I 
114TH CONGRESS 
1ST SESSION H. R. 3718 
To amend titles XVIII and XIX of the Social Security Act to curb waste, 
fraud, and abuse in the Medicare and Medicaid programs. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 8, 2015 
Mr. ROSKAM (for himself and Mr. CARNEY) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to curb waste, fraud, and abuse in the Medicare and 
Medicaid programs. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Preventing and Reduc-
ing Improper Medicare and Medicaid Expenditures to Re-
store Integrity to Benefits Act of 2015’’. 
VerDate Sep 11 2014 
03:49 Oct 14, 2015
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3718.IH
H3718
smartinez on DSK4TPTVN1PROD with BILLS
SEC. 2. STRENGTHENING MEDICAID PROGRAM INTEGRITY 
THROUGH FLEXIBILITY. 
Section 1936 of the Social Security Act (42 U.S.C. 
1396u–6) is amended— 
(1) in subsection (a), by inserting ‘‘, or other-
wise,’’ after ‘‘entities’’; and 
(2) in subsection (e)— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by inserting ‘‘(includ-
ing the costs of equipment, salaries and bene-
fits, and travel and training)’’ after ‘‘Program 
under this section’’; and 
(B) in paragraph (3), by striking ‘‘by 100’’ 
and inserting ‘‘by 100, or such number as de-
termined necessary by the Secretary to carry 
out the Program,’’. 
SEC. 3. ESTABLISHING MEDICARE ADMINISTRATIVE CON-
TRACTOR ERROR REDUCTION INCENTIVES. 
(a) IN GENERAL.—Section 1874A(b)(1)(D) of the 
Social Security Act (42 U.S.C. 1395kk–1(b)(1)(D)) is 
amended— 
(1) by striking ‘‘QUALITY.—The Secretary’’ and 
inserting ‘‘QUALITY.— 
‘‘(i) IN GENERAL.—Subject to clauses 
(ii) and (iii), the Secretary’’; and 
VerDate Sep 11 2014 
03:49 Oct 14, 2015
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3718.IH
H3718
smartinez on DSK4TPTVN1PROD with BILLS
(2) by inserting after clause (i), as added by 
paragraph (1), the following new clauses: 
‘‘(ii) IMPROPER PAYMENT RATE RE-
DUCTION
INCENTIVES.—The 
Secretary 
shall provide incentives for medicare ad-
ministrative contractors to reduce the im-
proper payment error rates in their juris-
dictions. 
‘‘(iii) INCENTIVES.—The incentives 
provided for under clause (ii)— 
‘‘(I) may include a sliding scale 
of award fee payments and additional 
incentives to medicare administrative 
contractors that either reduce the im-
proper payment rates in their jurisdic-
tions to certain thresholds, as deter-
mined by the Secretary, or accomplish 
tasks, as determined by the Secretary, 
that further improve payment accu-
racy; and 
‘‘(II) may include substantial re-
ductions in award fee payments under 
cost-plus-award-fee 
contracts, 
for 
medicare administrative contractors 
that reach an upper end improper 
VerDate Sep 11 2014 
03:49 Oct 14, 2015
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3718.IH
H3718
smartinez on DSK4TPTVN1PROD with BILLS