SEC. 5. LIABILITY OF MEDICARE ADMINISTRATIVE CON-
TRACTORS FOR CLAIMS SUBMITTED BY EX-
CLUDED PROVIDERS. 
(a) REIMBURSEMENT
TO
THE
SECRETARY
FOR 
AMOUNTS PAID
TO EXCLUDED PROVIDERS.—Section 
1874A(b) of the Social Security Act (42 U.S.C. 
1395kk(b)) is amended by adding at the end the following 
new paragraph: 
‘‘(6) REIMBURSEMENTS
TO
SECRETARY
FOR 
AMOUNTS PAID TO EXCLUDED PROVIDERS.— 
‘‘(A) LIMITATION.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), the Secretary shall not 
enter into a contract with a Medicare ad-
ministrative contractor under this section 
unless the contractor agrees to reimburse 
the Secretary for any amounts paid by the 
contractor for with respect to any item or 
service (other than an emergency item or 
service, not including items or services fur-
nished in an emergency room of a hospital) 
which is furnished— 
‘‘(I) by an individual or entity 
during the period when such indi-
vidual or entity is excluded pursuant 
to section 1128, 1128A, 1156 or 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
1842(j)(2) from participation in the 
program under this title; or 
‘‘(II) at the medical direction or 
on the prescription of a physician dur-
ing the period when he is excluded 
pursuant to section 1128, 1128A, 
1156, or 1842(j)(2) from participation 
in the program under this title and 
when the person furnishing such item 
or service knew or had reason to know 
of the exclusion (after a reasonable 
time period after reasonable notice 
has been furnished to the person). 
‘‘(ii) EXCEPTION.—Where a Medicare 
administrative contractor pays a claim for 
payment for items or services furnished by 
an individual or entity excluded from par-
ticipation in the programs under this title, 
pursuant to section 1128, 1128A, 1156, or 
l866, and such Medicare administrative 
contractor did not know or have reason to 
know that such individual or entity was so 
excluded, then, to the extent permitted by 
this title, and notwithstanding such exclu-
sion, the contractor shall not be required 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
to reimburse the Secretary under clause (i) 
for any amounts paid with respect to such 
items or services. In each such case the 
Secretary shall notify the contractor of the 
exclusion of the individual or entity fur-
nishing the items or services. A Medicare 
administrative contractor shall not make 
payment for items or services furnished by 
an excluded individual or entity to a bene-
ficiary after a reasonable time (as deter-
mined by the Secretary in regulations) 
after the Secretary has notified the con-
tractor of the exclusion of that individual 
or entity. 
‘‘(B) REQUIREMENT TO REVIEW CLAIMS.— 
A Medicare administrative contractor shall re-
view claims submitted to the contractor for pay-
ment for services under this title in order to en-
sure that such services were not furnished by 
an individual or entity during any period for 
which the individual or entity is excluded from 
such participation (as described in subpara-
graph (A)).’’. 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
(b) REPORT
ON EFFECTIVENESS
AND DEVELOP-
MENT OF SCORECARD AND MEASURABLE PERFORMANCE 
METRICS FOR MEDICARE CONTRACTORS.— 
(1) REPORT.— 
(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of this Act, 
the Secretary of Health and Human Services 
shall submit to Congress a report on the overall 
effectiveness and potential of Medicare contrac-
tors. 
(B) CONTENTS OF REPORT.—The report 
submitted under subparagraph (A) shall include 
the Secretary’s recommendations for the devel-
opment of measurable performance metrics and 
a scorecard for Medicare contractors (or, in the 
case of Medicare administrative contractors, up-
dated and revised measurable performance 
metrics and a revised scorecard), together with 
recommendations for such legislation and ad-
ministrative action as the Secretary determines 
appropriate. 
(2) CONSULTATION.—The Secretary shall con-
sult with Medicare contractors, the Inspector Gen-
eral of the Department of Health and Human Serv-
ices, private sector waste, fraud, and abuse experts, 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
and entities with experience combating and pre-
venting waste, fraud, and abuse, including through 
the review of Medicare claims, in preparing the re-
port submitted under paragraph (1). 
(3) MEDICARE
CONTRACTORS
DEFINED.—In 
this subsection, the term ‘‘Medicare contractor’’ 
means any of the following: 
(A) A Medicare administrative contractor 
under section 1874A of the Social Security Act. 
(B) A Medicare Program Safeguard Con-
tractor. 
(C) A Zone Program Integrity Contractor. 
(D) A Medicare Drug Integrity Contractor. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
subsection (a) shall apply to claims for reimburse-
ment submitted on or after the date of enactment of 
this Act. 
