2080 
SEC. 1503. RULES FOR COUNTING RESIDENT TIME FOR DI-
DACTIC AND SCHOLARLY ACTIVITIES AND 
OTHER ACTIVITIES. 
(a) DIRECT GME.—Section 1886(h) of the 
Social Security Act (42 U.S.C. 1395ww(h)) is 
amended— 
(1) in paragraph (4)(E), as amended 
by section 1502(a)— 
(A) in clause (i), by striking ‘‘Such 
rules’’ 
and 
inserting 
‘‘Subject 
to 
clause (ii), such rules’’; and 
(B) by adding at the end the fol-
lowing new clause: 
‘‘(ii) TREATMENT
OF
CERTAIN 
NONPROVIDER AND DIDACTIC ACTIVI-
TIES.—Such rules shall provide 
that all time spent by an intern or 
resident in an approved medical 
residency training program in a 
nonprovider setting that is pri-
marily engaged in furnishing pa-
tient care (as defined in para-
graph (5)(K)) in nonpatient care 
activities, such as didactic con-
ferences and seminars, but not in-
cluding research not associated 
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with the treatment or diagnosis of 
a particular patient, as such time 
and activities are defined by the 
Secretary, shall be counted to-
ward the determination of full- 
time equivalency.’’; 
(2) in paragraph (4), by adding at the 
end the following new subparagraph: 
‘‘(I) TREATMENT OF CERTAIN TIME IN 
APPROVED
MEDICAL
RESIDENCY
TRAIN-
ING PROGRAMING.—In determining the 
hospital’s number of full-time equiva-
lent residents for purposes of this 
subsection, all the time that is spent 
by an intern or resident in an ap-
proved medical residency training 
program on vacation, sick leave, or 
other approved leave, as such time is 
defined by the Secretary, and that 
does not prolong the total time the 
resident is participating in the ap-
proved program beyond the normal 
duration of the program shall be 
counted toward the determination of 
full-time equivalency.’’; and 
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(3) in paragraph (5), by adding at the 
end the following new subparagraph: 
‘‘(K) NONPROVIDER SETTING THAT IS 
PRIMARILY ENGAGED IN FURNISHING PA-
TIENT
CARE.—The term ‘nonprovider 
setting that is primarily engaged in 
furnishing patient care’ means a non-
provider setting in which the primary 
activity is the care and treatment of 
patients, as defined by the Sec-
retary.’’. 
(b) 
IME 
DETERMINATIONS.—Section 
1886(d)(5)(B) 
of 
such 
Act 
(42 
U.S.C. 
1395ww(d)(5)(B)), as amended by section 
1501(b), is amended by adding at the end the 
following new clause: 
‘‘(xi)(I) The provisions of subparagraph (I) 
of subsection (h)(4) shall apply under this sub-
paragraph in the same manner as they apply 
under such subsection. 
‘‘(II) In determining the hospital’s number 
of full-time equivalent residents for purposes 
of this subparagraph, all the time spent by an 
intern or resident in an approved medical 
residency training program in nonpatient 
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care activities, such as didactic conferences 
and seminars, as such time and activities are 
defined by the Secretary, that occurs in the 
hospital shall be counted toward the deter-
mination of full-time equivalency if the hos-
pital— 
‘‘(aa) is recognized as a subsection (d) 
hospital; 
‘‘(bb) is recognized as a subsection (d) 
Puerto Rico hospital; 
‘‘(cc) is reimbursed under a reim-
bursement system authorized under sec-
tion 1814(b)(3); or 
‘‘(dd) is a provider-based hospital out-
patient department. 
‘‘(III) In determining the hospital’s num-
ber of full-time equivalent residents for pur-
poses of this subparagraph, all the time spent 
by an intern or resident in an approved med-
ical residency training program in research 
activities that are not associated with the 
treatment or diagnosis of a particular patient, 
as such time and activities are defined by the 
Secretary, shall not be counted toward the de-
termination of full-time equivalency.’’. 
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(c) EFFECTIVE DATES; APPLICATION.— 
(1) IN GENERAL.—Except as otherwise 
provided, the Secretary of Health and 
Human Services shall implement the 
amendments made by this section in a 
manner so as to apply to cost reporting 
periods beginning on or after January 1, 
1983. 
(2) 
DIRECT
GME.—Section 
1886(h)(4)(E)(ii) of the Social Security 
Act, as added by subsection (a)(1)(B), 
shall apply to cost reporting periods be-
ginning on or after July 1, 2008. 
(3) IME.—Section 1886(d)(5)(B)(x)(III) 
of the Social Security Act, as added by 
subsection (b), shall apply to cost report-
ing periods beginning on or after October 
1, 2001. Such section, as so added, shall 
not give rise to any inference on how the 
law in effect prior to such date should be 
interpreted. 
(4) 
APPLICATION.—The 
amendments 
made by this section shall not be applied 
in a manner that requires reopening of 
any settled hospital cost reports as to 
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which there is not a jurisdictionally prop-
er appeal pending as of the date of the 
enactment of this Act on the issue of pay-
ment for indirect costs of medical edu-
cation under section 1886(d)(5)(B) of the 
Social Security Act or for direct graduate 
medical education costs under section 
1886(h) of such Act. 
SEC. 1504. PRESERVATION OF RESIDENT CAP POSITIONS 
FROM CLOSED HOSPITALS. 
(a) DIRECT GME.—Section 1886(h)(4)(H) of 
the Social Security Act (42 U.S.C. Section 
1395ww(h)(4)(H)) is amended by adding at the 
end the following new clause: 
‘‘(vi) REDISTRIBUTION
OF
RESI-
DENCY
SLOTS
AFTER
A
HOSPITAL 
CLOSES.— 
‘‘(I) IN GENERAL.—The Sec-
retary shall, by regulation, es-
tablish a process consistent 
with subclauses (II) and (III) 
under 
which, 
in 
the 
case 
where a hospital (other than a 
hospital described in clause 
(v)) with an approved medical 
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residency program in a State 
closes on or after the date 
that is 2 years before the date 
of 
the 
enactment 
of 
this 
clause, the Secretary shall in-
crease the otherwise applica-
ble resident limit under this 
paragraph for other hospitals 
in the State in accordance 
with this clause. 
‘‘(II) 
PROCESS
FOR
HOS-
PITALS
IN
CERTAIN
AREAS.—In 
determining for which hos-
pitals the increase in the oth-
erwise 
applicable 
resident 
limit described in subclause 
(I) is provided, the Secretary 
shall establish a process to 
provide for such increase to 
one or more hospitals located 
in the State. Such process 
shall take into consideration 
the 
recommendations 
sub-
mitted to the Secretary by the 
senior health official (as des-
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ignated by the chief executive 
officer of such State) if such 
recommendations 
are 
sub-
mitted not later than 180 days 
after the date of the hospital 
closure involved (or, in the 
case of a hospital that closed 
after the date that is 2 years 
before the date of the enact-
ment of this clause, 180 days 
after such date of enactment). 
