I 

113TH CONGRESS 

1ST SESSION H. R. 418 

To reduce Medicare waste, fraud, and abuse by providing for enhanced penalties to combat Medicare and Medicaid fraud, for a Medicare datamining system, for a study on applying biometric technology, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 25, 2013 

Ms. ROS-LEHTINEN introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committee 

on Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To reduce Medicare waste, fraud, and abuse by providing 

for enhanced penalties to combat Medicare and Medicaid 

fraud, for a Medicare data-mining system, for a study 

on applying biometric technology, 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. 

4 This Act may be cited as the ‘‘Medicare Fraud En5 forcement and Prevention Act of 2013’’. 


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1 SEC. 2. ENHANCED CRIMINAL PENALTIES TO COMBAT 

2 MEDICARE AND MEDICAID FRAUD. 

3 (a) IN GENERAL.—Section 1128B of the Social Secu4 rity Act (42 U.S.C. 1320a–7b) is amended— 

5 (1) in subsection (a), by striking ‘‘$10,000 or 

6 imprisoned for not more than one year’’ and insert7 ing ‘‘$20,000 or imprisoned for not more than two 

8 years’’; and 

9 (2) in each of subsections (a), (b)(1), (b)(2), 

10 (c), and (d), by striking ‘‘$25,000 or imprisoned for 

11 not more than five years’’ and inserting ‘‘$50,000 or 

12 imprisoned for not more than 10 years’’. 

13 (b) ILLEGAL DISTRIBUTION OF MEDICARE OR MED14 ICAID BENEFICIARY IDENTIFICATION OR BILLING PRIVI15 LEGES.—Section 1128B of the Social Security Act (42 

16 U.S.C. 1320a–7b) is amended by adding at the end the 

17 following new subsection: 

18 ‘‘(h) Whoever knowingly purchases, sells, or unlaw19 fully distributes, or arranges for the purchase, sale, or un20 lawful distribution of two or more Medicare or Medicaid 

21 beneficiary identification numbers or billing privileges 

22 under title XVIII or title XIX shall be imprisoned for not 

23 more than 10 years or fined under title 18, United States 

24 Code (or, if greater, an amount equal to the monetary loss 

25 to the Federal and any State government as a result of 

26 such acts), or both.’’. 


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

2 this section shall apply to acts committed on or after the 

3 date of the enactment of this Act. 

4 SEC. 3. ENHANCED CIVIL AUTHORITIES TO COMBAT MEDI5 CARE AND MEDICAID FRAUD. 

6 (a) CIVIL MONETARY PENALTIES LAW ALIGNMENT

7 AND OTHER CHANGES.— 

8 (1) Section 1128A(a) of the Social Security Act 

9 (42 U.S.C. 1320a–7a(a)) is amended— 

10 (A) in paragraph (1), by striking ‘‘to an 

11 officer, employee, or agent of the United States, 

12 or of any department or agency thereof, or of 

13 any State agency (as defined in subsection 

14 (i)(1)),’’; 

15 (B) by inserting after paragraph (10), as 

16 added by section 6402(d)(2) of the Patient Pro17 tection and Affordable Care Act (Public Law 

18 111–148) the following new paragraphs: 

19 ‘‘(11) conspires to commit a violation of this 

20 section; or 

21 ‘‘(12) knowingly makes, uses, or causes to be 

22 made or used, a false record or statement material 

23 to an obligation to pay or transmit money or prop24 erty to a Federal health care program, or knowingly 

25 conceals or knowingly and improperly avoids or deVerDate Mar 15 2010 04:34 Feb 06, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H418.IH H418

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1 creases an obligation to pay or transmit money or 

2 property to a Federal health care program;’’; 

