 

25 PI project’’ (in this subsection referred to as 


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1 the ‘‘project’’) by not later than January 1, 

2 2013. 

3 (2) ACCESS.—The Secretary, in consultation 

4 with Inspector General of the Department of Health 

5 and Human Services, may allow stakeholders who 

6 combat, or could assist in combating, waste, fraud, 

7 and abuse under Federal health care programs to 

8 have access to the One PI system established under 

9 the project. Such stakeholders may include the Di10 rector of the Federal Bureau of Investigation, the 

11 Comptroller General of the United States, Medicare 

12 administrative contractors, fiscal intermediaries, and 

13 carriers. 

14 (d) FEDERAL AND STATE AGENCY ACCESS TO NA15 TIONAL PRACTITIONER DATA BANK.—For purposes of 

16 enhancing data sharing in order to identify programmatic 

17 weaknesses and improving the timeliness of analysis and 

18 actions to prevent waste, fraud, and abuse, relevant Fed19 eral and State agencies, including the Department of 

20 Health and Human Services, the Department of Justice, 

21 State departments of health, State Medicaid plans under 

22 title XIX of the Social Security Act, State child health 

23 plans under title XXI of such Act, and State Medicaid 

24 fraud control units (as described in section 1903(q) of the 

25 Social Security Act (42 U.S.C. 1396b(q))), shall have realVerDate Mar 15 2010 02:02 Oct 15, 2010 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6378.IH H6378

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1 time access to the National Practitioner Data Bank, as 

2 directed by the Secretary. The Secretary may, in consulta3 tion with the Inspector General of the Department of 

4 Health and Human Services, give such real-time access 

5 to State attorneys general and State and local law enforce6 ment agencies. 

7 (e) ACCESS TO CLAIMS AND PAYMENT DATA8 BASES.—Section 1128J(a)(2) of the Social Security Act, 

9 as added by section 6402(a) of the Patient Protection and 

10 Affordable Care Act (Public Law 111–148) is amended— 

11 (1) by striking ‘‘DATABASES.—For purposes’’ 

12 and inserting ‘‘DATABASES.— 

13 ‘‘(A) ACCESS FOR THE CONDUCT OF LAW

14 ENFORCEMENT AND OVERSIGHT ACTIVITIES.— 

15 For purposes’’; 

16 (2) in subparagraph (A), as added by para17 graph (1), by inserting ‘‘, including the Integrated 

18 Data Repository under paragraph (1)’’ before the 

19 period at the end; and 

20 (3) by adding at the end the following new sub21 paragraph: 

22 ‘‘(B) ACCESS TO REDUCE WASTE, FRAUD, 

23 AND ABUSE.—For purposes of reducing waste, 

24 fraud, and abuse, and to the extent consistent 

25 with applicable information, privacy, security, 


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1 and disclosure laws, including the regulations 

2 promulgated under the Health Insurance Port3 ability and Accountability Act of 1996 and sec4 tion 552a of title 5, United States Code, and 

5 subject to any information systems security re6 quirements under such laws or otherwise re7 quired by the Secretary, the Secretary, in con8 sultation with the Inspector General of the De9 partment of Health and Human Services, may 

10 allow State Medicaid fraud control units and 

11 State and local law enforcement officials to 

12 have access to claims and payment data of the 

13 Department of Health and Human Services and 

14 its contractors related to titles XVIII, XIX, and 

15 XXI, including the Integrated Data Repository 

16 under paragraph (1).’’. 

17 (f) ENSURING DATA IS UPLOADED TO THE IDR ON

18 A DAILY BASIS.—Section 1128J(a)(1) of the Social Secu19 rity Act, as added by section 6402(a) of the Patient Pro20 tection and Affordable Care Act (Public Law 111–148) 

21 is amended by adding at the end the following new sub22 paragraph: 

23 ‘‘(C) UPLOADING OF MEDICARE CLAIMS

24 DATA ON A DAILY BASIS.—All Medicare claims 


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1 data shall be uploaded into the Integrated Data 

2 Repository on a daily basis.’’. 

3 (g) REAL-TIME ACCESS TO DATA.— 

4 (1) IN GENERAL.—The Secretary shall ensure 

5 that any data provided to an entity or individual 

6 under the provisions of or amendments made by this 

7 section is provided to such entity or individual on a 

8 real-time basis, in accordance with protocols estab9 lished by the Secretary under paragraph (2). The 

10 Secretary shall consult with the Inspector General of 

11 the Department of Health and Human Services 

12 prior to implementing this subsection. 

13 (2) PROTOCOLS.— 

14 (A) IN GENERAL.—The Secretary shall es15 tablish protocols to ensure the secure transfer 

16 and storage of any data provided to another en17 tity or individual under the provisions of or 

18 amendments made by this section. 

19 (B) CONSIDERATION OF HHS OIG REC20 OMMENDATIONS.—In establishing protocols 

21 under subparagraph (A), the Secretary shall 

22 take into account recommendations submitted 

23 to the Secretary by the Inspector General of the 

24 Department of Health and Human Services 


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1 with respect to the secure transfer and storage 

2 of such data. 

