II 

110TH CONGRESS 

2D SESSION S. 3164 

To amend title XVIII of the Social Security Act to reduce fraud under 

the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

JUNE 19, 2008 

Mr. MARTINEZ (for himself and Mr. CORNYN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to reduce 

fraud under the Medicare program. 

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. 

4 This Act may be cited as the ‘‘Seniors and Taxpayers 

5 Obligation Protection Act of 2008’’. 


hsrobinson on PROD1PC76 with BILLS
2 

•S 3164 IS

1 SEC. 2. REQUIRING THE SECRETARY OF HEALTH AND 

2 HUMAN SERVICES TO CHANGE THE MEDI3 CARE BENEFICIARY IDENTIFIER USED TO 

4 IDENTIFY MEDICARE BENEFICIARIES UNDER 

5 THE MEDICARE PROGRAM. 

6 (a) PROCEDURES.— 

7 (1) IN GENERAL.—Not later than 1 year after 

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

9 Health and Human Services (in this section referred 

10 to as the ‘‘Secretary’’) shall establish and implement 

11 procedures to change the Medicare beneficiary iden12 tifier used to identify individuals entitled to benefits 

13 under part A of title XVIII of the Social Security 

14 Act or enrolled under part B of such title so that 

15 such an individual’s social security account number 

16 is not used. 

17 (2) MAINTAINING EXISTING HICN STRUC18 TURE.—In order to minimize the impact of the 

19 change under paragraph (1) on systems that com20 municate with Medicare beneficiary eligibility sys21 tems, the procedures under paragraph (1) shall pro22 vide that the new Medicare beneficiary identifier 

23 maintain the existing Health Insurance Claim Num24 ber structure. 

25 (3) PROTECTION AGAINST FRAUD.—The proce26 dures under paragraph (1) shall provide for a procVerDate Aug 31 2005 16:46 Jun 21, 2008 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3164.IS S3164

hsrobinson on PROD1PC76 with BILLS
3 

•S 3164 IS

1 ess for changing the Medicare beneficiary identifier 

2 for an individual to a different identifier in the case 

3 of the discovery of fraud, including identity theft. 

4 (4) PHASE-IN AUTHORITY.— 

5 (A) IN GENERAL.—Subject to subpara6 graphs (B) and (C), the Secretary may phase in 

7 the change under paragraph (1) in such man8 ner as the Secretary determines appropriate. 

9 (B) LIMIT.—The phase-in period under 

10 subparagraph (A) shall not exceed 10 years. 

11 (C) NEWLY ENTITLED AND ENROLLED IN12 DIVIDUALS.—The Secretary shall ensure that 

13 the change under paragraph (1) is implemented 

14 not later than January 1, 2010 with respect to 

15 any individual who first becomes entitled to 

16 benefits under part A of title XVIII of the So17 cial Security Act or enrolled under part B of 

18 such title on or after such date. 

19 (b) EDUCATION AND OUTREACH.—The Secretary 

20 shall establish a program of education and outreach for 

21 individuals entitled to benefits under part A of title XVIII 

22 of the Social Security Act or enrolled under part B of such 

23 title, providers of services (as defined in subsection (u) of 

24 section 1861 of such Act (42 U.S.C. 1395x)), and supVerDate Aug 31 2005 16:46 Jun 21, 2008 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3164.IS S3164

hsrobinson on PROD1PC76 with BILLS
4 

•S 3164 IS

1 pliers (as defined in subsection (d) of such section) on the 

2 change under paragraph (1). 

3 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated such sums as may be 

5 necessary to carry out this section. 

6 SEC. 3. MONTHLY VERIFICATION OF ACCURACY OF 

7 CHARGES FOR PHYSICIANS’ SERVICES. 

8 (a) IN GENERAL.—Section 1893 of the Social Secu9 rity Act (42 U.S.C. 1395ddd) is amended— 

10 (1) in subsection (b), by adding at the end the 

11 following new paragraph: 

12 ‘‘(7) The monthly verification of the accuracy of 

13 charges for physicians’ services under the system 

14 under subsection (i).’’; 

15 (2) in subsection (c), by adding at the end of 

16 the flush matter following paragraph (4), the fol17 lowing new sentence: ‘‘In the case of the activity de18 scribed in subsection (b)(7), an entity shall only be 