3 (C) in the first sentence— 

4 (i) by striking ‘‘or in cases under 

5 paragraph (9)’’ and inserting ‘‘in cases 

6 under paragraph (9)’’; and 

7 (ii) by striking ‘‘fact)’’ and inserting 

8 ‘‘fact), in cases under paragraph (11), 

9 $50,000 for any violation described in this 

10 section committed in furtherance of the 

11 conspiracy involved, and in cases under 

12 paragraph (12), $50,000 for each false 

13 record or statement, or concealment, avoid14 ance, or decrease’’; and 

15 (D) in the second sentence, by striking 

16 ‘‘material fact).’’ and inserting ‘‘material fact); 

17 or in cases under paragraph (11), an assess18 ment of not more than 3 times the total 

19 amount that would otherwise apply for any vio20 lation described in this section committed in 

21 furtherance of the conspiracy involved; or in 

22 cases under paragraph (12), an assessment of 

23 not more than 3 times the total amount of the 

24 obligation to which the false record or stateVerDate Mar 15 2010 04:34 Feb 06, 2013 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H418.IH H418

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1 ment was material or that was avoided or de2 creased.’’. 

3 (2) Section 1128A(c)(1) of the Social Security 

4 Act (42 U.S.C. 1320a–7a(c)(1)) is amended by 

5 striking ‘‘six years’’ and inserting ‘‘10 years’’. 

6 (3) Section 1128A(i) of the Social Security Act 

7 (42 U.S.C. 1320a–7a(i)) is amended— 

8 (A) by amending paragraph (2) to read as 

9 follows: 

10 ‘‘(2) The term ‘claim’ means any application, 

11 request, or demand, whether under contract, or oth12 erwise, for money or property for items and services 

13 under a Federal health care program (as defined in 

14 section 1128B(f)), whether or not the United States 

15 or a State agency has title to the money or property, 

16 that— 

17 ‘‘(A) is presented or caused to be pre18 sented to an officer, employee, or agent of the 

19 United States, or of any department or agency 

20 thereof, or of any State agency (as defined in 

21 subsection (i)(1)); or 

22 ‘‘(B) is made to a contractor, grantee, or 

23 other recipient if the money or property is to be 

24 spent or used on the Federal health care pro25 gram’s behalf or to advance a Federal health 


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1 care program interest, and if the Federal health 

2 care program— 

3 ‘‘(i) provides or has provided any por4 tion of the money or property requested or 

5 demanded; or 

6 ‘‘(ii) will reimburse such contractor, 

7 grantee, or other recipient for any portion 

8 of the money or property which is re9 quested or demanded.’’; 

10 (B) by amending paragraph (3) to read as 

11 follows: 

12 ‘‘(3) The term ‘item or service’ means, without 

13 limitation, any medical, social, management, admin14 istrative, or other item or service used in connection 

15 with or directly or indirectly related to a Federal 

16 health care program.’’; 

17 (C) in paragraph (7)— 

18 (i) by striking ‘‘term ‘should know’ 

19 means’’ and inserting ‘‘terms ‘knowing’, 

20 ‘knowingly’, and ‘should know’ mean’’; 

21 (ii) by redesignating subparagraphs 

22 (A) and (B) as subparagraphs (B) and 

23 (C), respectively; 


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1 (iii) by inserting before subparagraph 

2 (B), as redesignated by clause (ii), the fol3 lowing new subparagraph: 

4 ‘‘(A) has actual knowledge of the informa5 tion;’’; and 

6 (iv) in the matter following subpara7 graph (C), as redesignated by clause (ii)— 

8 (I) by inserting ‘‘require’’ after 

9 ‘‘and’’; and 

10 (II) by striking ‘‘is required’’; 

11 and 

12 (D) by adding at the end the following new 

13 paragraphs: 

14 ‘‘(8) The term ‘obligation’ means an established 

15 duty, whether or not fixed, arising from an express 

16 or implied contractual, grantor-grantee, or licensor 

17 licensee relationship, from a fee-based or similar re18 lationship, from statute or regulation, or from the 

19 retention of any overpayment. 

20 ‘‘(9) The term ‘material’ means having a nat21 ural tendency to influence, or be capable of influ22 encing, the payment or receipt of money or prop23 erty.’’. 