3 (h) GAO STUDY AND REPORT ON USE OF FEDERA4 TION OF STATE MEDICAL BOARDS TO STRENGTHEN EN5 ROLLMENT INTEGRITY PROCESSES.— 

6 (1) STUDY.—The Comptroller General of the 

7 United States shall, in consultation with the Federa8 tion of State Medical Boards, conduct a study on 

9 whether and, if so, to what degree, such Federation 

10 may be useful to the Secretary in further strength11 ening the integrity of processes for enrolling pro12 viders of services and suppliers under Federal health 

13 care programs. 

14 (2) REPORT.—Not later than 1 year after the 

15 date of enactment of this Act, the Comptroller Gen16 eral of the United States shall submit to Congress 

17 a report containing the results of the study con18 ducted under paragraph (1), together with rec19 ommendations for such legislation and administra20 tive action as the Comptroller General determines 

21 appropriate. 

22 (i) DEFINITIONS.—In this section: 

23 (1) ADMINISTRATOR.—The term ‘‘Adminis24 trator’’ means the Administrator of the Centers for 

25 Medicare & Medicaid Services. 


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1 (2) CHIP.—The term ‘‘CHIP’’ means the 

2 State Children’s Health Insurance Program under 

3 title XXI of the Social Security Act (42 U.S.C. 

4 1397aa et seq.). 

5 (3) FEDERAL HEALTH CARE PROGRAM.—The 

6 term ‘‘Federal health care program’’ has the mean7 ing given such term in section 1128B(f) of the So8 cial Security Act (42 U.S.C. 1320a–7b(f)). 

9 (4) HHS OIG.—The term ‘‘HHS OIG’’ means 

10 the Inspector General of the Department of Health 

11 and Human Services. 

12 (5) MEDICARE ADMINISTRATIVE CONTRACTORS, 

13 FISCAL INTERMEDIARIES, AND CARRIERS.—The 

14 term ‘‘Medicare administrative contractors, fiscal 

15 intermediaries, and carriers’’ includes zone program 

16 integrity contractors, program safeguard or integrity 

17 contractors, recovery audit contractors under section 

18 1893(h) of the Social Security Act (42 U.S.C. 

19 1395ddd(h)), and special investigative units at Medi20 care contractors (as defined in section 1889(g) of 

21 the Social Security Act (42 U.S.C. 1395zz(g))). 

22 (6) MEDICARE PROGRAM.—The term ‘‘Medicare 

23 program’’ means the program under title XVIII of 

24 the Social Security Act (42 U.S.C. 1395 et seq.). 


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1 (7) PROVIDER OF SERVICES.—The term ‘‘pro2 vider of services’’ has the meaning given such term 

3 in section 1861(u) of the Social Security Act (42 

4 U.S.C. 1395x(u)). 

5 (8) SECRETARY.—The term ‘‘Secretary’’ means 

6 the Secretary of Health and Human Services. 

7 (9) STATE.—The term ‘‘State’’ includes the 

8 District of Columbia, the Commonwealth of Puerto 

9 Rico, the Virgin Islands, Guam, and American 

10 Samoa. 

11 (10) SUPPLIER.—The term ‘‘supplier’’ has the 

12 meaning given such term in section 1861(d) of the 

13 Social Security Act (42 U.S.C. 1395x(d)). 

14 SEC. 4. ACCESS FOR PRIVATE SECTOR AND GOVERN15 MENTAL ENTITIES. 

16 (a) IN GENERAL.—Title XI of the Social Security Act 

17 (42 U.S.C. 1301 et seq.), as amended by section 6402(a) 

18 of the Patient Protection and Affordable Care Act (Public 

19 Law 111–148), is amended by inserting after section 

20 1128J the following new section: 

21 ‘‘EXPANDED ACCESS TO THE NATIONAL PRACTITIONER

22 DATA BANK

23 ‘‘SEC. 1128K. (a) EXPANDED ACCESS.— 

24 ‘‘(1) IN GENERAL.—The information in the Na25 tional Practitioner Data Bank established pursuant 

26 to the Health Care Quality Improvement Act of 


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1 1986 (42 U.S.C. 11101 et seq.) may be made avail2 able on a real-time basis, in accordance with proto3 cols established by the Secretary under subsection 

4 (b), to— 

5 ‘‘(A) Federal and State government agen6 cies and health plans, commercial health plans, 

7 and any health care provider, supplier, or prac8 titioner entering an employment or contractual 

9 relationship with an individual or entity who 

10 has been subject to a final adverse action in the 

11 past 10 years, where the contract involves the 

12 furnishing of items or services reimbursed by 

13 one or more Federal health care programs (re14 gardless of whether the individual or entity is 

15 paid by the programs directly, or whether the 

16 items or services are reimbursed directly or in17 directly through the claims of a direct pro18 vider); and 

19 ‘‘(B) utilization and quality control peer 

20 review organizations and accreditation entities 

21 as defined by the Secretary, including but not 

22 limited to organizations described in part B of 

23 this title and in section 1154(a)(4)(C). 