‘‘(III) LIMITATION.—The es-
timated aggregate number of 
increases in the otherwise ap-
plicable resident limits for 
hospitals under this clause 
shall be equal to the esti-
mated number of resident po-
sitions in the approved med-
ical residency programs that 
closed on or after the date de-
scribed in subclause (I).’’. 
(b) NO EFFECT ON TEMPORARY FTE CAP AD-
JUSTMENTS.—The amendments made by this 
section shall not effect any temporary adjust-
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ment to a hospital’s FTE cap under section 
413.79(h) of title 42, Code of Federal Regula-
tions (as in effect on the date of enactment of 
this Act) and shall not affect the application 
of section 1886(h)(4)(H)(v) of the Social Secu-
rity Act. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 422(b)(2) of the Medicare 
Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 
108–173), as amended by section 1501(c), 
is amended by striking ‘‘(7) and’’ and in-
serting ‘‘(4)(H)(vi), (7), and’’. 
(2) Section 1886(h)(7)(E) of the Social 
Security Act (42 U.S.C. 1395ww(h)(7)(E)) 
is amended by inserting ‘‘or under para-
graph (4)(H)(vi)’’ after ‘‘under this para-
graph’’. 
SEC. 1505. IMPROVING ACCOUNTABILITY FOR APPROVED 
MEDICAL RESIDENCY TRAINING. 
(a) SPECIFICATION OF GOALS FOR APPROVED 
MEDICAL
RESIDENCY
TRAINING
PROGRAMS.— 
Section 1886(h)(1) of the Social Security Act 
(42 U.S.C. 1395ww(h)(1)) is amended— 
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(1) by designating the matter begin-
ning with ‘‘Notwithstanding’’ as a sub-
paragraph (A) with the heading ‘‘IN GEN-
ERAL.—’’ and with appropriate indenta-
tion; and 
(2) by adding at the end the following 
new subparagraph: 
‘‘(B) GOALS
AND
ACCOUNTABILITY 
FOR
APPROVED
MEDICAL
RESIDENCY 
TRAINING
PROGRAMS.—The 
goals 
of 
medical residency training programs 
are to foster a physician workforce so 
that physicians are trained to be able 
to do the following: 
‘‘(i) Work effectively in var-
ious health care delivery settings, 
such as nonprovider settings. 
‘‘(ii) Coordinate patient care 
within and across settings rel-
evant to their specialties. 
‘‘(iii) Understand the relevant 
cost and value of various diag-
nostic and treatment options. 
‘‘(iv) 
Work 
in 
inter-profes-
sional teams and multi-discipli-
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nary team-based models in pro-
vider and nonprovider settings to 
enhance safety and improve qual-
ity of patient care. 
‘‘(v) 
Be 
knowledgeable 
in 
methods of identifying systematic 
errors in health care delivery and 
in implementing systematic solu-
tions in case of such errors, in-
cluding experience and participa-
tion in continuous quality im-
provement projects to improve 
health outcomes of the population 
the physicians serve. 
‘‘(vi) 
Be 
meaningful 
EHR 
users (as determined under sec-
tion 1848(o)(2)) in the delivery of 
care and in improving the quality 
of the health of the community 
and the individuals that the hos-
pital serves.’’ 
(b) GAO STUDY ON EVALUATION OF TRAIN-
ING PROGRAMS.— 
(1) 
IN
GENERAL.—The 
Comptroller 
General of the United States shall con-
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duct a study to evaluate the extent to 
which medical residency training pro-
grams— 
(A) are meeting the goals de-
scribed in section 1886(h)(1)(B) of the 
Social Security Act, as added by sub-
section (a), in a range of residency 
programs, including primary care 
and other specialties; and 
(B) have the appropriate faculty 
expertise to teach the topics required 
to achieve such goals. 
(2) REPORT.—Not later than 18 months 
after the date of the enactment of this 
Act, the Comptroller General shall submit 
to Congress a report on such study and 
shall include in such report recommenda-
tions as to how medical residency train-
ing programs could be further encour-
aged to meet such goals through means 
such as— 
(A) development of curriculum re-
quirements; and 
(B) assessment of the accredita-
tion processes of the Accreditation 
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Council for Graduate Medical Edu-
cation and the American Osteopathic 
Association and effectiveness of those 
processes in accrediting medical resi-
dency programs that meet the goals 
referred to in paragraph (1)(A). 
TITLE VI—PROGRAM INTEGRITY 
Subtitle A—Increased Funding to 
Fight Waste, Fraud, and Abuse 
SEC. 1601. INCREASED FUNDING AND FLEXIBILITY TO 
FIGHT FRAUD AND ABUSE. 
(a) IN GENERAL.—Section 1817(k) of the So-
cial Security Act (42 U.S.C. 1395i(k)) is amend-
ed— 
(1) by adding at the end the following 
new paragraph: 
‘‘(7) ADDITIONAL FUNDING.—In addition 
to the funds otherwise appropriated to 
the Account from the Trust Fund under 
paragraphs (3) and (4) and for purposes 
described in paragraphs (3)(C) and (4)(A), 
there are hereby appropriated an addi-
tional $100,000,000 to such Account from 
such Trust Fund for each fiscal year be-
ginning with 2011. The funds appro-
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priated under this paragraph shall be al-
located in the same proportion as the 
total funding appropriated with respect 
to paragraphs (3)(A) and (4)(A) was allo-
cated with respect to fiscal year 2010, and 
shall be available without further appro-
priation until expended.’’. 
(2) in paragraph (4)(A)— 
(A) by inserting ‘‘for activities de-
scribed in paragraph (3)(C) and’’ after 
‘‘necessary’’; and 
(B) by inserting ‘‘until expended’’ 
after ‘‘appropriation’’. 
(b) FLEXIBILITY
IN PURSUING FRAUD
AND 
ABUSE.—Section 1893(a) of the Social Security 
Act (42 U.S.C. 1395ddd(a)) is amended by in-
serting ‘‘, or otherwise,’’ after ‘‘entities’’. 
Subtitle B—Enhanced Penalties for 
Fraud and Abuse 
SEC. 1611. ENHANCED PENALTIES FOR FALSE STATEMENTS 
ON PROVIDER OR SUPPLIER ENROLLMENT 
APPLICATIONS. 
