MAP Act of 2013

To amend titles XI and XVIII of the Social Security Act to prevent fraud and abuse under the Medicare program and to require National Provider Identifiers for reimbursement of prescriptions under part D of the Medicare program, and for other purposes. 1. Short title This Act may be cited as the Medicare Abuse Prevention Act of 2013 MAP Act of 2013 2. Increased civil and criminal penalties (a) Increased civil money penalties and criminal fines for Federal health care program fraud and abuse (1) Increased civil money penalties Section 1128A of the Social Security Act (42 U.S.C. 1320a–7a) is amended— (A) in subsection (a), in the matter following paragraph (10)— (i) by striking $10,000 $20,000 (ii) by striking $15,000 $30,000 (iii) by striking $50,000 $100,000 (B) in subsection (b)— (i) in paragraph (1), in the flush text following subparagraph (B), by striking $2,000 $4,000 (ii) in paragraph (2), by striking $2,000 $4,000 (iii) in paragraph (3)(A)(i), by striking $5,000 $10,000 (2) Increased criminal fines Section 1128B of such Act ( 42 U.S.C. 1320a–7b (A) in subsection (a), in the matter following paragraph (6)— (i) by striking $25,000 $100,000 (ii) by striking $10,000 $20,000 (B) in subsection (b)— (i) in paragraph (1), in the flush text following subparagraph (B), by striking $25,000 $100,000 (ii) in paragraph (2), in the flush text following subparagraph (B), by striking $25,000 $100,000 (C) in subsection (c), by striking $25,000 $100,000 (D) in subsection (d), in the flush text following paragraph (2), by striking $25,000 $100,000 (E) in subsection (e), by striking $2,000 $4,000 (b) Increased sentences for felonies involving Federal health care program fraud and abuse (1) False statements and representations Section 1128B(a) of the Social Security Act (42 U.S.C. 1320a–7b(a)) is amended, in the matter following paragraph (6), by striking not more than five years or both, or (ii) not more than 10 years or both, or (ii) (2) Antikickback Section 1128B(b) of such Act (42 U.S.C. 1320a–7b(b)) is amended— (A) in paragraph (1), in the flush text following subparagraph (B), by striking not more than five years not more than 10 years (B) in paragraph (2), in the flush text following subparagraph (B), by striking not more than five years not more than 10 years (3) False statement or representation with respect to conditions or operations of facilities Section 1128B(c) of such Act (42 U.S.C. 1320a–7b(c)) is amended by striking not more than five years not more than 10 years (4) Excess charges Section 1128B(d) of such Act (42 U.S.C. 1320a–7b(d)) is amended, in the flush text following paragraph (2), by striking not more than five years not more than 10 years (c) Effective date The amendments made by this section shall apply to acts committed after the date of the enactment of this Act. 3. Annual Medicare, Medicaid, and CHIP fraud reports (a) In general By not later than July 1, 2014, and each subsequent year, the Secretary of Health and Human Services shall submit to the Committees on Ways and Means and Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report that contains the following: (1) Amount of fraud The amount, as estimated by the Secretary— (A) of total suspected fraud committed against the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the Children’s Health Insurance Program under title XXI of such Act; and (B) the amount of such suspected fraud that is committed by employees of the Department of Health and Human Services who have access to data from any of the programs under subparagraph (A) (2) Data access implementation Information on implementation of the data access requirement under section 1128J(a)(2) of the Social Security Act (42 U.S.C. 1320a–7k(a)(2)). (b) Use of audits (1) Estimate based on audited claims The Secretary shall base the estimate of suspected fraud under subsection (a)(1)(A) on an audit of a random sample of at least 10,000 claims for payment made under the programs under title XVIII, XIX, or XXI of the Social Security Act. (2) Authority of the Secretary For purposes of conducting the audits under paragraph (1) (A) request that a health care provider or supplier submit documentation relating to the claim being audited and review such documentation; (B) conduct unannounced onsite visits; and (C) interview patients. (3) Submission of information Not later than 30 days after receiving a request for documentation under paragraph (2)(A) (4) Internal audit The Secretary shall base the estimate of suspected fraud committed by employees of the Department of Health and Human Services under subsection (a)(1)(B) on an internal audit. (c) Fraud defined In this section, the term fraud section 455.2 4. Protecting predictive analytics technologies from compelled disclosure under the Freedom of Information Act Section 4241 of the Small Business Jobs Act of 2010 ( 42 U.S.C. 1320a–7m (j) Exemption from FOIA The algorithms used in predictive modeling and other analytics technologies under this section are exempt from disclosure under section 552(b)(3) (k) Audit and review The Inspector General of the Department of Health and Human Services and the Comptroller General of the United States shall, beginning on January 1, 2015, and annually thereafter, complete an audit and review of the implementation of this section, including the effectiveness of the algorithms used in predictive modeling and other analytics technologies under this section. . 