24 ‘‘(2) NO EFFECT ON ACCESS UNDER OTHER AP25 PLICABLE LAW; APPROPRIATE COORDINATION.— 


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1 Nothing in this section shall affect the availability of 

2 information in the National Practitioner Data Bank 

3 under other applicable law, including the availability 

4 of such information to entities or individuals under 

5 part B of the Health Care Quality Improvement Act 

6 of 1986 (42 U.S.C. 11131 et seq.). In implementing 

7 this section, the Secretary shall provide for the max8 imum appropriate coordination with such part. 

9 ‘‘(b) PROTOCOLS.—The Secretary shall establish pro10 tocols to ensure the secure transfer and storage of data 

11 made available under this section. In establishing such 

12 protocols the Secretary shall take into account rec13 ommendations submitted to the Secretary by the Inspector 

14 General of the Department of Health and Human Services 

15 and the National Association of Insurance Commissioners 

16 with respect to the secure transfer and storage of such 

17 data, the establishment or approval of a fee structure 

18 under subsection (c), and the establishment of user access 

19 protocols. 

20 ‘‘(c) FEES FOR DISCLOSURE.— 

21 ‘‘(1) IN GENERAL.— 

22 ‘‘(A) FEES.—Subject to paragraph (2), the 

23 Secretary may establish or approve reasonable 

24 fees for the disclosure of information under this 

25 section, including with respect to requests by 


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1 Federal agencies or other entities, such as fiscal 

2 intermediaries and carriers, acting under con3 tract on behalf of such agencies. 

4 ‘‘(B) ESTABLISHMENT OR APPROVAL OF

5 FEE AMOUNTS.—In establishing or approving 

6 the amount of such fees, the Secretary shall en7 sure that the total amount of the fees to be col8 lected is equal to the total costs of processing 

9 the requests for disclosure and of providing 

10 such information. Such fees shall be available to 

11 the Secretary to cover such costs. 

12 ‘‘(C) FOR-PROFIT ENTITIES.—The Sec13 retary may allow for-profit entities to receive 

14 data under this section for a fee that is com15 parable to the fee charged to a Federal agency 

16 or other entity under subparagraph (A) with re17 spect to a similar request. 

18 ‘‘(2) FREE ACCESS TO CERTAIN DATA.— 

19 ‘‘(A) IN GENERAL.—Not later than 1 year 

20 after the date of enactment of the Fighting 

21 Fraud and Abuse to Save Taxpayers’ Dollars 

22 Act, for purposes of identifying additional strat23 egies and tools to combat waste, fraud, and 

24 abuse, the Secretary— 


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1 ‘‘(i) shall establish protocols to ensure 

2 the secure transmission of data under this 

3 section; and 

4 ‘‘(ii) may ensure nonprofit academic, 

5 policy, and research institutions have ac6 cess to data from the National Practitioner 

7 Data Bank. 

8 ‘‘(B) ACCESS FREE OF CHARGE.—Data 

9 shall be provided under subparagraph (A)(ii) 

10 free of charge to academic, policy, and research 

11 institutions. 

12 ‘‘(C) REQUIREMENT.—Any academic, pol13 icy, or research institution that is provided data 

14 under subparagraph (A)(ii) shall, as a condition 

15 of receiving such data, be required to share 

16 with the Secretary any findings using such data 

17 to combat waste, fraud, and abuse (in a form 

18 and manner of the academic, policy, or research 

19 institution’s choosing). 

20 ‘‘(d) ESTABLISHMENT OF APPEALS PROCESS.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall estab22 lish a transparent and responsive appeals process 

23 under which a provider of services or supplier may 

24 have their name removed from the National Practi25 tioner Data Bank. Under such process, appeals shall 


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1 be conducted in a timely manner (not more than 90 

2 days after the earlier of the date of the listing in the 

3 National Practitioner Data Bank or the issuance of 

4 any penalty involved) in order to minimize the time 

5 that providers of services or suppliers who success6 fully appeal are excluded from participation under 

7 the programs under titles XVIII and XIX. 

8 ‘‘(2) CONSULTATION.—The Secretary shall con9 sult with major colleges of medical practice in the 

10 United States, commercial health plans, the Inspec11 tor General of the Department of Health and 

12 Human Services, the National Association of Insur13 ance Commissioners, and the Federation of State 

14 Medical Boards in establishing the appeals process 

15 under paragraph (1). 

16 ‘‘(e) DEFINITIONS.—In this section: 

17 ‘‘(1) COMMERCIAL HEALTH PLAN.—The term 

18 ‘commercial health plan’ means health insurance 

19 coverage (as defined in section 2791 of the Public 

20 Health Service Act and including group health 

21 plans). 

22 ‘‘(2) FINAL ADVERSE ACTION.—The term ‘final 

23 adverse action’ means one or more of the following 

24 actions: 


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1 ‘‘(A) A Medicare-imposed revocation of any 

2 Medicare billing privileges. 

3 ‘‘(B) Suspension or revocation of a license 

4 to provide health care by any State licensing 

5 authority. 

6 ‘‘(C) A conviction of a Federal or State fel7 ony offense within the last 10 years preceding 

8 enrollment, revalidation, or re-enrollment. 

9 ‘‘(D) An exclusion or debarment from par10 ticipation in a Federal or State health care pro11 gram.’’. 