(a) IN GENERAL.—Section 1128A(a) of the 
Social Security Act (42 U.S.C. 1320a–7a(a)) is 
amended— 
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(1) in paragraph (1)(D), by striking all 
that follows ‘‘in which the person was ex-
cluded’’ and inserting ‘‘under Federal law 
from the Federal health care program 
under which the claim was made, or’’; 
(2) by striking ‘‘or’’ at the end of para-
graph (6); 
(3) in paragraph (7), by inserting at 
the end ‘‘or’’; 
(4) by inserting after paragraph (7) 
the following new paragraph: 
‘‘(8) knowingly makes or causes to be 
made any false statement, omission, or 
misrepresentation of a material fact in 
any application, agreement, bid, or con-
tract to participate or enroll as a pro-
vider of services or supplier under a Fed-
eral health care program, including man-
aged care organizations under title XIX, 
Medicare Advantage organizations under 
part C of title XVIII, prescription drug 
plan sponsors under part D of title XVIII, 
and entities that apply to participate as 
providers of services or suppliers in such 
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managed care organizations and such 
plans;’’; 
(5) in the matter following paragraph 
(8), as inserted by paragraph (4), by strik-
ing ‘‘or in cases under paragraph (7), 
$50,000 for each such act)’’ and inserting 
‘‘in cases under paragraph (7), $50,000 for 
each such act, or in cases under para-
graph (8), $50,000 for each false state-
ment, omission, or misrepresentation of a 
material fact)’’; and 
(6) in the second sentence, by striking 
‘‘for a lawful purpose)’’ and inserting ‘‘for 
a lawful purpose, or in cases under para-
graph (8), an assessment of not more than 
3 times the amount claimed as the result 
of the false statement, omission, or mis-
representation of material fact claimed 
by a provider of services or supplier 
whose application to participate con-
tained such false statement, omission, or 
misrepresentation)’’. 
(b) EFFECTIVE
DATE.—The amendments 
made by subsection (a) shall apply to acts 
committed on or after January 1, 2010. 
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SEC. 1612. ENHANCED PENALTIES FOR SUBMISSION OF 
FALSE STATEMENTS MATERIAL TO A FALSE 
CLAIM. 
(a) IN GENERAL.—Section 1128A(a) of the 
Social Security Act (42 U.S.C. 1320a–7a(a)), as 
amended by section 1611, is further amend-
ed— 
(1) in paragraph (7), by striking ‘‘or’’ 
at the end; 
(2) in paragraph (8), by inserting ‘‘or’’ 
at the end; and 
(3) by inserting after paragraph (8), 
the following new paragraph: 
‘‘(9) knowingly makes, uses, or causes 
to be made or used, a false record or 
statement material to a false or fraudu-
lent claim for payment for items and 
services 
furnished 
under 
a 
Federal 
health care program;’’; and 
(4) in the matter following paragraph 
(9), as inserted by paragraph (3)— 
(A) by striking ‘‘or in cases under 
paragraph (8)’’ and inserting ‘‘in cases 
under paragraph (8)’’; and 
(B) by striking ‘‘a material fact)’’ 
and inserting ‘‘a material fact, in 
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cases under paragraph (9), $50,000 for 
each false record or statement)’’. 
(b) EFFECTIVE
DATE.—The amendments 
made by subsection (a) shall apply to acts 
committed on or after January 1, 2010. 
SEC. 1613. ENHANCED PENALTIES FOR DELAYING INSPEC-
TIONS. 
(a) IN GENERAL.—Section 1128A(a) of the 
Social Security Act (42 U.S.C. 1320a–7a(a)), as 
amended by sections 1611 and 1612, is further 
amended— 
(1) in paragraph (8), by striking ‘‘or’’ 
at the end; 
(2) in paragraph (9), by inserting ‘‘or’’ 
at the end; 
(3) by inserting after paragraph (9) 
the following new paragraph: 
‘‘(10) fails to grant timely access, 
upon reasonable request (as defined by 
the Secretary in regulations), to the In-
spector General of the Department of 
Health and Human Services, for the pur-
pose of audits, investigations, evalua-
tions, or other statutory functions of the 
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Inspector General of the Department of 
Health and Human Services;’’; and 
(4) in the matter following paragraph 
(10), as inserted by paragraph (3), by in-
serting ‘‘, or in cases under paragraph 
(10), $15,000 for each day of the failure 
described in such paragraph’’ after ‘‘false 
record or statement’’. 
(b) ENSURING TIMELY INSPECTIONS RELAT-
ING TO CONTRACTS WITH MA ORGANIZATIONS.— 
Section 1857(d)(2) of such Act (42 U.S.C. 
1395w–27(d)(2)) is amended— 
(1) in subparagraph (A), by inserting 
‘‘timely’’ before ‘‘inspect’’; and 
(2) in subparagraph (B), by inserting 
‘‘timely’’ before ‘‘audit and inspect’’. 
(c) EFFECTIVE
DATE.—The amendments 
made by subsection (a) shall apply to viola-
tions committed on or after January 1, 2010. 
SEC. 1614. ENHANCED HOSPICE PROGRAM SAFEGUARDS. 
(a) MEDICARE.—Part A of title XVIII of the 
Social Security Act is amended by inserting 
after section 1819 the following new section: 
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‘‘SEC. 1819A. ASSURING QUALITY OF CARE IN HOSPICE 
CARE. 
‘‘(a) IN GENERAL.—If the Secretary deter-
mines on the basis of a survey or otherwise, 
that a hospice program that is certified for 
participation 
under 
this 
title 
has 
dem-
onstrated a substandard quality of care and 
failed to meet such other requirements as the 
Secretary may find necessary in the interest 
of the health and safety of the individuals 
who are provided care and services by the 
agency or organization involved and deter-
mines— 
‘‘(1) that the deficiencies involved im-
mediately jeopardize the health and safe-
ty of the individuals to whom the pro-
gram furnishes items and services, the 
Secretary shall take immediate action to 
remove the jeopardy and correct the defi-
ciencies through the remedy specified in 
subsection (b)(2)(A)(iii) or terminate the 
certification of the program, and may 
provide, in addition, for 1 or more of the 
other remedies described in subsection 
(b)(2)(A); or 
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‘‘(2) that the deficiencies involved do 
not immediately jeopardize the health 
and safety of the individuals to whom the 
program furnishes items and services, 
the Secretary may— 
‘‘(A) impose intermediate sanc-
tions developed pursuant to sub-
section (b), in lieu of terminating the 
certification of the program; and 
‘‘(B) if, after such a period of in-
termediate sanctions, the program is 
still not in compliance with such re-
quirements, the Secretary shall termi-
nate the certification of the program. 
