II 

111TH CONGRESS 

1ST SESSION S. 2774 

To amend title XVIII of the Social Security Act to prevent Medicare payments 

being lost to fraud, waste, or abuse. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 16, 2009 

Mr. GRASSLEY 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 prevent 

Medicare payments being lost to fraud, waste, or abuse. 

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 ‘‘Fighting Medicare 

5 Payment Fraud Act of 2009’’. 


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1 SEC. 2. EXTENSION OF NUMBER OF DAYS IN WHICH MEDI2 CARE CLAIMS ARE REQUIRED TO BE PAID IN 

3 ORDER TO PREVENT OR COMBAT FRAUD, 

4 WASTE, OR ABUSE. 

5 (a) PART A CLAIMS.—Section 1816(c)(2) of the So6 cial Security Act (42 U.S.C. 1395h(c)(2)) is amended— 

7 (1) in subparagraph (B)(ii)(V), by striking 

8 ‘‘with respect’’ and inserting ‘‘subject to subpara9 graph (D), with respect’’; and 

10 (2) by adding at the end the following new sub11 paragraph: 

12 ‘‘(D)(i) Upon a determination by the Sec13 retary that there is a likelihood of fraud, waste, 

14 or abuse involving a particular category of pro15 viders of services or suppliers, categories of pro16 viders of services or suppliers in a certain geo17 graphic area, or individual providers of services 

18 or suppliers, the Secretary shall extend the 

19 number of calendar days described in subpara20 graph (B)(ii)(V) to— 

21 ‘‘(I) up to 365 calendar days with re22 spect to claims submitted by— 

23 ‘‘(aa) categories of providers of 

24 services or suppliers; or 


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1 ‘‘(bb) categories of providers of 

2 services or suppliers in a certain geo3 graphic area; or 

4 ‘‘(II) such time that the Secretary de5 termines is necessary to ensure that the 

6 claims with respect to individual providers 

7 of services or suppliers are clean claims. 

8 ‘‘(ii) During the extended period of time 

9 under subclauses (I) and (II) of clause (ii), the 

10 Secretary shall engage in heightened scrutiny of 

11 claims, such as prepayment review and other 

12 methods the Secretary determines to be appro13 priate. 

14 ‘‘(iii) Not later than 90 days after the date 

15 of enactment of this subparagraph and not less 

16 than annually thereafter, the Inspector General 

17 of the Department of Health and Human Serv18 ices shall submit to the Secretary a report con19 taining recommendations with respect to the 

20 application of this subparagraph and section 

21 1842(c)(2)(D). Not later than 60 days after re22 ceiving such a report, the Secretary shall sub23 mit to the Inspector General a written response 

24 to the recommendations contained in the report. 


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1 ‘‘(iv) There shall be no administrative or 

2 judicial review under section 1869, section 

3 1878, or otherwise of the implementation of 

4 this subparagraph by the Secretary.’’. 

5 (b) PART B CLAIMS.—Section 1842(c)(2) of the So6 cial Security Act (42 U.S.C. 1395u(c)(2)) is amended— 

7 (1) in subparagraph (B)(ii)(V), by striking 

8 ‘‘with respect’’ and inserting ‘‘subject to subpara9 graph (D), with respect’’; and 

10 (2) by adding at the end the following new sub11 paragraph: 

12 ‘‘(D)(i) Upon a determination by the Sec13 retary that there is a likelihood of fraud, waste, 

14 or abuse involving a particular category of pro15 viders of services or suppliers, categories of pro16 viders of services or suppliers in a certain geo17 graphic area, or individual providers of services 

18 or suppliers, the Secretary shall extend the 

19 number of calendar days described in subpara20 graph (B)(ii)(V) to— 

21 ‘‘(I) up to 365 calendar days with re22 spect to claims submitted by— 

23 ‘‘(aa) categories of providers of 

24 services or suppliers; or 


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1 ‘‘(bb) categories of providers of 

2 services or suppliers in a certain geo3 graphic area; or 

4 ‘‘(II) such time that the Secretary de5 termines is necessary to ensure that the 

6 claims with respect to individual providers 

7 of services or suppliers are clean claims. 

8 ‘‘(ii) During the extended period of time 

9 under subclauses (I) and (II) of clause (ii), the 

10 Secretary shall engage in heightened scrutiny of 

11 claims, such as prepayment review and other 

12 methods the Secretary determines to be appro13 priate. 

14 ‘‘(iii) There shall be no administrative or 

15 judicial review under section 1869, section 

16 1878, or otherwise of the implementation of 

17 this subparagraph by the Secretary.’’. 

18 (c) EFFECTIVE DATE.— 

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

20 this section shall take effect on the day that is 6 

21 months after the date of the enactment of this Act. 

22 (2) EXPEDITING IMPLEMENTATION.—The Sec23 retary shall promulgate regulations to carry out the 

24 amendments made by this section which may be ef25 fective and final immediately on an interim basis as 


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1 of the date of publication of the interim final regula2 tion. If the Secretary provides for an interim final 

3 regulation, the Secretary shall provide for a period 

4 of public comment on such regulation after the date 

5 of publication. The Secretary may change or revise 

6 such regulation after completion of the period of 

7 public comment. 

Æ 


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