5. Requiring valid National Provider Identifiers for prescribers on pharmacy claims and limiting access to the National Provider Identifier registry (a) Requiring valid National Provider Identifiers of prescribers on pharmacy claims (1) In general Section 1860D–2(e)(2) of the Social Security Act (42 U.S.C. 1395w–102(e)(2)) is amended by adding at the end the following new subparagraph: (C) Drugs prescribed by nonvalid prescribers For plan years that begin on or after January 1, 2015, such term does not include a drug prescribed by an individual who does not have a valid National Provider Identifier, as determined through procedures established by the Secretary. . (2) Identifying and reporting invalid prescribers (A) Transfer of information to the Inspector general In the case that the procedures established by the Secretary of Health and Human Services under section 1860D–2(e)(2) of the Social Security Act ( 42 U.S.C. 1395w–102(e)(2) (B) Responsibility of the Inspector General The Inspector General of the Department of Health and Human Services shall provide to the appropriate law enforcement agencies information submitted under subparagraph (A) (C) Report to Congress Not later than January 1, 2016, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on the effectiveness of the procedures established under section 1860D–2(e)(2)(C) of the Social Security Act ( 42 U.S.C. 1395w–102(e)(2)(C) (b) Limiting access to National Provider Identifier registry (1) In general The Secretary of Health and Human Services, in consultation with the Attorney General, the Inspector General of the Department of Health and Human Services, the Chairman of the Federal Trade Commission, and affected parties (including prescription drug plans under part D of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–101 et seq. 42 U.S.C. 1395w–21 et seq. (2) Access (A) In general The procedures established under paragraph (1) shall provide governmental and nongovernmental entities with appropriate (as determined by the Secretary) access to the National Provider Identifier Registry. (B) Data use agreements In order to receive such access, each such governmental and nongovernmental entity shall enter into a data use agreement with the Secretary and agree to use the data in such registry in accordance with rules established by the Secretary pursuant such paragraph. 6. Encouraging the establishment of State prescription drug monitoring programs (a) In general Section 1905 of the Social Security Act ( 42 U.S.C. 1396d (ee) Incentives for States To identify fraud through State prescription drug monitoring programs (1) In general With respect to a calendar quarter, the Federal medical assistance percentage for the amounts under clauses (i) and (II) of subparagraph (C) shall be decreased by 10 percent for such quarter, if— (A) a State is receiving a grant for a State controlled substance monitoring program under section 399O of the Public Health Service Act (or the Secretary determines that the State meets the requirements for such a grant); (B) through such program, the State identifies fraud, waste, or abuse in connection the provision of prescription drug coverage under the State plan; and (C) the State or a political subdivision of the State— (i) is reimbursed an amount by a third party (pursuant to the provisions of the State plan in compliance with section 1902(a)(25)) for expenditures related to such fraud, waste, or abuse; or (ii) recovered (as such term is used under section 1903(d)(3)(A)) an amount. (2) Use of funds A State may use the amounts received as a result of the increased Federal medical assistance percentage under paragraph (1) . (b) Conforming amendments Section 1905(b) of the Social Security Act ( 42 U.S.C. 1396d(b) Subject to subsections (y), (z), and (aa) Subject to subsections (y), (z), (aa), and (ee) (c) Effective date The amendments made by this subsection shall apply to calendar quarters beginning on or after the end of the 30-day period after the date of the enactment of this Act. 7. Prohibiting the display of Social Security account numbers on newly issued Medicare identification cards and communications provided to Medicare beneficiaries (a) In general Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the Secretary (b) Newly issued medicare cards and communications provided to beneficiaries Not later than 4 years after the date of the enactment of this Act, the Secretary shall do the following: (1) Newly issued cards Acting in consultation with the Commissioner of Social Security, ensure that each newly issued Medicare identification card does not display or electronically store, in an unencrypted format, a Medicare beneficiary’s Social Security account number, except— (A) if the health insurance claim number of a beneficiary is the Social Security number of the beneficiary, the beneficiary's spouse, or another individual, the Secretary may use such number on such card; and (B) if the Secretary determines that the risk of fraudulent use of such numbers is not unacceptably high, the Secretary may use a partial Social Security account number on a Medicare identification card. (2) Communications provided to beneficiaries Prohibit the display of a Medicare beneficiary’s Social Security account number in any written or electronic communication provided to the beneficiary unless the Secretary, in consultation with the Commissioner of Social Security, determines that inclusion of Social Security account numbers in such communications is essential for the operation of the Medicare program. (c) Medicare beneficiary defined In this section, the term Medicare beneficiary (d) Conforming amendments (1) Reference in the Social Security Act Section 205(c)(2)(C) of the Social Security Act ( 42 U.S.C. 405(c)(2)(C) (A) by moving clause (x), as added by section 1414(a)(2) of the Patient Protection and Affordable Care Act ( Public Law 111–148 (B) by redesignating clause (x), as added by section 2(a)(1) of the Social Security Number Protection Act of 2010 ( 42 U.S.C. 1305 (C) by adding after clause (xii), as redesignated by subparagraph (B), the following new clause: (xiii) Subject to section 7 of the Medicare Abuse Prevention Act of 2013, social security account numbers shall not be displayed on Medicare identification cards or on communications provided to Medicare beneficiaries. . (2) Access to information Section 205(r) of the Social Security Act (405 U.S.C. 405(r)) is amended by adding at the end the following new paragraph: (10) (A) To prevent and identify fraudulent activity— (i) the Attorney General or the Secretary of Health and Human Services may submit to the Commissioner a request that the Commissioner enter into an agreement under this paragraph; and (ii) subject to the requirements of subparagraphs (A) and (B) of paragraph (3), upon receiving a request under subparagraph (A), the Commissioner shall enter into a reimbursable agreement with the individual making such request to provide to such individual the information collected under paragraph (1). (B) The agreement under subparagraph (A)(ii) . (e) Pilot program (1) Establishment Not later than 1 year after the date of the enactment of this Act, the Secretary shall establish a pilot program utilizing smart card technology to evaluate— (A) the applicability of smart card technology to the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. (B) whether such cards would be effective in preventing fraud under the Medicare program. (2) Scope and duration The Secretary shall conduct the pilot program— (A) in not less than 2 States; and (B) for a period of not less than 180 days and not more than 2 years. (3) Report Not later than 12 months after the completion of the pilot program under this subsection, the Secretary shall submit to the appropriate committees of Congress and make available to the public a report that includes the following: (A) A summary of the pilot program and findings resulting from such program, including— (i) any costs or savings to the Medicare program as a result of the implementation of the pilot program; (ii) whether the use of smart card technology resulted in improvements in the quality of care provided to Medicare beneficiaries under the pilot program; and (iii) whether such technology was useful in preventing or detecting fraud, waste, and abuse in the Medicare program. (B) Recommendations regarding whether the use of smart card technology should be expanded under the Medicare program. (4) Definitions In this subsection: (A) Medicare beneficiary The term Medicare beneficiary 42 U.S.C. 1395c et seq. 42 U.S.C. 1395j et seq. (B) Medicare provider The term Medicare provider (i) a provider of services (as defined in section 1861(u) of the Social Security Act ( 42 U.S.C. 1395x(u) (ii) a supplier (as defined in section 1861(d) of such Act (42 U.S.C. 1395x(d))). (C) Smart card The term smart card (i) may rely on existing commercial data transfer networks or on a network of proprietary card readers or databases; and (ii) may include— (I) cards using technology adapted from the financial services industry; (II) cards containing individual biometric identification, provided that such identification is encrypted and not contained in any central database; (III) cards adapting technology and processes utilized in the TRICARE program under chapter 55 of title 10, United States Code, or by the Veterans’ Administration; or (IV) such other technology as the Secretary determines appropriate. 