If the Secretary determines that a hos-
pice program that is certified for partici-
pation under this title is in compliance 
with such requirements but, as of a pre-
vious period, was not in compliance with 
such requirements, the Secretary may 
provide for a civil money penalty under 
subsection (b)(2)(A)(i) for the days in 
which it finds that the program was not 
in compliance with such requirements. 
‘‘(b) INTERMEDIATE SANCTIONS.— 
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‘‘(1) DEVELOPMENT
AND
IMPLEMENTA-
TION.—The Secretary shall develop and 
implement, by not later than July 1, 
2012— 
‘‘(A) a range of intermediate sanc-
tions to apply to hospice programs 
under the conditions described in 
subsection (a), and 
‘‘(B) appropriate procedures for 
appealing determinations relating to 
the imposition of such sanctions. 
‘‘(2) SPECIFIED SANCTIONS.— 
‘‘(A) 
IN
GENERAL.—The 
inter-
mediate sanctions developed under 
paragraph (1) may include— 
‘‘(i) civil money penalties in 
an amount not to exceed $10,000 
for each day of noncompliance or, 
in the case of a per instance pen-
alty applied by the Secretary, not 
to exceed $25,000, 
‘‘(ii) denial of all or part of the 
payments to which a hospice pro-
gram would otherwise be entitled 
under this title with respect to 
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items and services furnished by a 
hospice program on or after the 
date on which the Secretary de-
termines that intermediate sanc-
tions should be imposed pursuant 
to subsection (a)(2), 
‘‘(iii) the appointment of tem-
porary management to oversee 
the operation of the hospice pro-
gram and to protect and assure 
the health and safety of the indi-
viduals under the care of the pro-
gram 
while 
improvements 
are 
made, 
‘‘(iv) corrective action plans, 
and 
‘‘(v) in-service training for 
staff. 
The 
provisions 
of 
section 
1128A 
(other than subsections (a) and (b)) 
shall apply to a civil money penalty 
under clause (i) in the same manner 
as such provisions apply to a penalty 
or proceeding under section 1128A(a). 
The temporary management under 
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clause (iii) shall not be terminated 
until the Secretary has determined 
that the program has the manage-
ment capability to ensure continued 
compliance with all requirements re-
ferred to in that clause. 
‘‘(B) 
CLARIFICATION.—The 
sanc-
tions specified in subparagraph (A) 
are in addition to sanctions otherwise 
available under State or Federal law 
and shall not be construed as limiting 
other remedies, including any remedy 
available to an individual at common 
law. 
‘‘(C) 
COMMENCEMENT
OF
PAY-
MENT.—A denial of payment under 
subparagraph (A)(ii) shall terminate 
when the Secretary determines that 
the hospice program no longer dem-
onstrates a substandard quality of 
care and meets such other require-
ments as the Secretary may find nec-
essary in the interest of the health 
and safety of the individuals who are 
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provided care and services by the 
agency or organization involved. 
‘‘(3) 
SECRETARIAL
AUTHORITY.—The 
Secretary shall develop and implement, 
by not later than July 1, 2011, specific 
procedures with respect to the conditions 
under which each of the intermediate 
sanctions developed under paragraph (1) 
is to be applied, including the amount of 
any fines and the severity of each of 
these sanctions. Such procedures shall be 
designed so as to minimize the time be-
tween identification of deficiencies and 
imposition of these sanctions and shall 
provide for the imposition of incremen-
tally more severe fines for repeated or 
uncorrected deficiencies.’’. 
(b) APPLICATION
TO
MEDICAID.—Section 
1905(o) of the Social Security Act (42 U.S.C. 
1396d(o)) is amended by adding at the end the 
following new paragraph: 
‘‘(4) The provisions of section 1819A shall 
apply to a hospice program providing hospice 
care under this title in the same manner as 
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such provisions apply to a hospice program 
providing hospice care under title XVIII.’’. 
(c) APPLICATION TO CHIP.—Title XXI of the 
Social Security Act is amended by adding at 
the end the following new section: 
‘‘SEC. 2114. ASSURING QUALITY OF CARE IN HOSPICE CARE. 
‘‘The provisions of section 1819A shall 
apply to a hospice program providing hospice 
care under this title in the same manner such 
provisions apply to a hospice program pro-
viding hospice care under title XVIII.’’. 
SEC. 1615. ENHANCED PENALTIES FOR INDIVIDUALS EX-
CLUDED FROM PROGRAM PARTICIPATION. 
(a) IN GENERAL.—Section 1128A(a) of the 
Social Security Act (42 U.S.C. 1320a–7a(a)), as 
amended by the previous sections, is further 
amended— 
(1) by striking ‘‘or’’ at the end of para-
graph (9); 
(2) by inserting ‘‘or’’ at the end of 
paragraph (10); 
(3) by inserting after paragraph (10) 
the following new paragraph: 
‘‘(11) orders or prescribes an item or 
service, 
including 
without 
limitation 
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home health care, diagnostic and clinical 
lab tests, prescription drugs, durable 
medical equipment, ambulance services, 
physical or occupational therapy, or any 
other item or service, during a period 
when the person has been excluded from 
participation in a Federal health care 
program, and the person knows or should 
know that a claim for such item or serv-
ice will be presented to such a program;’’; 
and 
(4) in the matter following paragraph 
(11), as inserted by paragraph (2), by 
striking ‘‘$15,000 for each day of the fail-
ure described in such paragraph’’ and in-
serting ‘‘$15,000 for each day of the fail-
ure described in such paragraph, or in 
cases under paragraph (11), $50,000 for 
each order or prescription for an item or 
service by an excluded individual’’. 
(b) EFFECTIVE
DATE.—The amendments 
made by subsection (a) shall apply to viola-
tions committed on or after January 1, 2010. 
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SEC. 1616. ENHANCED PENALTIES FOR PROVISION OF 
FALSE INFORMATION BY MEDICARE ADVAN-
TAGE AND PART D PLANS. 
(a) IN GENERAL.—Section 1857(g)(2)(A) of 
the Social Security Act (42 U.S.C. 1395w— 
27(g)(2)(A)) is amended by inserting ‘‘except 
with respect to a determination under sub-
paragraph (E), an assessment of not more 
than 3 times the amount claimed by such plan 
or plan sponsor based upon the misrepresen-
tation or falsified information involved,’’ after 
‘‘for each such determination,’’. 
(b) EFFECTIVE
DATE.—The amendment 
made by subsection (a) shall apply to viola-
tions committed on or after January 1, 2010. 
SEC. 1617. ENHANCED PENALTIES FOR MEDICARE ADVAN-
TAGE AND PART D MARKETING VIOLATIONS. 