12 (b) CRIMINAL PENALTY FOR MISUSE OF INFORMA13 TION DISCLOSED.—Section 1128B(b) of the Social Secu14 rity Act (42 U.S.C. 1320a–7b(b)) is amended by adding 

15 at the end the following: 

16 ‘‘(4) Whoever knowingly uses information dis17 closed from the National Practitioner Data Bank 

18 under section 1128K for a purpose other than those 

19 authorized under that section shall be imprisoned for 

20 not more than 3 years or fined under title 18, 

21 United States Code, or both.’’. 

22 (c) EFFECTIVE DATE.—The amendments made by 

23 this section shall take effect on the date of enactment of 

24 this Act. 


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1 SEC. 5. LIABILITY OF MEDICARE ADMINISTRATIVE CON2 TRACTORS FOR CLAIMS SUBMITTED BY EX3 CLUDED PROVIDERS. 

4 (a) REIMBURSEMENT TO THE SECRETARY FOR

5 AMOUNTS PAID TO EXCLUDED PROVIDERS.—Section 

6 1874A(b) of the Social Security Act (42 U.S.C. 

7 1395kk(b)) is amended by adding at the end the following 

8 new paragraph: 

9 ‘‘(6) REIMBURSEMENTS TO SECRETARY FOR

10 AMOUNTS PAID TO EXCLUDED PROVIDERS.— 

11 ‘‘(A) LIMITATION.— 

12 ‘‘(i) IN GENERAL.—Except as pro13 vided in clause (ii), the Secretary shall not 

14 enter into a contract with a Medicare ad15 ministrative contractor under this section 

16 unless the contractor agrees to reimburse 

17 the Secretary for any amounts paid by the 

18 contractor for with respect to any item or 

19 service (other than an emergency item or 

20 service, not including items or services fur21 nished in an emergency room of a hospital) 

22 which is furnished— 

23 ‘‘(I) by an individual or entity 

24 during the period when such indi25 vidual or entity is excluded pursuant 

26 to section 1128, 1128A, 1156 or 


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1 1842(j)(2) from participation in the 

2 program under this title; or 

3 ‘‘(II) at the medical direction or 

4 on the prescription of a physician dur5 ing the period when he is excluded 

6 pursuant to section 1128, 1128A, 

7 1156, or 1842(j)(2) from participation 

8 in the program under this title and 

9 when the person furnishing such item 

10 or service knew or had reason to know 

11 of the exclusion (after a reasonable 

12 time period after reasonable notice 

13 has been furnished to the person). 

14 ‘‘(ii) EXCEPTION.—Where a Medicare 

15 administrative contractor pays a claim for 

16 payment for items or services furnished by 

17 an individual or entity excluded from par18 ticipation in the programs under this title, 

19 pursuant to section 1128, 1128A, 1156, or 

20 l866, and such Medicare administrative 

21 contractor did not know or have reason to 

22 know that such individual or entity was so 

23 excluded, then, to the extent permitted by 

24 this title, and notwithstanding such exclu25 sion, the contractor shall not be required 


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1 to reimburse the Secretary under clause (i) 

2 for any amounts paid with respect to such 

3 items or services. In each such case the 

4 Secretary shall notify the contractor of the 

5 exclusion of the individual or entity fur6 nishing the items or services. A Medicare 

7 administrative contractor shall not make 

8 payment for items or services furnished by 

9 an excluded individual or entity to a bene10 ficiary after a reasonable time (as deter11 mined by the Secretary in regulations) 

12 after the Secretary has notified the con13 tractor of the exclusion of that individual 

14 or entity. 

15 ‘‘(B) REQUIREMENT TO REVIEW CLAIMS.— 

16 A Medicare administrative contractor shall re17 view claims submitted to the contractor for pay18 ment for services under this title in order to en19 sure that such services were not furnished by 

20 an individual or entity during any period for 

21 which the individual or entity is excluded from 

22 such participation (as described in subpara23 graph (A)).’’. 


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1 (b) REPORT ON EFFECTIVENESS AND DEVELOP2 MENT OF SCORECARD AND MEASURABLE PERFORMANCE

3 METRICS FOR MEDICARE CONTRACTORS.— 

4 (1) REPORT.— 

5 (A) IN GENERAL.—Not later than 12 

6 months after the date of enactment of this Act, 

7 the Secretary of Health and Human Services 

8 shall submit to Congress a report on the overall 

9 effectiveness and potential of Medicare contrac10 tors. 

11 (B) CONTENTS OF REPORT.—The report 

12 submitted under subparagraph (A) shall include 

13 the Secretary’s recommendations for the devel14 opment of measurable performance metrics and 

15 a scorecard for Medicare contractors (or, in the 

16 case of Medicare administrative contractors, up17 dated and revised measurable performance 

18 metrics and a revised scorecard), together with 

19 recommendations for such legislation and ad20 ministrative action as the Secretary determines 

21 appropriate. 

22 (2) CONSULTATION.—The Secretary shall con23 sult with Medicare contractors, the Inspector Gen24 eral of the Department of Health and Human Serv25 ices, private sector waste, fraud, and abuse experts, 


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1 and entities with experience combating and pre2 venting waste, fraud, and abuse, including through 

3 the review of Medicare claims, in preparing the re4 port submitted under paragraph (1). 