8. Improving claims processing and detection of fraud within the Medicaid and CHIP programs (a) Medicaid Section 1903(i) of the Social Security Act ( 42 U.S.C. 1396b(i) (1) in paragraph (25), by striking or (2) in paragraph (26), by striking the period and inserting ; or (3) by inserting after paragraph (26) the following paragraph: (27) with respect to any amount expended for an item or service unless the claim for payment for such item or service contains— (A) a valid beneficiary identification number for the individual to whom such item or service was furnished, and the State has determined that such number corresponds to an individual who is enrolled under the State plan or an applicable waiver of a requirement of such plan; and (B) a valid provider identifier for the provider who furnished such item or service, and the State has determined that such identifier corresponds to a provider that is eligible to receive payment for furnishing such item or service under the State plan or an applicable waiver of a requirement of such plan. . (b) CHIP Section 2107(e)(1)(I) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1)(I) and (17) (17), and (27)

Summary: Medicare Abuse Prevention Act of 2013 or MAP Act of 2013 - Amends title XI of the Social Security Act (SSA) to increase civil money penalties, criminal fines, and prison sentences for fraud and abuse under the SSA title XVIII (Medicare) program. Directs the Secretary of Health and Human Services to submit to Congress annual fraud reports with respect to Medicare, SSA title XIX (Medicaid), and SSA title XXI (Children's Health Insurance) (CHIP). Amends the Small Business Jobs Act to exempt from disclosure under the Freedom of Information Act the algorithms used in predictive modeling and other analytics technology to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program. Requires valid National Provider Identifiers for prescribers on pharmacy claims for covered Medicare part D prescription drugs. Requires a prescription drug plan (PDP) sponsor identifying a claim for reimbursement for a drug prescribed by an individual without a valid National Provider Identifier to report to the HHS Inspector General any relevant information on such a prescriber, including any invalid national provider identifiers being used to submit such claims and related records. Requires the Inspector General of HHS to provide such information to appropriate law enforcement agencies. Directs the Secretary of HHS to establish procedures and rules to restrict access to the National Provider Identifier Registry in order to deter the fraudulent use of National Provider Identifiers. Decreases by 10% per quarter the federal medical assistance percentage (FMAP) for a state if: (1) it is receiving a grant for a state controlled substance monitoring program through which it identifies fraud, waste, or abuse in connection with the provision of prescription drug coverage under the state Medicaid plan; and (2) the state or a political subdivision is reimbursed by a third party for expenditures related to such fraud, waste, or abuse, or for a recovered amount. Directs the Secretary of HHS to establish procedures to eliminate the unnecessary collection, use, and display of Social Security account numbers of Medicare beneficiaries. Requires the Secretary of HHS to ensure that each newly issued Medicare identification card does not display or electronically store, in an unencrypted format, a Medicare beneficiary's Social Security account number, unless the beneficiary's health insurance claim number is the beneficiary's or spouse's Social Security number, and the risk of fraudulent use of such numbers is not unacceptably high. Requires the Secretary of HHS to prohibit the display of a Medicare beneficiary's Social Security account number in any written or electronic communication to the beneficiary unless its inclusion is essential for the operation of the Medicare program. Directs the Secretary of HHS to establish a pilot program to evaluate the applicability of smart card technology to the Medicare program, and whether such cards would be effective in preventing Medicare fraud. Prohibits payment for an item or service under Medicaid or CHIP unless the claim contains: (1) a valid beneficiary identification number corresponding to an individual enrolled under the state plan or an applicable waiver; and (2) a valid provider identifier corresponding to a provider eligible to receive payment for furnishing such item or service.