(a) IN GENERAL.—Section 1857(g)(1) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1395w— 
27(g)(1)), as amended by section 1221(b), is 
amended— 
(1) in subparagraph (G), by striking 
‘‘or’’ at the end; 
(2) by inserting after subparagraph 
(H) the following new subparagraphs: 
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‘‘(I) except as provided under sub-
paragraph 
(C) 
or 
(D) 
of 
section 
1860D–1(b)(1), enrolls an individual in 
any plan under this part without the 
prior consent of the individual or the 
designee of the individual; 
‘‘(J) transfers an individual en-
rolled under this part from one plan 
to another without the prior consent 
of the individual or the designee of 
the individual or solely for the pur-
pose of earning a commission; 
‘‘(K) fails to comply with mar-
keting restrictions described in sub-
sections (h) and (j) of section 1851 or 
applicable implementing regulations 
or guidance; or 
‘‘(L) employs or contracts with 
any individual or entity who engages 
in the conduct described in subpara-
graphs (A) through (K) of this para-
graph;’’; and 
(3) by adding at the end the following 
new sentence: ‘‘The Secretary may pro-
vide, in addition to any other remedies 
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authorized by law, for any of the rem-
edies described in paragraph (2), if the 
Secretary determines that any employee 
or agent of such organization, or any pro-
vider or supplier who contracts with 
such organization, has engaged in any 
conduct described in subparagraphs (A) 
through (L) of this paragraph.’’ 
(b) EFFECTIVE
DATE.—The amendments 
made by subsection (a) shall apply to viola-
tions committed on or after January 1, 2010. 
SEC. 1618. ENHANCED PENALTIES FOR OBSTRUCTION OF 
PROGRAM AUDITS. 
(a) IN GENERAL.—Section 1128(b)(2) of the 
Social Security Act (42 U.S.C. 1320a–7(b)(2)) is 
amended— 
(1) in the heading, by inserting ‘‘OR 
AUDIT’’ after ‘‘INVESTIGATION’’; and 
(2) by striking ‘‘investigation into’’ 
and all that follows through the period 
and inserting ‘‘investigation or audit re-
lated to—’’ 
‘‘(i) any offense described in 
paragraph (1) or in subsection (a); 
or 
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‘‘(ii) the use of funds received, 
directly or indirectly, from any 
Federal health care program (as 
defined in section 1128B(f)).’’. 
(b) EFFECTIVE
DATE.—The amendments 
made by subsection (a) shall apply to viola-
tions committed on or after January 1, 2010. 
SEC. 1619. EXCLUSION OF CERTAIN INDIVIDUALS AND EN-
TITIES FROM PARTICIPATION IN MEDICARE 
AND STATE HEALTH CARE PROGRAMS. 
(a) IN GENERAL.—Section 1128(c) of the So-
cial Security Act, as previously amended by 
this division, is further amended— 
(1) in the heading, by striking ‘‘AND 
PERIOD’’ and inserting ‘‘PERIOD, AND EF-
FECT’’; and 
(2) by adding at the end the following 
new paragraph: 
‘‘(4)(A) For purposes of this Act, subject to 
subparagraph (C), the effect of exclusion is 
that no payment may be made by any Federal 
health care program (as defined in section 
1128B(f)) with respect to any item or service 
furnished— 
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‘‘(i) by an excluded individual or enti-
ty; or 
‘‘(ii) at the medical direction or on 
the prescription of a physician or other 
authorized individual when the person 
submitting a claim for such item or serv-
ice knew or had reason to know of the ex-
clusion of such individual. 
‘‘(B) For purposes of this section and sec-
tions 1128A and 1128B, subject to subpara-
graph (C), an item or service has been fur-
nished by an individual or entity if the indi-
vidual or entity directly or indirectly pro-
vided, ordered, manufactured, distributed, 
prescribed, or otherwise supplied the item or 
service regardless of how the item or service 
was paid for by a Federal health care pro-
gram or to whom such payment was made. 
‘‘(C)(i) Payment may be made under a Fed-
eral health care program for emergency items 
or services (not including items or services 
furnished in an emergency room of a hospital) 
furnished by an excluded individual or entity, 
or at the medical direction or on the prescrip-
tion of an excluded physician or other author-
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ized individual during the period of such indi-
vidual’s exclusion. 
‘‘(ii) In the case that an individual eligible 
for benefits under title XVIII or XIX submits 
a claim for payment for items or services fur-
nished by an excluded individual or entity, 
and such individual eligible for such benefits 
did not know or have reason to know that 
such excluded individual or entity was so ex-
cluded, then, notwithstanding such exclusion, 
payment shall be made for such items or serv-
ices. In such case the Secretary shall notify 
such individual eligible for such benefits of 
the exclusion of the individual or entity fur-
nishing the items or services. Payment shall 
not be made for items or services furnished by 
an excluded individual or entity to an indi-
vidual eligible for such benefits after a rea-
sonable time (as determined by the Secretary 
in regulations) after the Secretary has noti-
fied the individual eligible for such benefits of 
the exclusion of the individual or entity fur-
nishing the items or services. 
‘‘(iii) In the case that a claim for payment 
for items or services furnished by an excluded 
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individual or entity is submitted by an indi-
vidual or entity other than an individual eligi-
ble for benefits under title XVIII or XIX or the 
excluded individual or entity, and the Sec-
retary determines that the individual or enti-
ty that submitted the claim took reasonable 
steps to learn of the exclusion and reasonably 
relied upon inaccurate or misleading informa-
tion from the relevant Federal health care 
program or its contractor, the Secretary may 
waive repayment of the amount paid in viola-
tion of the exclusion to the individual or enti-
ty that submitted the claim for the items or 
services furnished by the excluded individual 
or entity. If a Federal health care program 
contractor provided inaccurate or misleading 
information that resulted in the waiver of an 
overpayment under this clause, the Secretary 
shall take appropriate action to recover the 
improperly 
paid 
amount 
from 
the 
con-
tractor.’’. 
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Subtitle C—Enhanced Program 
and Provider Protections 
SEC. 1631. ENHANCED CMS PROGRAM PROTECTION AU-
THORITY. 
(a) IN GENERAL.—Title XI of the Social Se-
curity Act (42 U.S.C. 1301 et seq.) is amended 
by inserting after section 1128F the following 
new section: 
‘‘SEC. 1128G. ENHANCED PROGRAM AND PROVIDER PRO-
TECTIONS IN THE MEDICARE, MEDICAID, AND 
CHIP PROGRAMS. 