(2) CONTRACT MODIFICATION.—The Secretary 
of Health and Human Services shall take such steps 
as may be necessary to modify contracts entered 
into, renewed, or extended prior to the date of enact-
ment of this Act to conform such contracts to the 
provisions of and amendments made by this section. 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
SEC. 6. LIMITING THE DISCHARGE OF DEBTS IN BANK-
RUPTCY PROCEEDINGS IN CASES WHERE A 
HEALTH CARE PROVIDER OR A SUPPLIER EN-
GAGES IN FRAUDULENT ACTIVITY. 
(a) IN GENERAL.— 
(1) CIVIL
MONETARY
PENALTIES.—Section 
1128A(a) of the Social Security Act (42 U.S.C. 
1320a–7a(a)) is amended by adding at the end the 
following: ‘‘Notwithstanding any other provision of 
law, amounts made payable under this section are 
not dischargeable under section 727, 944, 1141, 
1228, or 1328 of title 11, United States Code, or 
any other provision of such title.’’. 
(2) RECOVERY
OF
OVERPAYMENT
TO
PRO-
VIDERS
OF
SERVICES
UNDER
PART
A.—Section 
1815(d) of the Social Security Act (42 U.S.C. 
1395g(d)) is amended— 
(A) by inserting ‘‘(1)’’ after ‘‘(d)’’; and 
(B) by adding at the end the following: 
‘‘(2) Notwithstanding any other provision of 
law, amounts due to the Secretary under this section 
are not dischargeable under section 727, 944, 1141, 
1228, or 1328 of title 11, United States Code, or 
any other provision of such title if the overpayment 
was the result of fraudulent activity, as may be de-
fined by the Secretary.’’. 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
SEC. 7. PREVENTION OF WASTE, FRAUD, AND ABUSE IN 
THE MEDICAID AND CHIP PROGRAMS. 
(a) DETECTION OF FRAUDULENT IDENTIFICATION 
NUMBERS WITHIN
THE MEDICAID
AND CHIP PRO-
GRAMS.— 
(1) MEDICAID.—Section 1903(i) of the Social 
Security Act (42 U.S.C. 1396b(i)), as amended by 
section 2001(a)(2)(B) of the Patient Protection and 
Affordable Care Act (Public Law 111–148), is 
amended— 
(A) in paragraph (25), by striking ‘‘or’’ at 
the end; 
(B) in paragraph (26), by striking the pe-
riod and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(27) with respect to amounts expended for an 
item or service for which medical assistance is pro-
vided under the State plan or under a waiver of such 
plan unless the claim for payment for such item or 
service contains— 
‘‘(A) a valid beneficiary identification num-
ber that, for purposes of the individual who re-
ceived such item or service, has been deter-
mined by the State agency to correspond to an 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
individual who is eligible to receive benefits 
under the State plan or waiver; and 
‘‘(B) a valid National Provider Identifier 
that, for purposes of the provider that fur-
nished such item or service, has been deter-
mined by the State agency to correspond to a 
participating provider that is eligible to receive 
payment for furnishing such item or service 
under the State plan or waiver.’’. 
(2) CHIP.—Section 2107(e)(1)(I) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)(I)) is amend-
ed by striking ‘‘and (17)’’ and inserting ‘‘(17), and 
(27)’’. 
(b) SCREENING
REQUIREMENTS
FOR
MANAGED 
CARE ENTITIES.— 
(1) IN GENERAL.—Section 1902 of the Social 
Security Act (42 U.S.C. 1396a) is amended— 
(A) by redesignating the second subsection 
(ii), as added by section 6401(b)(1)(B) of the 
Patient Protection and Affordable Care Act, as 
subsection (kk) of such section; and 
(B) in subsection (kk), as so redesig-
nated— 
(i) by redesignating paragraph (8) as 
paragraph (9); and 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
(ii) by inserting after paragraph (7) 
the following new paragraph: 
‘‘(8) MANAGED CARE ENTITIES.—The State es-
tablishes procedures to ensure that any managed 
care entity (as defined in section 1932(a)(1)(B)) 
under contract with the State complies with all ap-
plicable requirements under this subsection.’’. 
(2) MEDICAID
MANAGED
CARE
ORGANIZA-
TIONS.—Section 1903(m)(2)(A) of the Social Secu-
rity Act (42 U.S.C. 1396b(m)(2)(A)) is amended— 
(A) in clause (xii), by striking ‘‘and’’ at 
the end; 
(B) in clause (xiii), by striking the period 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(xiv) such contract requires that the 
entity comply with any applicable screen-
ing, oversight, and reporting requirements 
under section 1902(kk).’’. 
