Medicare Fraud Enforcement and Prevention Act of 2013

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. Short title This Act may be cited as the Medicare Fraud Enforcement and Prevention Act of 2013 2. Enhanced criminal penalties to combat Medicare and Medicaid fraud (a) In general Section 1128B of the Social Security Act ( 42 U.S.C. 1320a–7b (1) in subsection (a), by striking $10,000 or imprisoned for not more than one year $20,000 or imprisoned for not more than two years (2) in each of subsections (a), (b)(1), (b)(2), (c), and (d), by striking $25,000 or imprisoned for not more than five years $50,000 or imprisoned for not more than 10 years (b) Illegal distribution of Medicare or Medicaid beneficiary identification or billing privileges Section 1128B of the Social Security Act (42 U.S.C. 1320a–7b) is amended by adding at the end the following new subsection: (h) Whoever knowingly purchases, sells, or unlawfully distributes, or arranges for the purchase, sale, or unlawful distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges under title XVIII or title XIX shall be imprisoned for not more than 10 years or fined under title 18, United States Code (or, if greater, an amount equal to the monetary loss to the Federal and any State government as a result of such acts), or both. . (c) Effective date The amendments made by this section shall apply to acts committed on or after the date of the enactment of this Act. 3. Enhanced civil authorities to combat Medicare and Medicaid fraud (a) Civil monetary penalties law alignment and other changes (1) Section 1128A(a) of the Social Security Act (42 U.S.C. 1320a–7a(a)) is amended— (A) in paragraph (1), by striking to an officer, employee, or agent of the United States, or of any department or agency thereof, or of any State agency (as defined in subsection (i)(1)), (B) by inserting after paragraph (10), as added by section 6402(d)(2) of the Patient Protection and Affordable Care Act (Public Law 111–148) the following new paragraphs: (11) conspires to commit a violation of this section; or (12) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to a Federal health care program, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to a Federal health care program; ; (C) in the first sentence— (i) by striking or in cases under paragraph (9) in cases under paragraph (9) (ii) by striking fact) fact), in cases under paragraph (11), $50,000 for any violation described in this section committed in furtherance of the conspiracy involved, and in cases under paragraph (12), $50,000 for each false record or statement, or concealment, avoidance, or decrease (D) in the second sentence, by striking material fact). material fact); or in cases under paragraph (11), an assessment of not more than 3 times the total amount that would otherwise apply for any violation described in this section committed in furtherance of the conspiracy involved; or in cases under paragraph (12), an assessment of not more than 3 times the total amount of the obligation to which the false record or statement was material or that was avoided or decreased. (2) Section 1128A(c)(1) of the Social Security Act (42 U.S.C. 1320a–7a(c)(1)) is amended by striking six years 10 years (3) Section 1128A(i) of the Social Security Act (42 U.S.C. 1320a–7a(i)) is amended— (A) by amending paragraph (2) to read as follows: (2) The term claim (A) is presented or caused to be presented to an officer, employee, or agent of the United States, or of any department or agency thereof, or of any State agency (as defined in subsection (i)(1)); or (B) is made to a contractor, grantee, or other recipient if the money or property is to be spent or used on the Federal health care program’s behalf or to advance a Federal health care program interest, and if the Federal health care program— (i) provides or has provided any portion of the money or property requested or demanded; or (ii) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded. ; (B) by amending paragraph (3) to read as follows: (3) The term item or service ; (C) in paragraph (7)— (i) by striking term should know terms knowing knowingly should know (ii) by redesignating subparagraphs (A) and (B) as subparagraphs (B) and (C), respectively; (iii) by inserting before subparagraph (B), as redesignated by clause (ii), the following new subparagraph: (A) has actual knowledge of the information; ; and (iv) in the matter following subparagraph (C), as redesignated by clause (ii)— (I) by inserting require and (II) by striking is required (D) by adding at the end the following new paragraphs: (8) The term obligation (9) The term material . (b) Exclusion of responsible corporate officials Section 1128(b) of the Social Security Act ( 42 U.S.C. 1320a–7(b) (i) who has or had a direct or indirect ownership or control interest in a sanctioned entity at the time of and who knew or should have known (as defined in section 1128(i)(7)) of any of the conduct that formed a basis for the conviction or exclusion described in subparagraph (B); or (ii) who is or was an officer or managing employee (as defined in section 1126(b)) of such an entity at the time of any of the conduct that formed a basis for the conviction or exclusion so described. . (c) Payment suspensions Subsection (o)(1) of section 1862 of the Social Security Act ( 42 U.S.C. 1395y may shall (d) Civil monetary penalties for false statements or delaying inspections Paragraph (9) of section 1128A(a) of the Social Security Act (42 U.S.C. 1320a–7a(a)) is amended by inserting or to timely provide information in response to a request authorized by section 1128J(b), regulations), 4. Enhanced screening, Medicare data-mining system; biometric technology study (a) Enhanced screening Section 1866(j)(2)(B)(ii) of the Social Security Act ( 42 U.S.C. 1395cc(j)(2)(B)(ii) may shall (b) Access to Real Time Claims and Payment Data Section 1128J(a)(2) of the Social Security Act is amended— (1) by inserting including real time claims and payment data, access to claims and payment data (2) by adding at the end the following sentence: In carrying out this section, the Inspector General of the Department of Health and Human Services, in consultation with the Attorney General, shall implement mechanisms for the sharing of information about suspected fraud relating to the Federal health care programs under titles XVIII, XIX, and XXI with other appropriate law enforcement officials. (c) Study on use of biometric technology (1) In general The Secretary of Health and Human Services shall provide for a study that analyzes the feasibility and benefits in reducing waste, fraud, and abuse of carrying out a program (in this subsection referred to as a biometric technology program (2) Report Not later than 6 months after the date of the enactment of this Act, the Secretary shall submit to the Congress a report on the study conducted under paragraph (1). Such report shall include an analysis of the likely effectiveness of a biometric technology program on reducing waste, fraud, and abuse under the Medicare program and may include recommendations with regard to whether such a program, on a pilot or other basis, should be implemented.

Summary: Medicare Fraud Enforcement and Prevention Act of 2013 - Amends title XI of the Social Security Act (SSA) to increase criminal penalties for both felony and misdemeanor fraud under SSA titles XVIII (Medicare) and XIX (Medicaid). Adds a new offense of distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges. Applies civil monetary penalties to: (1) conspiracy to make false statements or commit other specified offenses with respect to Medicare or Medicaid claims; and (2) knowing creation or use of false records or statements with respect to the transmission of money or property to a federal health care program. Extends the statute of limitations from six to 10 years after presentation of a claim. Amends SSA title XVIII (Medicare), as amended by the Patient Protection and Affordable Care Act (PPACA), to revise screening requirements. Amends SSA title XI, as amended by PPACA, to require the access to claims and payment data granted to Inspector General of the Department of Health and Human Services (HHS) and the Attorney General to include access to real time claims and payment data. Requires the HHS Inspector General to implement mechanisms for the sharing of information about suspected fraud relating to the federal health care programs under Medicare, Medicaid, and SSA title XXI (Children's Health Insurance Program) (CHIP) with other appropriate law enforcement officials. Directs the HHS Secretary to provide for a study that analyzes the feasibility and benefits in reducing waste, fraud, and abuse of carrying out a program that implements biometric technology to ensure that individuals entitled to benefits under Medicare part A or enrolled under Medicare part B are physically present at the time and place of receipt of certain items and services for which payment may be made.