‘‘(a) CERTAIN AUTHORIZED SCREENING, EN-
HANCED OVERSIGHT PERIODS, AND ENROLLMENT 
MORATORIA.— 
‘‘(1) IN GENERAL.—For periods begin-
ning after January 1, 2011, in the case 
that the Secretary determines there is a 
significant risk of fraudulent activity (as 
determined by the Secretary based on 
relevant complaints, reports, referrals by 
law enforcement or other sources, data 
analysis, trending information, or claims 
submissions by providers of services and 
suppliers) with respect to a category of 
provider of services or supplier of items 
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or services, including a category within a 
geographic area, under title XVIII, XIX, 
or XXI, the Secretary may impose any of 
the following requirements with respect 
to a provider of services or a supplier 
(whether such provider or supplier is ini-
tially enrolling in the program or is re-
newing such enrollment): 
‘‘(A) Screening under paragraph 
(2). 
‘‘(B) Enhanced oversight periods 
under paragraph (3). 
‘‘(C) Enrollment moratoria under 
paragraph (4). 
In applying this subsection for purposes 
of title XIX and XXI the Secretary may re-
quire a State to carry out the provisions 
of this subsection as a requirement of the 
State plan under title XIX or the child 
health plan under title XXI. Actions taken 
and determinations made under this sub-
section shall not be subject to review by 
a judicial tribunal. 
‘‘(2) 
SCREENING.—For 
purposes 
of 
paragraph (1), the Secretary shall estab-
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lish procedures under which screening is 
conducted with respect to providers of 
services and suppliers described in such 
paragraph. Such screening may include— 
‘‘(A) licensing board checks; 
‘‘(B) screening against the list of 
individuals 
and 
entities 
excluded 
from the program under title XVIII, 
XIX, or XXI; 
‘‘(C) the excluded provider list 
system; 
‘‘(D) background checks; and 
‘‘(E) unannounced pre-enrollment 
or other site visits. 
‘‘(3) ENHANCED
OVERSIGHT
PERIOD.— 
For purposes of paragraph (1), the Sec-
retary shall establish procedures to pro-
vide for a period of not less than 30 days 
and not more than 365 days during which 
providers of services and suppliers de-
scribed in such paragraph, as the Sec-
retary determines appropriate, would be 
subject to enhanced oversight, such as re-
quired or unannounced (or required and 
unannounced) site visits or inspections, 
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prepayment review, enhanced review of 
claims, and such other actions as speci-
fied by the Secretary, under the pro-
grams under titles XVIII, XIX, and XXI. 
Under such procedures, the Secretary 
may extend such period for more than 
365 days if the Secretary determines that 
after the initial period such additional 
period of oversight is necessary. 
‘‘(4) MORATORIUM
ON
ENROLLMENT
OF 
PROVIDERS AND SUPPLIERS.—For purposes 
of paragraph (1), the Secretary, based 
upon a finding of a risk of serious ongo-
ing fraud within a program under title 
XVIII, XIX, or XXI, may impose a morato-
rium on the enrollment of providers of 
services and suppliers within a category 
of providers of services and suppliers (in-
cluding a category within a specific geo-
graphic area) under such title. Such a 
moratorium may only be imposed if the 
Secretary makes a determination that the 
moratorium would not adversely impact 
access of individuals to care under such 
program. 
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‘‘(5) CLARIFICATION.—Nothing in this 
subsection shall be interpreted to pre-
clude or limit the ability of a State to en-
gage in provider screening or enhanced 
provider 
oversight 
activities 
beyond 
those required by the Secretary.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) MEDICAID.—Section 1902(a) of the 
Social Security Act (42 U.S.C. 42 U.S.C. 
1396a(a)) is amended— 
(A) in paragraph (23), by inserting 
before the semicolon at the end the 
following: ‘‘or by a person to whom or 
entity to which a moratorium under 
section 1128G(a)(4) is applied during 
the period of such moratorium’’; 
(B) in paragraph (72); by striking 
at the end ‘‘and’’; 
(C) in paragraph (73), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
(D) by adding after paragraph 
(73) the following new paragraph: 
‘‘(74) provide that the State will en-
force any determination made by the Sec-
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retary under subsection (a) of section 
1128G (relating to a significant risk of 
fraudulent activity with respect to a cat-
egory of provider or supplier described 
in such subsection (a) through use of the 
appropriate procedures described in such 
subsection (a)), and that the State will 
carry out any activities as required by 
the Secretary for purposes of such sub-
section (a).’’. 
(2) CHIP.—Section 2102 of such Act 
(42 U.S.C. 1397bb) is amended by adding 
at the end the following new subsection: 
‘‘(d) PROGRAM INTEGRITY.—A State child 
health plan shall include a description of the 
procedures to be used by the State— 
‘‘(1) to enforce any determination 
made by the Secretary under subsection 
(a) of section 1128G (relating to a signifi-
cant risk of fraudulent activity with re-
spect to a category of provider or sup-
plier 
described 
in 
such 
subsection 
through use of the appropriate proce-
dures described in such subsection); and 
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‘‘(2) to carry out any activities as re-
quired by the Secretary for purposes of 
such subsection.’’. 
(3) MEDICARE.—Section 1866(j) of such 
Act (42 U.S.C. 1395cc(j)) is amended by 
adding at the end the following new 
paragraph: 
‘‘(3) PROGRAM
INTEGRITY.—The provi-
sions of section 1128G(a) apply to enroll-
ments and renewals of enrollments of 
providers of services and suppliers under 
this title.’’. 
SEC. 1632. ENHANCED MEDICARE, MEDICAID, AND CHIP 
PROGRAM DISCLOSURE REQUIREMENTS RE-
LATING TO PREVIOUS AFFILIATIONS. 
(a) IN GENERAL.—Section 1128G of the So-
cial Security Act, as inserted by section 1631, 
is amended by adding at the end the following 
new subsection: 
‘‘(b) ENHANCED PROGRAM DISCLOSURE RE-
QUIREMENTS.— 
‘‘(1) DISCLOSURE.—A provider of serv-
ices or supplier who submits on or after 
July 1, 2011, an application for enroll-
ment and renewing enrollment in a pro-
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2121 
gram under title XVIII, XIX, or XXI shall 
disclose (in a form and manner deter-
mined by the Secretary) any current af-
filiation or affiliation within the previous 
10-year period with a provider of services 
or supplier that has uncollected debt or 
with a person or entity that has been sus-
pended or excluded under such program, 
subject to a payment suspension, or has 
had its billing privileges revoked. 