19 eligible to enter into a contract under the Program 

20 to carry out the activity if the entity is a medicare 

21 administrative contractor with a contract under sec22 tion 1874A.’’; and 

23 (3) by adding at the end the following new sub24 section: 


hsrobinson on PROD1PC76 with BILLS
5 

•S 3164 IS

1 ‘‘(i) MONTHLY VERIFICATION OF ACCURACY OF

2 CHARGES FOR PHYSICIANS’ SERVICES.— 

3 ‘‘(1) SYSTEM.— 

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

5 after the date of the enactment of this sub6 section, the Secretary shall establish and imple7 ment a system to verify (electronically or other8 wise, taking into consideration the administra9 tive burden of such verification on physicians 

10 and group practices) on a monthly basis that 

11 the claims for reimbursement under part B for 

12 physicians’ services furnished in high risk areas 

13 are— 

14 ‘‘(i) for physicians’ services actually 

15 furnished by the physician (or the physi16 cian’s group practice); and 

17 ‘‘(ii) otherwise accurate. 

18 ‘‘(B) NO DETERMINATION OF MEDICAL

19 NECESSITY.—In no case shall any verification 

20 conducted under the system established under 

21 subparagraph (A) include a determination of 

22 the medical necessity of the physicians’ service. 

23 ‘‘(2) VERIFICATION.—Under the system, the 

24 Secretary, at the end of each month, shall provide 

25 the physician (or the group practice) with a detailed 


hsrobinson on PROD1PC76 with BILLS
6 

•S 3164 IS

1 list of such claims for reimbursement that were sub2 mitted during the month in order for the physician 

3 (or the group practice) to review and verify the list. 

4 In providing the detailed list, the Secretary shall use 

5 the provider number of the physician (or the group 

6 practice). 

7 ‘‘(3) AUDITS.—The Secretary shall conduct au8 dits of the review and verification by physicians and 

9 group practices of the detailed list provided under 

10 paragraph (2). Such audits shall assess whether the 

11 physician or group practice conducted such review 

12 and verification in a fraudulent manner. In the case 

13 where the Secretary determines such review and 

14 verification was conducted in a fraudulent manner, 

15 the Secretary shall recoup any payments resulting 

16 from the fraudulent review and verification and im17 pose a civil money penalty in an amount determined 

18 appropriate by the Secretary on the physician or 

19 group practice who conducted the fraudulent review 

20 and verification. The provisions of section 1128A 

21 (other than subsections (a) and (b)) shall apply to 

22 a civil money penalty under the previous sentence in 

23 the same manner as such provisions apply to a pen24 alty or proceeding under section 1128A(a). 


hsrobinson on PROD1PC76 with BILLS
7 

•S 3164 IS

1 ‘‘(4) HIGH RISK AREAS DEFINED.—In this sub2 section, the term ‘high risk area’ means a county 

3 designated as a high risk area under subsection 

4 (j)(1). 

5 ‘‘(5) ACTIONS THROUGH MEDICARE ADMINIS6 TRATIVE CONTRACTORS.—In carrying out this sub7 section, the Secretary shall act through medicare ad8 ministrative contractors with a contract under sec9 tion 1874A. 

10 ‘‘(6) REPORT BY THE SECRETARY.—Not later 

11 than 1 year after implementation of the system es12 tablished under paragraph (1), the Secretary shall 

13 submit a report to Congress on the progress of such 

14 implementation. Such report shall include rec15 ommendations— 

16 ‘‘(A) on how to improve such implementa17 tion, including whether the system should be ex18 panded to include verification of claims for re19 imbursement under part B for physicians’ serv20 ices furnished in additional areas; and 

21 ‘‘(B) for such legislation and administra22 tive action as the Secretary determines appro23 priate.’’. 

24 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

25 out the amendments made by this section, there are auVerDate Aug 31 2005 16:46 Jun 21, 2008 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3164.IS S3164

hsrobinson on PROD1PC76 with BILLS
8 

•S 3164 IS

1 thorized to be appropriated such sums as may be nec2 essary for each of fiscal years 2009 through 2013. 