5 (3) MEDICARE CONTRACTORS DEFINED.—In 

6 this subsection, the term ‘‘Medicare contractor’’ 

7 means any of the following: 

8 (A) A Medicare administrative contractor 

9 under section 1874A of the Social Security Act. 

10 (B) A Medicare Program Safeguard Con11 tractor. 

12 (C) A Zone Program Integrity Contractor. 

13 (D) A Medicare Drug Integrity Contractor. 

14 (c) EFFECTIVE DATE.— 

15 (1) IN GENERAL.—The amendments made by 

16 subsection (a) shall apply to claims for reimburse17 ment submitted on or after the date of enactment of 

18 this Act. 

19 (2) CONTRACT MODIFICATION.—The Secretary 

20 of Health and Human Services shall take such steps 

21 as may be necessary to modify contracts entered 

22 into, renewed, or extended prior to the date of enact23 ment of this Act to conform such contracts to the 

24 provisions of and amendments made by this section. 


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1 SEC. 6. LIMITING THE DISCHARGE OF DEBTS IN BANK2 RUPTCY PROCEEDINGS IN CASES WHERE A 

3 HEALTH CARE PROVIDER OR A SUPPLIER EN4 GAGES IN FRAUDULENT ACTIVITY. 

5 (a) IN GENERAL.— 

6 (1) CIVIL MONETARY PENALTIES.—Section 

7 1128A(a) of the Social Security Act (42 U.S.C. 

8 1320a–7a(a)) is amended by adding at the end the 

9 following: ‘‘Notwithstanding any other provision of 

10 law, amounts made payable under this section are 

11 not dischargeable under section 727, 944, 1141, 

12 1228, or 1328 of title 11, United States Code, or 

13 any other provision of such title.’’. 

14 (2) RECOVERY OF OVERPAYMENT TO PRO15 VIDERS OF SERVICES UNDER PART A.—Section 

16 1815(d) of the Social Security Act (42 U.S.C. 

17 1395g(d)) is amended— 

18 (A) by inserting ‘‘(1)’’ after ‘‘(d)’’; and 

19 (B) by adding at the end the following: 

20 ‘‘(2) Notwithstanding any other provision of 

21 law, amounts due to the Secretary under this section 

22 are not dischargeable under section 727, 944, 1141, 

23 1228, or 1328 of title 11, United States Code, or 

24 any other provision of such title if the overpayment 

25 was the result of fraudulent activity, as may be de26 fined by the Secretary.’’. 


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1 (3) RECOVERY OF OVERPAYMENT OF BENEFITS

2 UNDER PART B.—Section 1833(j) of the Social Secu3 rity Act (42 U.S.C. 1395l(j)) is amended— 

4 (A) by inserting ‘‘(1)’’ after ‘‘(j)’’; and 

5 (B) by adding at the end the following: 

6 ‘‘(2) Notwithstanding any other provision of 

7 law, amounts due to the Secretary under this section 

8 are not dischargeable under section 727, 944, 1141, 

9 1228, or 1328 of title 11, United States Code, or 

10 any other provision of such title if the overpayment 

11 was the result of fraudulent activity, as may be de12 fined by the Secretary.’’. 

13 (4) COLLECTION OF PAST-DUE OBLIGATIONS

14 ARISING FROM BREACH OF SCHOLARSHIP AND LOAN

15 CONTRACT.—Section 1892(a) of the Social Security 

16 Act (42 U.S.C. 1395ccc(a)) is amended by adding at 

17 the end the following: 

18 ‘‘(5) Notwithstanding any other provision of 

19 law, amounts due to the Secretary under this section 

20 are not dischargeable under section 727, 944, 1141, 

21 1228, or 1328 of title 11, United States Code, or 

22 any other provision of such title.’’. 

23 (b) EFFECTIVE DATE.—The amendments made by 

24 subsection (a) shall apply to bankruptcy petitions filed 

25 after the date of enactment of this Act. 


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1 SEC. 7. PREVENTION OF WASTE, FRAUD, AND ABUSE IN 

2 THE MEDICAID AND CHIP PROGRAMS. 

3 (a) DETECTION OF FRAUDULENT IDENTIFICATION

4 NUMBERS WITHIN THE MEDICAID AND CHIP PRO5 GRAMS.— 

6 (1) MEDICAID.—Section 1903(i) of the Social 

7 Security Act (42 U.S.C. 1396b(i)), as amended by 

8 section 2001(a)(2)(B) of the Patient Protection and 

9 Affordable Care Act (Public Law 111–148), is 

10 amended— 

11 (A) in paragraph (25), by striking ‘‘or’’ at 

12 the end; 

13 (B) in paragraph (26), by striking the pe14 riod and inserting ‘‘; or’’; and 

15 (C) by adding at the end the following new 

16 paragraph: 

17 ‘‘(27) with respect to amounts expended for an 

18 item or service for which medical assistance is pro19 vided under the State plan or under a waiver of such 

20 plan unless the claim for payment for such item or 

21 service contains— 

22 ‘‘(A) a valid beneficiary identification num23 ber that, for purposes of the individual who re24 ceived such item or service, has been deter25 mined by the State agency to correspond to an 


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1 individual who is eligible to receive benefits 

2 under the State plan or waiver; and 

3 ‘‘(B) a valid National Provider Identifier 

4 that, for purposes of the provider that fur5 nished such item or service, has been deter6 mined by the State agency to correspond to a 

7 participating provider that is eligible to receive 

8 payment for furnishing such item or service 

9 under the State plan or waiver.’’. 

