I 
111TH CONGRESS 
2D SESSION 
H. R. 6378 
To reduce waste, fraud, and abuse under the Medicare, Medicaid, and CHIP 
programs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2010 
Mr. ROSKAM introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means and the Judiciary, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To reduce waste, fraud, and abuse under the Medicare, 
Medicaid, and CHIP programs, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Fighting Fraud and Abuse to Save Taxpayers’ Dollars 
Act’’ or the ‘‘FAST Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
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Sec. 3. Tracking excluded providers across State lines. 
Sec. 4. Access for private sector and governmental entities. 
Sec. 5. Liability of Medicare administrative contractors for claims submitted by 
excluded providers. 
Sec. 6. Limiting the discharge of debts in bankruptcy proceedings in cases 
where a health care provider or a supplier engages in fraudu-
lent activity. 
Sec. 7. Prevention of waste, fraud, and abuse in the Medicaid and CHIP pro-
grams. 
Sec. 8. Illegal distribution of a Medicare, Medicaid, or CHIP beneficiary identi-
fication or billing privileges. 
Sec. 9. Pilot program for the use of universal product numbers on claim forms 
for reimbursement under the Medicare program. 
Sec. 10. Prohibition of inclusion of Social Security account numbers on Medi-
care cards. 
Sec. 11. Implementation. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) The Medicare program loses an estimated 
$60,000,000,000 annually to wasted and fraudulent 
payments. 
(2) The Medicaid program also suffers from 
rampant fraud. As the Office of the Inspector Gen-
eral of the Department of Health and Human Serv-
ices noted in 2009, in an analysis of the only source 
of nationwide Medicaid claims and beneficiary eligi-
bility information, the Medicaid Statistical Informa-
tion System, the Federal Government does not have 
‘‘timely, accurate, or comprehensive information for 
fraud, waste, and abuse detection’’ in the Medicaid 
program. 
(3) Absent comprehensive estimates, the Med-
icaid program’s improper payment rate may be the 
most objective measure of taxpayer dollars lost to 
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fraud. The national average improper payment rate 
ranges between 8.7 percent and 10.5 percent, but 
many States have much higher improper payment 
rates. 
(4) The new Federal health reform law substan-
tially expands the Medicaid program, significantly 
changes the Medicare program, creates new man-
dates and regulations, and will send hundreds of bil-
lions of dollars to insurance companies. 
(5) It is the duty of public officials and public 
servants in Congress and the Administration to pro-
tect the American public’s taxpayer dollars. Con-
gress and the Administration must continue to ag-
gressively combat waste, fraud, and abuse in public 
health care programs. 
(6) The Inspector General of the Department of 
Health and Human Services has stated that ‘‘swift 
and effective detection of and response to waste, 
fraud, and abuse remain an essential program integ-
rity strategy’’. Furthermore, the Inspector General 
noted that ‘‘effective use of Medicare and Medicaid 
data is critical to the success of the Government’s 
efforts to reduce waste, fraud, and abuse’’. 
(7) The loss of taxpayer dollars due to waste 
and fraud under the Medicare and Medicaid pro-
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grams not only threatens the financial viability of 
those programs, it erodes the public trust. American 
taxpayers should not be expected to tolerate ramp-
ant waste, fraud, and abuse in publicly funded 
health care programs. 
(8) Congress supports the commitment of the 
Office of the Inspector General of the Department of 
Health and Human Services to ‘‘enhancing existing 
data analysis and mining capabilities and employing 
advanced techniques such as predictive analytics and 
social network analysis, to counter new and existing 
fraud schemes’’. 
(9) Congress supports the use of predictive 
modeling and other smart technologies that can 
transform the current ‘‘pay and chase’’ payment cul-
tures under the Medicare and Medicaid programs 
and prevent taxpayer dollars from being lost to 
waste, fraud, and abuse. 
SEC. 3. TRACKING EXCLUDED PROVIDERS ACROSS STATE 
LINES. 
(a) GREATER COORDINATION.—In order to ensure 
that providers of services and suppliers that have operated 
in one State and are excluded from participation in the 
Medicare program are unable to begin operation and par-
ticipation in other Federal health care programs in an-
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other State, the Secretary shall provide for increased co-
ordination between the following: 
(1) The Administrator of the Centers for Medi-
care & Medicaid Services. 
(2) Regional offices of the Centers for Medicare 
& Medicaid Services. 
(3) Medicare administrative contractors, fiscal 
intermediaries, and carriers. 
(4) State health agencies, State plans under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.), State plans under title XXI of such Act (42 
U.S.C. 1397aa et seq.), and entities that contract 
with such agencies and plans, as directed by the 
Secretary. 
(5) The Federation of State Medical Boards. 
(b) IMPROVED INFORMATION SYSTEMS.— 
(1) IN GENERAL.—The Secretary shall improve 
information systems to allow greater integration be-
tween databases under the Medicare program so 
that— 
(A) Medicare administrative contractors, 
fiscal intermediaries, and carriers have imme-
diate access to information identifying providers 
and suppliers excluded from participation in the 
Medicare program, the Medicaid program under 
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title XIX of the Social Security Act, the State 
Children’s Health Insurance Program under 
title XXI of such Act, and other Federal health 
care programs; and 
(B) such information can be shared on a 
real-time basis, in accordance with protocols es-
tablished under subsection (g)(2)— 
(i) across Federal health care pro-
grams and agencies, including between the 
Department of Health and Human Serv-
ices, the Social Security Administration, 
the Department of Veterans Affairs, the 
Department of Defense, the Department of 
Justice, and the Office of Personnel Man-
agement; and 
(ii) with State health agencies, State 
plans under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.), State 
child health plans under title XXI of such 
Act (42 U.S.C. 1397aa et seq.), and enti-
ties that contract with such agencies and 
plans, as directed by the Secretary. 