3 SEC. 4. DETECTION OF MEDICARE FRAUD IN HIGH RISK 

4 AREAS. 

5 (a) IN GENERAL.—Section 1893 of the Social Secu6 rity Act (42 U.S.C. 1395ddd), as amended by section 3, 

7 is amended— 

8 (1) in subsection (b), by adding at the end the 

9 following new paragraph: 

10 ‘‘(8) Implementation of prepayment fraud de11 tection methods under subsection (j).’’; 

12 (2) in subsection (c), in the second sentence of 

13 the flush matter following paragraph (4), by striking 

14 ‘‘activity described in subsection (b)(7)’’ and insert15 ing ‘‘activities described in paragraphs (7) and (8) 

16 of subsection (b)’’; and 

17 (3) by adding at the end the following new sub18 section: 

19 ‘‘(j) DETECTION OF MEDICARE FRAUD IN HIGH

20 RISK AREAS.— 

21 ‘‘(1) ESTABLISHMENT OF SYSTEM TO IDENTIFY

22 COUNTIES MOST VULNERABLE TO FRAUD.—Not 

23 later than 6 months after the date of the enactment 

24 of this subsection, the Secretary shall establish a 

25 system to identify the 50 counties most vulnerable to 


hsrobinson on PROD1PC76 with BILLS
9 

•S 3164 IS

1 fraud with respect to items and services furnished by 

2 providers of services (other than hospitals and crit3 ical access hospitals) and suppliers based on the de4 gree of county-specific reimbursement and analysis 

5 of payment trends under this title. The Secretary 

6 shall designate the counties identified under the pre7 ceding sentence as ‘high risk areas’. 

8 ‘‘(2) PREPAYMENT FRAUD DETECTION.—The 

9 Secretary shall establish procedures for the imple10 mentation of prepayment fraud detection methods 

11 under this title with respect to items and services 

12 furnished by such providers of services and suppliers 

13 in high risk areas designated under paragraph (1), 

14 including the following: 

15 ‘‘(A) Pre-enrollment site visits for such 

16 providers of services and suppliers which have 

17 the highest probability of committing fraud 

18 under this title. 

19 ‘‘(B) Data analysis to establish prepay20 ment claim edits designed to target the claims 

21 for reimbursement under this title for such 

22 items and services that are most likely to be 

23 fraudulent. 

24 ‘‘(C) Prepayment benefit integrity reviews 

25 for claims for reimbursement under this title 


hsrobinson on PROD1PC76 with BILLS
10 

•S 3164 IS

1 for such items and services that are suspended 

2 as a result of such edits. 

3 ‘‘(3) ACTIONS THROUGH MEDICARE ADMINIS4 TRATIVE CONTRACTORS.—In carrying out this sub5 section, the Secretary shall act through medicare ad6 ministrative contractors with a contract under sec7 tion 1874A. 

8 ‘‘(4) REPORT TO CONGRESS.—The Secretary 

9 shall, upon request, appear and testify before Con10 gress regarding the status of the implementation of 

11 prepayment fraud detection methods under this sub12 section.’’. 

13 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

14 out the amendments made by this section, there are au15 thorized to be appropriated such sums as may be nec16 essary, not to exceed $50,000,000, for each of fiscal years 

17 2009 through 2013. 

18 SEC. 5. STUDY ON THE USE OF TECHNOLOGY FOR REAL19 TIME DATA REVIEW. 

20 (a) STUDY ON THE USE OF TECHNOLOGY FOR REAL21 TIME DATA REVIEW.—The Secretary of Health and 

22 Human Services shall conduct a study on the use of tech23 nology (similar to that used with respect to the analysis 

24 of credit card charging patterns) to provide real-time data 

25 analysis of claims for reimbursement under the Medicare 


hsrobinson on PROD1PC76 with BILLS
11 

•S 3164 IS

1 program under title XVIII of the Social Security Act to 

2 identify and investigate unusual billing or order practices 

3 under the Medicare program that could indicate fraud or 

4 abuse. Such study shall include an analysis of the fol5 lowing: 

6 (1) Whether such technology could be used to 

7 identify unusual billing or order practices under the 

8 Medicare program by an individual provider of serv9 ices or for a certain HCPCS code in a particular 

10 area of the country without alerting potentially 

11 fraudulent providers of services and allowing them to 

12 escape or go unnoticed. 

13 (2) How such technology can be implemented 

14 under the Medicare program to provide for the effec15 tive review of claim logs in an accurate and timely 

16 manner. 