10 (2) CHIP.—Section 2107(e)(1)(I) of the Social 

11 Security Act (42 U.S.C. 1397gg(e)(1)(I)) is amend12 ed by striking ‘‘and (17)’’ and inserting ‘‘(17), and 

13 (27)’’. 

14 (b) SCREENING REQUIREMENTS FOR MANAGED

15 CARE ENTITIES.— 

16 (1) IN GENERAL.—Section 1902 of the Social 

17 Security Act (42 U.S.C. 1396a) is amended— 

18 (A) by redesignating the second subsection 

19 (ii), as added by section 6401(b)(1)(B) of the 

20 Patient Protection and Affordable Care Act, as 

21 subsection (kk) of such section; and 

22 (B) in subsection (kk), as so redesig23 nated— 

24 (i) by redesignating paragraph (8) as 

25 paragraph (9); and 


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1 (ii) by inserting after paragraph (7) 

2 the following new paragraph: 

3 ‘‘(8) MANAGED CARE ENTITIES.—The State es4 tablishes procedures to ensure that any managed 

5 care entity (as defined in section 1932(a)(1)(B)) 

6 under contract with the State complies with all ap7 plicable requirements under this subsection.’’. 

8 (2) MEDICAID MANAGED CARE ORGANIZA9 TIONS.—Section 1903(m)(2)(A) of the Social Secu10 rity Act (42 U.S.C. 1396b(m)(2)(A)) is amended— 

11 (A) in clause (xii), by striking ‘‘and’’ at 

12 the end; 

13 (B) in clause (xiii), by striking the period 

14 and inserting ‘‘; and’’; and 

15 (C) by adding at the end the following new 

16 clause: 

17 ‘‘(xiv) such contract requires that the 

18 entity comply with any applicable screen19 ing, oversight, and reporting requirements 

20 under section 1902(kk).’’. 

21 (3) MANAGED CARE ENTITIES.—Section 

22 1932(d) of the Social Security Act (42 U.S.C. 

23 1396u–2(d)) is amended by adding at the end the 

24 following new paragraph: 


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1 ‘‘(5) COMPLIANCE WITH SCREENING, OVER2 SIGHT, AND REPORTING REQUIREMENTS.—A man3 aged care entity shall comply with any applicable 

4 screening, oversight, and reporting requirements 

5 under section 1902(kk).’’. 

6 (c) REQUIRED DATABASE CHECKS.—Clause (i) of 

7 section 1866(j)(2)(B) of the Social Security Act (42 

8 U.S.C. 1395cc(j)(2)(B)) is amended to read as follows: 

9 ‘‘(i) shall include— 

10 ‘‘(I) a licensure check, which may 

11 include such checks across States; and 

12 ‘‘(II) for purposes of the Med13 icaid program under title XIX— 

14 ‘‘(aa) database checks (in15 cluding such checks across 

16 States), which shall include— 

17 ‘‘(AA) the Medicaid 

18 Statistical Information Sys19 tem (as described in section 

20 1903(r)(1)(F)); and 

21 ‘‘(BB) any relevant 

22 medical databases that are 

23 maintained by the State 

24 agencies, as determined by 

25 the Secretary in consultation 


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1 with the directors of the 

2 State agencies; and 

3 ‘‘(bb) coordination of ex4 cluded provider lists between the 

5 Secretary and the State agency, 

6 including exchanges of data re7 garding excluding providers be8 tween Federal and State data9 bases; and’’. 

10 (d) TECHNICAL CORRECTIONS.—Section 1902 of the 

11 Social Security Act (42 U.S.C. 1396a), as amended by 

12 subsection (b)(1), is further amended— 

13 (1) in subsection (a)— 

14 (A) in paragraph (23), by striking ‘‘sub15 section (ii)(4)’’ and inserting ‘‘subsection 

16 (kk)(4)’’; and 

17 (B) in paragraph (77), by striking ‘‘sub18 section (ii)’’ and inserting ‘‘subsection (kk)’’; 

19 and 

20 (2) in subsection (kk), by striking ‘‘section 

21 1886’’ each place it appears and inserting ‘‘section 

22 1866’’. 


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1 SEC. 8. ILLEGAL DISTRIBUTION OF A MEDICARE, MED2 ICAID, OR CHIP BENEFICIARY IDENTIFICA3 TION OR BILLING PRIVILEGES. 