24 (b) EXCLUSION OF RESPONSIBLE CORPORATE OFFI25 CIALS.—Section 1128(b) of the Social Security Act (42 


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1 U.S.C. 1320a–7(b)) is amended by striking clauses (i) and 

2 (ii) of paragraph (15)(A) and inserting the following: 

3 ‘‘(i) who has or had a direct or indi4 rect ownership or control interest in a 

5 sanctioned entity at the time of and who 

6 knew or should have known (as defined in 

7 section 1128(i)(7)) of any of the conduct 

8 that formed a basis for the conviction or 

9 exclusion described in subparagraph (B); 

10 or 

11 ‘‘(ii) who is or was an officer or man12 aging employee (as defined in section 

13 1126(b)) of such an entity at the time of 

14 any of the conduct that formed a basis for 

15 the conviction or exclusion so described.’’. 

16 (c) PAYMENT SUSPENSIONS.—Subsection (o)(1) of 

17 section 1862 of the Social Security Act (42 U.S.C. 1395y) 

18 is amended by striking ‘‘may’’ and inserting ‘‘shall’’. 

19 (d) CIVIL MONETARY PENALTIES FOR FALSE STATE20 MENTS OR DELAYING INSPECTIONS.—Paragraph (9) of 

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

22 1320a–7a(a)) is amended by inserting ‘‘or to timely pro23 vide information in response to a request authorized by 

24 section 1128J(b),’’ after ‘‘regulations),’’. 


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1 SEC. 4. ENHANCED SCREENING, MEDICARE DATA-MINING 

2 SYSTEM; BIOMETRIC TECHNOLOGY STUDY. 

3 (a) ENHANCED SCREENING.—Section 

4 1866(j)(2)(B)(ii) of the Social Security Act (42 U.S.C. 

5 1395cc(j)(2)(B)(ii)) is amended by striking ‘‘may’’ and in6 serting ‘‘shall’’. 

7 (b) ACCESS TO REAL TIME CLAIMS AND PAYMENT

8 DATA.—Section 1128J(a)(2) of the Social Security Act is 

9 amended— 

10 (1) by inserting ‘‘including real time claims and 

11 payment data,’’ after ‘‘access to claims and payment 

12 data’’; and 

13 (2) by adding at the end the following sentence: 

14 ‘‘In carrying out this section, the Inspector General 

15 of the Department of Health and Human Services, 

16 in consultation with the Attorney General, shall im17 plement mechanisms for the sharing of information 

18 about suspected fraud relating to the Federal health 

19 care programs under titles XVIII, XIX, and XXI 

20 with other appropriate law enforcement officials.’’. 

21 (c) STUDY ON USE OF BIOMETRIC TECHNOLOGY.— 

22 (1) IN GENERAL.—The Secretary of Health and 

23 Human Services shall provide for a study that ana24 lyzes the feasibility and benefits in reducing waste, 

25 fraud, and abuse of carrying out a program (in this 

26 subsection referred to as a ‘‘biometric technology 


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1 program’’) that implements biometric technology to 

2 ensure that individuals entitled to benefits under 

3 part A of title XVIII of the Social Security Act or 

4 enrolled under part B of such title are physically 

5 present at the time and place of receipt of certain 

6 items and services (specified by the Secretary) for 

7 which payment may be made under such title. Such 

8 a program may provide for financial incentives to 

9 encourage voluntary participation of providers of 

10 services (as defined in section 1861(u) of such Act) 

11 and suppliers (as defined in section 1861(d) of such 

12 Act). 

13 (2) REPORT.—Not later than 6 months after 

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

15 shall submit to the Congress a report on the study 

16 conducted under paragraph (1). Such report shall 

17 include an analysis of the likely effectiveness of a bi18 ometric technology program on reducing waste, 

19 fraud, and abuse under the Medicare program and 

20 may include recommendations with regard to wheth21 er such a program, on a pilot or other basis, should 

22 be implemented. 

Æ 


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