(3) 
MANAGED
CARE
ENTITIES.—Section 
1932(d) of the Social Security Act (42 U.S.C. 
1396u–2(d)) is amended by adding at the end the 
following new paragraph: 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
‘‘(5) COMPLIANCE
WITH
SCREENING, OVER-
SIGHT, AND REPORTING REQUIREMENTS.—A man-
aged care entity shall comply with any applicable 
screening, oversight, and reporting requirements 
under section 1902(kk).’’. 
(c) REQUIRED DATABASE CHECKS.—Clause (i) of 
section 1866(j)(2)(B) of the Social Security Act (42 
U.S.C. 1395cc(j)(2)(B)) is amended to read as follows: 
‘‘(i) shall include— 
‘‘(I) a licensure check, which may 
include such checks across States; and 
‘‘(II) for purposes of the Med-
icaid program under title XIX— 
‘‘(aa) database checks (in-
cluding 
such 
checks 
across 
States), which shall include— 
‘‘(AA) 
the 
Medicaid 
Statistical Information Sys-
tem (as described in section 
1903(r)(1)(F)); and 
‘‘(BB) 
any 
relevant 
medical databases that are 
maintained by the State 
agencies, as determined by 
the Secretary in consultation 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
with the directors of the 
State agencies; and 
‘‘(bb) coordination of ex-
cluded provider lists between the 
Secretary and the State agency, 
including exchanges of data re-
garding excluding providers be-
tween Federal and State data-
bases; and’’. 
(d) TECHNICAL CORRECTIONS.—Section 1902 of the 
Social Security Act (42 U.S.C. 1396a), as amended by 
subsection (b)(1), is further amended— 
(1) in subsection (a)— 
(A) in paragraph (23), by striking ‘‘sub-
section 
(ii)(4)’’ 
and 
inserting 
‘‘subsection 
(kk)(4)’’; and 
(B) in paragraph (77), by striking ‘‘sub-
section (ii)’’ and inserting ‘‘subsection (kk)’’; 
and 
(2) in subsection (kk), by striking ‘‘section 
1886’’ each place it appears and inserting ‘‘section 
1866’’. 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00032
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
SEC. 8. ILLEGAL DISTRIBUTION OF A MEDICARE, MED-
ICAID, OR CHIP BENEFICIARY IDENTIFICA-
TION OR BILLING PRIVILEGES. 
Section 1128B(b) of the Social Security Act (42 
U.S.C. 1320a–7b(b)), as amended by section 4(b), is 
amended by adding at the end the following: 
‘‘(5) Whoever knowingly, intentionally, and with 
the intent to defraud purchases, sells or distributes, 
or arranges for the purchase, sale, or distribution of 
a Medicare, Medicaid, or CHIP beneficiary identi-
fication number or billing privileges under title 
XVIII, title XIX, or title XXI shall be imprisoned 
for not more than 10 years or fined not more than 
$500,000 ($1,000,000 in the case of a corporation), 
or both.’’. 
SEC. 9. PILOT PROGRAM FOR THE USE OF UNIVERSAL 
PRODUCT NUMBERS ON CLAIM FORMS FOR 
REIMBURSEMENT 
UNDER 
THE 
MEDICARE 
PROGRAM. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—Not later than January 1, 
2013, the Secretary shall establish a pilot program 
under which claims for reimbursement under the 
Medicare program for UPN covered items contain 
the universal product number of the UPN covered 
item. 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00033
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
(2) DURATION.—The pilot program under this 
section shall be conducted for a 2-year period. 
(3) CONSIDERATION
OF
GAO
RECOMMENDA-
TIONS.—The Secretary shall take into account the 
recommendations of the Comptroller General of the 
United States in establishing the pilot program 
under this section. 
(b) DEVELOPMENT AND IMPLEMENTATION OF PRO-
CEDURES.— 
(1) INFORMATION
INCLUDED
IN
UPN.—The 
Secretary, in consultation with manufacturers and 
entities with appropriate expertise, shall determine 
the relevant descriptive information appropriate for 
inclusion in a universal product number for a UPN 
covered item under the pilot program. 
(2) REVIEW OF PROCEDURE.—The Secretary, 
in consultation with interested parties (which shall, 
at a minimum, include the Inspector General of the 
Department of Health and Human Services and pri-
vate sector and health industry experts), shall use 
information obtained under the pilot program 
through the use of universal product numbers on 
claims for reimbursement under the Medicare pro-
gram to periodically review the UPN covered items 
billed under the Health Care Financing Administra-
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00034
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
tion Common Procedure Coding System and adjust 
such coding system to ensure that functionally 
equivalent UPN covered items are billed and reim-
bursed under the same codes. 