4 Section 1128B(b) of the Social Security Act (42 

5 U.S.C. 1320a–7b(b)), as amended by section 4(b), is 

6 amended by adding at the end the following: 

7 ‘‘(5) Whoever knowingly, intentionally, and with 

8 the intent to defraud purchases, sells or distributes, 

9 or arranges for the purchase, sale, or distribution of 

10 a Medicare, Medicaid, or CHIP beneficiary identi11 fication number or billing privileges under title 

12 XVIII, title XIX, or title XXI shall be imprisoned 

13 for not more than 10 years or fined not more than 

14 $500,000 ($1,000,000 in the case of a corporation), 

15 or both.’’. 

16 SEC. 9. PILOT PROGRAM FOR THE USE OF UNIVERSAL 

17 PRODUCT NUMBERS ON CLAIM FORMS FOR 

18 REIMBURSEMENT UNDER THE MEDICARE 

19 PROGRAM. 

20 (a) ESTABLISHMENT.— 

21 (1) IN GENERAL.—Not later than January 1, 

22 2013, the Secretary shall establish a pilot program 

23 under which claims for reimbursement under the 

24 Medicare program for UPN covered items contain 

25 the universal product number of the UPN covered 

26 item. 


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1 (2) DURATION.—The pilot program under this 

2 section shall be conducted for a 2-year period. 

3 (3) CONSIDERATION OF GAO RECOMMENDA4 TIONS.—The Secretary shall take into account the 

5 recommendations of the Comptroller General of the 

6 United States in establishing the pilot program 

7 under this section. 

8 (b) DEVELOPMENT AND IMPLEMENTATION OF PRO9 CEDURES.— 

10 (1) INFORMATION INCLUDED IN UPN.—The 

11 Secretary, in consultation with manufacturers and 

12 entities with appropriate expertise, shall determine 

13 the relevant descriptive information appropriate for 

14 inclusion in a universal product number for a UPN 

15 covered item under the pilot program. 

16 (2) REVIEW OF PROCEDURE.—The Secretary, 

17 in consultation with interested parties (which shall, 

18 at a minimum, include the Inspector General of the 

19 Department of Health and Human Services and pri20 vate sector and health industry experts), shall use 

21 information obtained under the pilot program 

22 through the use of universal product numbers on 

23 claims for reimbursement under the Medicare pro24 gram to periodically review the UPN covered items 

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1 tion Common Procedure Coding System and adjust 

2 such coding system to ensure that functionally 

3 equivalent UPN covered items are billed and reim4 bursed under the same codes. 

5 (c) GAO REPORTS TO CONGRESS ON EFFECTIVE6 NESS OF IMPLEMENTATION OF PILOT PROGRAM.— 

7 (1) INITIAL REPORT.—Not later than 6 months 

8 after the implementation of the pilot program under 

9 this section, the Comptroller General of the United 

10 States shall submit to Congress a report on the ef11 fectiveness of such implementation. 

12 (2) FINAL REPORT.—Not later than 18 months 

13 after the completion of the pilot program under this 

14 section, the Comptroller General of the United 

15 States shall submit to Congress a report on the ef16 fectiveness of the pilot program, together with rec17 ommendations regarding the use of universal prod18 uct numbers and the use of data obtained from the 

19 use of such numbers, and recommendations for such 

20 legislation and administrative action as the Comp21 troller General determines appropriate. 

22 (d) USE OF AVAILABLE FUNDING.—The Secretary 

23 shall use amounts available in the Centers for Medicare 

24 & Medicaid Services Program Management Account or in 

25 the Health Care Fraud and Abuse Control Account under 


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1 section 1817(k) of the Social Security Act (42 U.S.C. 

2 1395i(k)) to carry out the pilot program under this sec3 tion. 

4 (e) DEFINITIONS.—In this section: 

5 (1) MEDICARE PROGRAM.—The term ‘‘Medicare 

6 program’’ means the program under title XVIII of 

7 the Social Security Act (42 U.S.C. 1395 et seq.). 

8 (2) SECRETARY.—The term ‘‘Secretary’’ means 

9 the Secretary of Health and Human Services. 

10 (3) UNIVERSAL PRODUCT NUMBER.—The term 

11 ‘‘universal product number’’ means a number that 

12 is— 

13 (A) affixed by the manufacturer to each in14 dividual UPN covered item that uniquely identi15 fies the item at each packaging level; and 

16 (B) based on commercially acceptable iden17 tification standards such as, but not limited to, 

18 standards established by the Uniform Code 

19 Council—International Article Numbering Sys20 tem or the Health Industry Business Commu21 nication Council. 

22 (4) UPN COVERED ITEM.— 

23 (A) IN GENERAL.—Except as provided in 

24 subparagraph (B), the term ‘‘UPN covered 

25 item’’ means— 


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1 (i) a covered item as that term is de2 fined in section 1834(a)(13) of the Social 

3 Security Act (42 U.S.C. 1395m(a)(13)); 

4 (ii) an item described in paragraph 

5 (8) or (9) of section 1861(s) of such Act 

6 (42 U.S.C. 1395x); 

7 (iii) an item described in paragraph 

8 (5) of such section 1861(s); and 

9 (iv) any other item for which payment 

10 is made under this title that the Secretary 

11 determines to be appropriate. 

12 (B) EXCLUSION.—The term ‘‘UPN cov13 ered item’’ does not include a customized item 

14 for which payment is made under this title. 