‘‘(2) ENHANCED
SAFEGUARDS.—If the 
Secretary determines that such previous 
affiliation of such provider or supplier 
poses a risk of fraud, waste, or abuse, the 
Secretary may apply such enhanced safe-
guards as the Secretary determines nec-
essary to reduce such risk associated 
with such provider or supplier enrolling 
or participating in the program under 
title XVIII, XIX, or XXI. Such safeguards 
may include enhanced oversight, such as 
enhanced screening of claims, required 
or unannounced (or required and unan-
nounced) site visits or inspections, addi-
tional 
information 
reporting 
require-
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ments, and conditioning such enrollment 
on the provision of a surety bond. 
‘‘(3) AUTHORITY
TO
DENY
PARTICIPA-
TION.—If the Secretary determines that 
there has been at least one such affili-
ation and that such affiliation or affili-
ations, as applicable, of such provider or 
supplier poses a serious risk of fraud, 
waste, or abuse, the Secretary may deny 
the application of such provider or sup-
plier.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) MEDICAID.—Paragraph (74) of sec-
tion 1902(a) of such Act (42 U.S.C. 
1396a(a)), as added by section 1631(b)(1), 
is amended— 
(A) by inserting ‘‘or subsection (b) 
of such section (relating to disclosure 
requirements)’’ before ‘‘, and that the 
State’’; and 
(B) by inserting before the period 
the following: ‘‘and apply any en-
hanced safeguards, with respect to a 
provider or supplier described in 
such subsection (b), as the Secretary 
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determines 
necessary 
under 
such 
subsection (b)’’. 
(2) CHIP.—Subsection (d) of section 
2102 of such Act (42 U.S.C. 1397bb), as 
added by section 1631(b)(2), is amended— 
(A) in paragraph (1), by striking 
at the end ‘‘and’’; 
(B) in paragraph (2) by striking 
the period at the end and inserting ‘‘; 
and’ ’’ and 
(C) by adding at the end the fol-
lowing new paragraph: 
‘‘(3) to enforce any determination 
made by the Secretary under subsection 
(b) of section 1128G (relating to disclo-
sure requirements) and to apply any en-
hanced safeguards, with respect to a pro-
vider or supplier described in such sub-
section, as the Secretary determines nec-
essary under such subsection.’’. 
SEC. 1633. REQUIRED INCLUSION OF PAYMENT MODIFIER 
FOR CERTAIN EVALUATION AND MANAGE-
MENT SERVICES. 
Section 1848 of the Social Security Act (42 
U.S.C. 1395w–4), as amended by section 4101 
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of the HITECH Act (Public Law 111–5), is 
amended by adding at the end the following 
new subsection: 
‘‘(p) PAYMENT MODIFIER FOR CERTAIN EVAL-
UATION AND MANAGEMENT SERVICES.—The Sec-
retary shall establish a payment modifier 
under the fee schedule under this section for 
evaluation and management services (as spec-
ified in section 1842(b)(16)(B)(ii)) that result 
in the ordering of additional services (such as 
lab tests), the prescription of drugs, the fur-
nishing or ordering of durable medical equip-
ment in order to enable better monitoring of 
claims for payment for such additional serv-
ices under this title, or the ordering, fur-
nishing, or prescribing of other items and 
services determined by the Secretary to pose 
a high risk of waste, fraud, and abuse. The 
Secretary may require providers of services 
or suppliers to report such modifier in claims 
submitted for payment.’’. 
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SEC. 1634. EVALUATIONS AND REPORTS REQUIRED UNDER 
MEDICARE INTEGRITY PROGRAM. 
(a) IN GENERAL.—Section 1893(c) of the So-
cial Security Act (42 U.S.C. 1395ddd(c)) is 
amended— 
(1) in paragraph (3), by striking at the 
end ‘‘and’’; 
(2) by redesignating paragraph (4) as 
paragraph (5); and 
(3) by inserting after paragraph (3) 
the following new paragraph: 
‘‘(4) for the contract year beginning 
in 2011 and each subsequent contract 
year, the entity provides assurances to 
the satisfaction of the Secretary that the 
entity will conduct periodic evaluations 
of the effectiveness of the activities car-
ried out by such entity under the Pro-
gram and will submit to the Secretary an 
annual report on such activities; and’’. 
(b) REFERENCE
TO
MEDICAID
INTEGRITY 
PROGRAM.—For a similar provision with re-
spect to the Medicaid Integrity Program, see 
section 1752. 
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SEC. 1635. REQUIRE PROVIDERS AND SUPPLIERS TO 
ADOPT 
PROGRAMS 
TO 
REDUCE 
WASTE, 
FRAUD, AND ABUSE. 
(a) IN GENERAL.—Section 1874 of the So-
cial Security Act (42 U.S.C. 42 U.S.C. 1395kk) 
is amended by adding at the end the following 
new subsection: 
‘‘(e) COMPLIANCE PROGRAMS FOR PROVIDERS 
OF SERVICES AND SUPPLIERS.— 
‘‘(1) IN GENERAL.—The Secretary may 
disenroll a provider of services or a sup-
plier (other than a physician or a skilled 
nursing facility) under this title (or may 
impose any civil monetary penalty or 
other intermediate sanction under para-
graph (4)) if such provider of services or 
supplier fails to, subject to paragraph (5), 
establish a compliance program that con-
tains the core elements established under 
paragraph (2). 
‘‘(2) 
ESTABLISHMENT
OF
CORE
ELE-
MENTS.—The Secretary, in consultation 
with the Inspector General of the Depart-
ment of Health and Human Services, 
shall establish core elements for a com-
pliance program under paragraph (1). 
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Such elements may include written poli-
cies, procedures, and standards of con-
duct, a designated compliance officer and 
a compliance committee; effective train-
ing and education pertaining to fraud, 
waste, and abuse for the organization’s 
employees and contractors; a confidential 
or anonymous mechanism, such as a hot-
line, to receive compliance questions and 
reports of fraud, waste, or abuse; discipli-
nary guidelines for enforcement of stand-
ards; internal monitoring and auditing 
procedures, including monitoring and au-
diting of contractors; procedures for en-
suring prompt responses to detected of-
fenses and development of corrective ac-
tion initiatives, including responses to 
potential offenses; and procedures to re-
turn all identified overpayments to the 
programs under this title, title XIX, and 
title XXI. 
‘‘(3) TIMELINE FOR IMPLEMENTATION.— 
The Secretary shall determine a timeline 
for the establishment of the core ele-
ments under paragraph (2) and the date 
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on which a provider of services and sup-
pliers (other than physicians) shall be re-
quired to have established such a pro-
gram for purposes of this subsection. 