17 (b) REPORT.—Not later than 1 year after the date 

18 of enactment of this Act, the Secretary shall submit a re19 port to Congress on the study conducted under subsection 

20 (a), together with recommendations for such legislation 

21 and administrative action as the Secretary determines ap22 propriate. 


hsrobinson on PROD1PC76 with BILLS
12 

•S 3164 IS

1 SEC. 6. EDITS ON 855S MEDICARE ENROLLMENT APPLICA2 TION. 

3 Section 1834(a) of the Social Security Act (42 U.S.C. 

4 1395m(a)) is amended by adding at the end the following 

5 new paragraph: 

6 ‘‘(22) CONFIRMATION WITH NATIONAL SUP7 PLIER CLEARINGHOUSE PRIOR TO REIMBURSE8 MENT.— 

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

10 after the date of enactment of this paragraph, 

11 the Secretary shall establish procedures to re12 quire carriers, prior to paying a claim for reim13 bursement for durable medical equipment, pros14 thetics, orthotics, and supplies under this title, 

15 to confirm with the National Supplier Clearing16 house— 

17 ‘‘(i) that the Medicare identification 

18 number of the supplier is active; and 

19 ‘‘(ii) that the item or service for which 

20 the claim for reimbursement is submitted 

21 was properly identified on the CMS–855S 

22 Medicare enrollment application. 

23 ‘‘(B) ONLINE DATABASE FOR IMPLEMEN24 TATION.—Not later than 18 months after the 

25 date of enactment of this paragraph, the Sec26 retary shall establish an online database similar 


hsrobinson on PROD1PC76 with BILLS
13 

•S 3164 IS

1 to that used for the National Provider Identifier 

2 to enable providers of services, accreditors, car3 riers, and the National Supplier Clearinghouse 

4 to view information on specialties and the types 

5 of items and services each supplier has indi6 cated on the CMS–855S Medicare enrollment 

7 application submitted by the supplier. 

8 ‘‘(C) NOTIFICATION OF CLAIM DENIAL

9 AND RESUBMISSION.—In the case where a claim 

10 for reimbursement for durable medical equip11 ment, prosthetics, orthotics, and supplies under 

12 this title is denied because the item or service 

13 furnished does not correctly match up with the 

14 information on file with the National Supplier 

15 Clearinghouse— 

16 ‘‘(i) the National Supplier Clearing17 house shall— 

18 ‘‘(I) provide the supplier written 

19 notification of the reason for such de20 nial; and 

21 ‘‘(II) allow the supplier 60 days 

22 to provide the National Supplier 

23 Clearinghouse with appropriate certifi24 cation, licensing, or accreditation; and 


hsrobinson on PROD1PC76 with BILLS
14 

•S 3164 IS

1 ‘‘(ii) the Secretary shall waive applica2 ble requirements relating to the time frame 

3 for the submission of claims for payment 

4 under this title in order to permit the re5 submission of such claim if payment of 

6 such claim would otherwise be allowed 

7 under this title.’’. 

8 SEC. 7. SERIAL NUMBER TRACKING SYSTEM FOR DURABLE 

9 MEDICAL EQUIPMENT. 

10 (a) IN GENERAL.—Section 1834(a) of the Social Se11 curity Act (42 U.S.C. 1395m(a)), as amended by section 

12 6(a), is amended by adding at the end the following new 

13 paragraph: 

14 ‘‘(23) SERIAL NUMBER TRACKING SYSTEM FOR

15 DURABLE MEDICAL EQUIPMENT.— 

16 ‘‘(A) ESTABLISHMENT.—In the case of 

17 any item of durable medical equipment which 

18 has not been issued a unique identifier under 

19 the unique device identification system estab20 lished under section 519(f) of the Federal 

21 Food, Drug, and Cosmetic Act, the Secretary 

22 shall promulgate regulations establishing a sys23 tem for such durable medical equipment requir24 ing the label of such equipment to bear a 

25 unique identifier, unless the Secretary requires 


hsrobinson on PROD1PC76 with BILLS
15 

•S 3164 IS

1 an alternative placement or provides an excep2 tion for a particular item or type of durable 

3 medical equipment under such section 519(f). 

4 ‘‘(B) PROVISION OF UNIQUE IDENTIFIER

5 TO THE SECRETARY.—A manufacturer of an 

6 item of durable medical equipment shall submit 

7 to the Secretary the unique identifier issued 

8 under subparagraph (A) or such section 519(f) 

9 with respect to such item (in accordance with 

10 procedures established by the Secretary). The 

11 Secretary shall provide for the storage of such 

12 unique identifier in accordance with subpara13 graph (D)(i). 