15 SEC. 10. PROHIBITION OF INCLUSION OF SOCIAL SECURITY 

16 ACCOUNT NUMBERS ON MEDICARE CARDS. 

17 (a) IN GENERAL.—Section 205(c)(2)(C) of the Social 

18 Security Act (42 U.S.C. 405(c)(2)(C)), as amended by 

19 section 1414(a)(2) of the Patient Protection and Afford20 able Care Act (Public Law 111–148), is amended by add21 ing at the end the following new clause: 

22 ‘‘(xi) The Secretary of Health and Human Services, 

23 in consultation with the Commissioner of Social Security, 

24 shall establish cost-effective procedures to ensure that a 

25 Social Security account number (or any derivative thereof) 


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1 is not displayed, coded, or embedded on the Medicare card 

2 issued to an individual who is entitled to benefits under 

3 part A of title XVIII or enrolled under part B of title 

4 XVIII and that any other identifier displayed on such card 

5 is easily identifiable as not being the Social Security ac6 count number (or a derivative thereof).’’. 

7 (b) EFFECTIVE DATE.— 

8 (1) IN GENERAL.—The amendment made by 

9 subsection (a) shall apply with respect to Medicare 

10 cards issued on and after an effective date specified 

11 by the Secretary of Health and Human Services, but 

12 in no case shall such effective date be later than the 

13 date that is 24 months after the date adequate fund14 ing is provided pursuant to subsection (d)(2). 

15 (2) REISSUANCE.—Subject to subsection (d)(2), 

16 in the case of individuals who have been issued such 

17 cards before such date, the Secretary of Health and 

18 Human Services— 

19 (A) shall provide for the reissuance for 

20 such individuals of such a card that complies 

21 with such amendment not later than 3 years 

22 after the effective date specified under para23 graph (1); and 

24 (B) may permit such individuals to apply 

25 for the reissuance of such a card that complies 


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1 with such amendment before the date of 

2 reissuance otherwise provided under subpara3 graph (A) in such exceptional circumstances as 

4 the Secretary may specify. 

5 (c) OUTREACH PROGRAM.—Subject to subsection 

6 (d)(2), the Secretary of Health and Human Services, in 

7 consultation with the Commissioner of Social Security, 

8 shall conduct an outreach program to Medicare bene9 ficiaries and providers about the new Medicare card pro10 vided under this section. 

11 (d) REPORT TO CONGRESS AND LIMITATIONS ON EF12 FECTIVE DATE.— 

13 (1) REPORT.—Not later than 90 days after the 

14 date of the enactment of this Act, the Secretary of 

15 Health and Human Services, acting through the Ad16 ministrator of the Centers for Medicare & Medicaid 

17 Services and in consultation with the Commissioner 

18 of Social Security, shall submit to Congress a report 

19 that includes detailed options regarding the imple20 mentation of this section, including line-item esti21 mates of and justifications for the costs associated 

22 with such options and estimates of timeframes for 

23 each stage of implementation. In recommending 

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1 ation, among other factors, cost-effectiveness and 

2 beneficiary outreach and education. 

3 (2) LIMITATION; MODIFICATION OF DEAD4 LINES.—With respect to the amendment made by 

5 subsection (a), and the requirements of subsections 

6 (b) and (c)— 

7 (A) such amendment and requirements 

8 shall not apply until adequate funding is trans9 ferred pursuant to section 11(b) to implement 

10 the provisions of this section, as determined by 

11 Congress; and 

12 (B) any deadlines otherwise established 

13 under this section for such amendment and re14 quirements are contingent upon the receipt of 

15 adequate funding (as determined in subpara16 graph (A)) for such implementation. 

17 The previous sentence shall not affect the timely 

18 submission of the report required under paragraph 

19 (1). 

20 SEC. 11. IMPLEMENTATION. 

21 (a) EMPOWERING THE HHS OIG AND GAO.—Ex22 cept as otherwise provided, to the extent practicable, the 

23 Secretary of Health and Human Services (in this section 

24 referred to as the ‘‘Secretary’’) shall— 


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1 (1) carry out the provisions of and amendments 

2 made by this Act in consultation with the Inspector 

3 General of the Department of Health and Human 

4 Services; and 

5 (2) take into consideration the findings and rec6 ommendations of the Comptroller General of the 

7 United States in carrying out such provisions and 

8 amendments. 

9 (b) FUNDING.—The Secretary shall provide for the 

10 transfer, from the Health Care Fraud and Abuse Control 

11 Account under section 1817(k) of the Social Security Act 

12 (42 U.S.C. 1395i(k)), to the Centers for Medicare & Med13 icaid Services Program Management Account, of such 

14 sums, provided such sums are fully offset, as the Secretary 

15 determines are for necessary administrative expenses asso16 ciated with carrying out the provisions of and amendments 

17 made by this Act (other than section 9). Amounts trans18 ferred under the preceding sentence shall remain available 

19 until expended. 

20 (c) SAVINGS.—Any reduction in outlays under the 

21 Medicare program under title XVIII of the Social Security 

22 Act under the provisions of, and amendments made by, 

23 this Act may only be utilized to offset outlays under part 

24 A of such title. 

Æ 


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