(c) GAO REPORTS TO CONGRESS ON EFFECTIVE-
NESS OF IMPLEMENTATION OF PILOT PROGRAM.— 
(1) INITIAL REPORT.—Not later than 6 months 
after the implementation of the pilot program under 
this section, the Comptroller General of the United 
States shall submit to Congress a report on the ef-
fectiveness of such implementation. 
(2) FINAL REPORT.—Not later than 18 months 
after the completion of the pilot program under this 
section, the Comptroller General of the United 
States shall submit to Congress a report on the ef-
fectiveness of the pilot program, together with rec-
ommendations regarding the use of universal prod-
uct numbers and the use of data obtained from the 
use of such numbers, and recommendations for such 
legislation and administrative action as the Comp-
troller General determines appropriate. 
(d) USE OF AVAILABLE FUNDING.—The Secretary 
shall use amounts available in the Centers for Medicare 
& Medicaid Services Program Management Account or in 
the Health Care Fraud and Abuse Control Account under 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00035
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
section 1817(k) of the Social Security Act (42 U.S.C. 
1395i(k)) to carry out the pilot program under this sec-
tion. 
(e) DEFINITIONS.—In this section: 
(1) MEDICARE PROGRAM.—The term ‘‘Medicare 
program’’ means the program under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.). 
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(3) UNIVERSAL PRODUCT NUMBER.—The term 
‘‘universal product number’’ means a number that 
is— 
(A) affixed by the manufacturer to each in-
dividual UPN covered item that uniquely identi-
fies the item at each packaging level; and 
(B) based on commercially acceptable iden-
tification standards such as, but not limited to, 
standards established by the Uniform Code 
Council—International Article Numbering Sys-
tem or the Health Industry Business Commu-
nication Council. 
(4) UPN COVERED ITEM.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘‘UPN covered 
item’’ means— 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00036
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
(i) a covered item as that term is de-
fined in section 1834(a)(13) of the Social 
Security Act (42 U.S.C. 1395m(a)(13)); 
(ii) an item described in paragraph 
(8) or (9) of section 1861(s) of such Act 
(42 U.S.C. 1395x); 
(iii) an item described in paragraph 
(5) of such section 1861(s); and 
(iv) any other item for which payment 
is made under this title that the Secretary 
determines to be appropriate. 
(B) EXCLUSION.—The term ‘‘UPN cov-
ered item’’ does not include a customized item 
for which payment is made under this title. 
SEC. 10. PROHIBITION OF INCLUSION OF SOCIAL SECURITY 
ACCOUNT NUMBERS ON MEDICARE CARDS. 
(a) IN GENERAL.—Section 205(c)(2)(C) of the Social 
Security Act (42 U.S.C. 405(c)(2)(C)), as amended by 
section 1414(a)(2) of the Patient Protection and Afford-
able Care Act (Public Law 111–148), is amended by add-
ing at the end the following new clause: 
‘‘(xi) The Secretary of Health and Human Services, 
in consultation with the Commissioner of Social Security, 
shall establish cost-effective procedures to ensure that a 
Social Security account number (or any derivative thereof) 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00037
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS
is not displayed, coded, or embedded on the Medicare card 
issued to an individual who is entitled to benefits under 
part A of title XVIII or enrolled under part B of title 
XVIII and that any other identifier displayed on such card 
is easily identifiable as not being the Social Security ac-
count number (or a derivative thereof).’’. 
(b) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendment made by 
subsection (a) shall apply with respect to Medicare 
cards issued on and after an effective date specified 
by the Secretary of Health and Human Services, but 
in no case shall such effective date be later than the 
date that is 24 months after the date adequate fund-
ing is provided pursuant to subsection (d)(2). 
(2) REISSUANCE.—Subject to subsection (d)(2), 
in the case of individuals who have been issued such 
cards before such date, the Secretary of Health and 
Human Services— 
(A) shall provide for the reissuance for 
such individuals of such a card that complies 
with such amendment not later than 3 years 
after the effective date specified under para-
graph (1); and 
(B) may permit such individuals to apply 
for the reissuance of such a card that complies 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
Jkt 099200
PO 00000
Frm 00038
Fmt 6652
Sfmt 6201
E:\BILLS\H6378.IH
H6378
rfrederick on DSKD9S0YB1PROD with BILLS