14 ‘‘(C) REQUIREMENTS FOR MANUFACTUR15 ERS AND WHOLESALERS.—A manufacturer of 

16 an item of durable medical equipment, or, in 

17 the case where a wholesaler provides an item of 

18 durable medical equipment to a supplier, the 

19 wholesaler, shall— 

20 ‘‘(i) upon issuing an item to a sup21 plier, develop a product description for the 

22 item which includes— 

23 ‘‘(I) the unique identifier of the 

24 item; 


hsrobinson on PROD1PC76 with BILLS
16 

•S 3164 IS

1 ‘‘(II) the specific Healthcare 

2 Common Procedure Coding System 

3 (HCPCS) code for the item; 

4 ‘‘(III) the name of the supplier 

5 the item was shipped to; and 

6 ‘‘(IV) the supplier’s Medicare 

7 identification number; and 

8 ‘‘(ii) submit the product description 

9 developed under clause (i) to the Secretary 

10 for storage in the unique identifier data11 base in accordance with subparagraph 

12 (E)(i). 

13 ‘‘(D) REQUIREMENTS FOR SUPPLIERS.—A 

14 supplier of an item of durable medical equip15 ment shall— 

16 ‘‘(i) upon issuing the item to a bene17 ficiary, note the unique identifier of such 

18 item on— 

19 ‘‘(I) the claim form submitted for 

20 such item; and 

21 ‘‘(II) when appropriate or other22 wise required, the detailed product de23 scription of the item; 

24 ‘‘(ii) in the case where the item is 

25 issued to a beneficiary on a rental basis, 


hsrobinson on PROD1PC76 with BILLS
17 

•S 3164 IS

1 designate the unique identifier with an ‘R’ 

2 after the number to indicate that the item 

3 was rented, and not purchased, by the ben4 eficiary; and 

5 ‘‘(iii) upon return of the item to the 

6 supplier, notify the Secretary— 

7 ‘‘(I) before reissuing that item 

8 and resubmitting that number on 

9 such a claim form; or 

10 ‘‘(II) upon resubmitting that 

11 number on such a claim form. 

12 ‘‘(E) REQUIREMENTS FOR THE SEC13 RETARY.— 

14 ‘‘(i) MAINTENANCE OF DATABASE OF

15 SERIAL NUMBERS.—The Secretary shall 

16 establish and maintain a database con17 taining the unique identifiers submitted by 

18 manufacturers of items of durable medical 

19 equipment under subparagraph (B). 

20 ‘‘(ii) PAYMENT.— 

21 ‘‘(I) LIMITATION.—Subject to 

22 subclause (II), payment may only be 

23 made for an item of durable medical 

24 equipment under this part if the 

25 unique identifier on the claim form 


hsrobinson on PROD1PC76 with BILLS
18 

•S 3164 IS

1 submitted for such item matches the 

2 unique identifier submitted by the 

3 manufacturer of such item under sub4 paragraph (B). 

5 ‘‘(II) EXCEPTION TO LIMITATION

6 AFTER VERIFICATION OF RECEIPT.— 

7 In the case where the unique identi8 fier is not on the claim form sub9 mitted for such item or does not 

10 match the unique identifier submitted 

11 by the manufacturer of such item 

12 under subparagraph (B), no payment 

13 shall be made under this part for the 

14 item of durable medical equipment 

15 until the Secretary has verified that 

16 the beneficiary has received such item 

17 in accordance with subclause (IV). 

18 ‘‘(III) DUPLICATIVE UNIQUE

19 IDENTIFIERS.—In the case where a 

20 unique identifier is submitted on more 

21 than 1 claim form submitted for such 

22 an item and there is no indication 

23 from the supplier that the item of du24 rable medical equipment has been re25 turned by 1 beneficiary and is now 


hsrobinson on PROD1PC76 with BILLS
19 

•S 3164 IS

1 being used by another beneficiary, no 

2 payment shall be made under this 

3 part for such item of durable medical 

4 equipment unless the Secretary has 

5 verified that the beneficiary has re6 ceived such item in accordance with 

7 subclause (IV). 

8 ‘‘(IV) VERIFICATION.—The Sec9 retary shall conduct any verification 

10 required under subclause (II) or (III) 

11 within 30 days after receipt by the 

12 Secretary of the relevant claim form. 

13 In the case where such verification is 

14 not completed within such time pe15 riod, the Secretary shall pay such 

16 claim, complete the verification, and, 

17 in the case where the Secretary has 

18 entered into a contract with an entity 

19 for the conduct of such verification, 

20 recover any payments that would not 

21 have been made if the verification had 

22 been completed within such time pe23 riod from such entity. 