‘‘(4) CMS ENFORCEMENT
AUTHORITY.— 
The Administrator for the Centers of 
Medicare & Medicaid Services shall have 
the authority to determine whether a 
provider of services or supplier described 
in subparagraph (3) has met the require-
ment of this subsection and to impose a 
civil monetary penalty not to exceed 
$50,000 for each violation. The Secretary 
may also impose other intermediate sanc-
tions, including corrective action plans 
and additional monitoring in the case of 
a violation of this subsection. 
‘‘(5) PILOT
PROGRAM.—The Secretary 
may conduct a pilot program on the ap-
plication of this subsection with respect 
to a category of providers of services or 
suppliers (other than physicians) that the 
Secretary determines to be a category 
which is at high risk for waste, fraud, 
and abuse before implementing the re-
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quirements of this subsection to all pro-
viders of services and suppliers described 
in paragraph (3).’’. 
(b) REFERENCE TO SIMILAR MEDICAID PRO-
VISION.—For a similar provision with respect 
to the Medicaid program under title XIX of 
the Social Security Act, see section 1753. 
SEC. 1636. MAXIMUM PERIOD FOR SUBMISSION OF MEDI-
CARE CLAIMS REDUCED TO NOT MORE THAN 
12 MONTHS. 
(a) PURPOSE.—In general, the 36-month pe-
riod currently allowed for claims filing under 
parts A, B, C, and, D of title XVIII of the Social 
Security Act presents opportunities for fraud 
schemes in which processing patterns of the 
Centers for Medicare & Medicaid Services can 
be observed and exploited. Narrowing the 
window for claims processing will not over-
burden providers and will reduce fraud and 
abuse. 
(b) REDUCING MAXIMUM PERIOD FOR SUB-
MISSION.— 
(1) PART A.—Section 1814(a) of the So-
cial Security Act (42 U.S.C. 1395f(a)) is 
amended— 
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(A) in paragraph (1), by striking 
‘‘period of 3 calendar years’’ and all 
that follows and inserting ‘‘period of 1 
calendar year from which such serv-
ices are furnished; and’’; and 
(B) by adding at the end the fol-
lowing new sentence: ‘‘In applying 
paragraph (1), the Secretary may 
specify exceptions to the 1 calendar 
year period specified in such para-
graph.’’. 
(2) PART
B.—Section 1835(a) of such 
Act (42 U.S.C. 1395n(a)) is amended— 
(A) in paragraph (1), by striking 
‘‘period of 3 calendar years’’ and all 
that follows and inserting ‘‘period of 1 
calendar year from which such serv-
ices are furnished; and’’; and 
(B) by adding at the end the fol-
lowing new sentence: ‘‘In applying 
paragraph (1), the Secretary may 
specify exceptions to the 1 calendar 
year period specified in such para-
graph.’’. 
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(3) PARTS C AND D.—Section 1857(d) of 
such Act is amended by adding at the end 
the following new paragraph: 
‘‘(7) 
PERIOD
FOR
SUBMISSION
OF 
CLAIMS.—The contract shall require an 
MA organization or PDP sponsor to re-
quire any provider of services under con-
tract with, in partnership with, or affili-
ated with such organization or sponsor to 
ensure that, with respect to items and 
services furnished by such provider to an 
enrollee of such organization, written re-
quest, signed by such enrollee, except in 
cases in which the Secretary finds it im-
practicable for the enrollee to do so, is 
filed for payment for such items and serv-
ices in such form, in such manner, and by 
such person or persons as the Secretary 
may by regulation prescribe, no later 
than the close of the 1 calendar year pe-
riod after such items and services are 
furnished. In applying the previous sen-
tence, the Secretary may specify excep-
tions to the 1 calendar year period speci-
fied.’’. 
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(c) EFFECTIVE
DATE.—The amendments 
made by subsection (b) shall be effective for 
items and services furnished on or after Janu-
ary 1, 2011. 
SEC. 1637. PHYSICIANS WHO ORDER DURABLE MEDICAL 
EQUIPMENT OR HOME HEALTH SERVICES RE-
QUIRED TO BE MEDICARE ENROLLED PHYSI-
CIANS OR ELIGIBLE PROFESSIONALS. 
(a) DME.—Section 1834(a)(11)(B) of the So-
cial Security Act (42 U.S.C. 1395m(a)(11)(B)) is 
amended by striking ‘‘physician’’ and insert-
ing ‘‘physician enrolled under section 1866(j) 
or an eligible professional under section 
1848(k)(3)(B)’’. 
(b) HOME HEALTH SERVICES.— 
(1) PART A.—Section 1814(a)(2) of such 
Act (42 U.S.C. 1395(a)(2)) is amended in 
the matter preceding subparagraph (A) 
by inserting ‘‘in the case of services de-
scribed in subparagraph (C), a physician 
enrolled under section 1866(j) or an eligi-
ble 
professional 
under 
section 
1848(k)(3)(B),’’ before ‘‘or, in the case of 
services’’. 
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(2) PART B.—Section 1835(a)(2) of such 
Act (42 U.S.C. 1395n(a)(2)) is amended in 
the matter preceding subparagraph (A) 
by inserting ‘‘, or in the case of services 
described in subparagraph (A), a physi-
cian enrolled under section 1866(j) or an 
eligible 
professional 
under 
section 
1848(k)(3)(B),’’ after ‘‘a physician’’. 
(c) DISCRETION TO EXPAND APPLICATION.— 
The Secretary may extend the requirement 
applied by the amendments made by sub-
sections (a) and (b) to durable medical equip-
ment and home health services (relating to re-
quiring certifications and written orders to be 
made by enrolled physicians and health pro-
fessions) to other categories of items or serv-
ices under this title, including covered part D 
drugs as defined in section 1860D–2(e), if the 
Secretary determines that such application 
would help to reduce the risk of waste, fraud, 
and abuse with respect to such other cat-
egories under title XVIII of the Social Secu-
rity Act. 
(d) EFFECTIVE
DATE.—The amendments 
made by this section shall apply to written or-
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and employees of the Social Security 
Administration, with respect to any 
taxpayer identified by the Commis-
sioner of Social Security— 
‘‘(i) return information for the 
applicable year from returns with 
respect to wages (as defined in 
section 3121(a) or 3401(a)) and 
payments of retirement income 
(as described in paragraph (1) of 
this subsection), 
‘‘(ii) unearned income infor-
mation and income information of 
the taxpayer from partnerships, 
trusts, estates, and subchapter S 
corporations for the applicable 
year, 
‘‘(iii) if the individual filed an 
income tax return for the applica-
ble year, the filing status, number 
of dependents, income from farm-
ing, and income from self-employ-
ment, on such return, 
‘‘(iv) if the individual is a mar-
ried individual filing a separate 
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