24 ‘‘(iii) QUALITY CONTROL AUDITS.— 

25 The Secretary shall conduct quality control 


hsrobinson on PROD1PC76 with BILLS
20 

•S 3164 IS

1 audits to identify unusual billing patterns 

2 with respect to items of durable medical 

3 equipment for which payment is made 

4 under this part and may conduct unan5 nounced site visits or commission other 

6 agencies to conduct such site visits as part 

7 of such quality control audits. 

8 ‘‘(iv) NO USE AS A PRECERTIFICATION

9 MECHANISM.—In no case shall a unique 

10 identifier issued under subparagraph (A) 

11 or section 519(f) of the Federal Food, 

12 Drug, and Cosmetic Act be used as a 

13 precertification mechanism for the supply 

14 of an item of durable medical equipment or 

15 the payment of a claim for such an item 

16 under this part.’’. 

17 (b) EFFECTIVE DATE.—The amendment made by 

18 subsection (a) shall take effect 3 years after the date of 

19 enactment of this Act. 

20 SEC. 8. SENSE OF THE SENATE REGARDING SURETY BOND 

21 REQUIREMENTS FOR SUPPLIERS OF DURA22 BLE MEDICAL EQUIPMENT. 

23 (a) FINDINGS.—The Senate finds the following: 

24 (1) Documented fraud in the Medicare Durable 

25 Medical Equipment, Prosthetics, Orthotics, and SupVerDate Aug 31 2005 16:46 Jun 21, 2008 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S3164.IS S3164

hsrobinson on PROD1PC76 with BILLS
21 

•S 3164 IS

1 plies Competitive Bidding Program under section 

2 1847 of the Social Security Act (42 U.S.C. 1395w– 

3 3) has potentially cost taxpayers in the United 

4 States billions of dollars. 

5 (2) Congress, having previously recognized 

6 fraudulent practices with respect to durable medical 

7 equipment under the Medicare program under title 

8 XVIII of the Social Security Act, directed the Sec9 retary of Health and Human Services to take action 

10 against such fraudulent practices through the imple11 mentation of a surety bond requirement under sec12 tion 1834(a)(16) of the Social Security Act (42 

13 U.S.C. 1395m(a)(16)), as added by section 4312 of 

14 the Balanced Budget Act of 1997 (Public Law 105– 

15 33). 

16 (3) Such surety bond requirement is necessary 

17 to— 

18 (A) limit the risk to the Medicare program 

19 of fraudulent suppliers of durable medical 

20 equipment; 

21 (B) enhance the enrollment process under 

22 the Medicare program to ensure that only legiti23 mate suppliers of durable medical equipment 

24 are enrolled or are allowed to remain enrolled in 


hsrobinson on PROD1PC76 with BILLS
22 

•S 3164 IS

1 any programs established or implemented under 

2 the Medicare program; 

3 (C) ensure that the Medicare program re4 coups erroneous payments that result from 

5 fraudulent or abusive billing practices by allow6 ing the Centers for Medicare & Medicaid Serv7 ices, or entities under a contract with the Cen8 ters for Medicare & Medicaid Services, to seek 

9 payments from a surety up to the penal sum; 

10 and 

11 (D) help ensure that beneficiaries under 

12 the Medicare program receive items and serv13 ices that are considered reasonable and nec14 essary from legitimate suppliers of durable 

15 medical equipment. 

16 (4) To date, more than a decade after the en17 actment of the Balanced Budget Act of 1997 (Public 

18 Law 105–33), such section 1834(a)(16) has yet to 

19 be implemented by the Secretary of Health and 

20 Human Services, potentially costing taxpayers and 

21 Medicare beneficiaries billions of additional dollars 

22 and negatively impacting responsible suppliers of du23 rable medical equipment under the Medicare pro24 gram. 


hsrobinson on PROD1PC76 with BILLS
23 

•S 3164 IS

1 (b) SENSE OF THE SENATE.—It is the Sense of the 

2 Senate that the Secretary of Health and Human Services 

3 must put in place the surety bond requirement under sec4 tion 1834(a)(16) of the Social Security Act (42 U.S.C. 

5 1395m(a)(16)) within 6 months of the date of enactment 

6 of this Act in order to maintain integrity under the Medi7 care program. 

Æ 


hsrobinson on PROD1PC76 with BILLS