(2) SHARING OF INFORMATION IN ADDITION TO 
HEAT
EFFORTS.—The information shared under 
paragraph (1) shall be in addition to, and shall not 
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replace, activities of the Health Care Fraud Preven-
tion and Enforcement Action Team (HEAT) estab-
lished by the Attorney General and the Department 
of Health and Human Services. 
(3) APPROPRIATE
COORDINATION.—In imple-
menting this subsection, the Secretary shall provide 
for the maximum appropriate coordination with the 
process established under section 6401(b)(2) of the 
Patient Protection and Affordable Care Act (Public 
Law 111–148). 
(c) ‘‘ONE PI’’ DATABASE FOR MEDICARE, MEDICAID, 
AND CHIP.— 
(1) IN GENERAL.—The Secretary shall— 
(A) continue to upload Medicare claims, 
provider, and beneficiary data into the Inte-
grated 
Data 
Repository 
under 
section 
1128J(a)(1) of the Social Security Act, as 
added by section 6402(a) of the Patient Protec-
tion and Affordable Care Act until such time as 
the Secretary determines that the Integrated 
Data Repository is completed; and 
(B) fully implement the waste, fraud, and 
abuse detection solution of the Centers for 
Medicare & Medicaid Services, called the ‘‘One 
PI project’’ (in this subsection referred to as 
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the ‘‘project’’) by not later than January 1, 
2013. 
(2) ACCESS.—The Secretary, in consultation 
with Inspector General of the Department of Health 
and Human Services, may allow stakeholders who 
combat, or could assist in combating, waste, fraud, 
and abuse under Federal health care programs to 
have access to the One PI system established under 
the project. Such stakeholders may include the Di-
rector of the Federal Bureau of Investigation, the 
Comptroller General of the United States, Medicare 
administrative contractors, fiscal intermediaries, and 
carriers. 
(d) FEDERAL AND STATE AGENCY ACCESS TO NA-
TIONAL PRACTITIONER DATA BANK.—For purposes of 
enhancing data sharing in order to identify programmatic 
weaknesses and improving the timeliness of analysis and 
actions to prevent waste, fraud, and abuse, relevant Fed-
eral and State agencies, including the Department of 
Health and Human Services, the Department of Justice, 
State departments of health, State Medicaid plans under 
title XIX of the Social Security Act, State child health 
plans under title XXI of such Act, and State Medicaid 
fraud control units (as described in section 1903(q) of the 
Social Security Act (42 U.S.C. 1396b(q))), shall have real- 
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time access to the National Practitioner Data Bank, as 
directed by the Secretary. The Secretary may, in consulta-
tion with the Inspector General of the Department of 
Health and Human Services, give such real-time access 
to State attorneys general and State and local law enforce-
ment agencies. 
(e) ACCESS
TO
CLAIMS
AND
PAYMENT
DATA-
BASES.—Section 1128J(a)(2) of the Social Security Act, 
as added by section 6402(a) of the Patient Protection and 
Affordable Care Act (Public Law 111–148) is amended— 
(1) by striking ‘‘DATABASES.—For purposes’’ 
and inserting ‘‘DATABASES.— 
‘‘(A) ACCESS FOR THE CONDUCT OF LAW 
ENFORCEMENT AND OVERSIGHT ACTIVITIES.— 
For purposes’’; 
(2) in subparagraph (A), as added by para-
graph (1), by inserting ‘‘, including the Integrated 
Data Repository under paragraph (1)’’ before the 
period at the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(B) ACCESS TO REDUCE WASTE, FRAUD, 
AND ABUSE.—For purposes of reducing waste, 
fraud, and abuse, and to the extent consistent 
with applicable information, privacy, security, 
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and disclosure laws, including the regulations 
promulgated under the Health Insurance Port-
ability and Accountability Act of 1996 and sec-
tion 552a of title 5, United States Code, and 
subject to any information systems security re-
quirements under such laws or otherwise re-
quired by the Secretary, the Secretary, in con-
sultation with the Inspector General of the De-
partment of Health and Human Services, may 
allow State Medicaid fraud control units and 
State and local law enforcement officials to 
have access to claims and payment data of the 
Department of Health and Human Services and 
its contractors related to titles XVIII, XIX, and 
XXI, including the Integrated Data Repository 
under paragraph (1).’’. 
(f) ENSURING DATA IS UPLOADED TO THE IDR ON 
A DAILY BASIS.—Section 1128J(a)(1) of the Social Secu-
rity Act, as added by section 6402(a) of the Patient Pro-
tection and Affordable Care Act (Public Law 111–148) 
is amended by adding at the end the following new sub-
paragraph: 
‘‘(C) UPLOADING
OF
MEDICARE
CLAIMS 
DATA ON A DAILY BASIS.—All Medicare claims 
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data shall be uploaded into the Integrated Data 
Repository on a daily basis.’’. 
(g) REAL-TIME ACCESS TO DATA.— 
(1) IN GENERAL.—The Secretary shall ensure 
that any data provided to an entity or individual 
under the provisions of or amendments made by this 
section is provided to such entity or individual on a 
real-time basis, in accordance with protocols estab-
lished by the Secretary under paragraph (2). The 
Secretary shall consult with the Inspector General of 
the Department of Health and Human Services 
prior to implementing this subsection. 
(2) PROTOCOLS.— 
(A) IN GENERAL.—The Secretary shall es-
tablish protocols to ensure the secure transfer 
and storage of any data provided to another en-
tity or individual under the provisions of or 
amendments made by this section. 
(B) CONSIDERATION
OF
HHS
OIG
REC-
OMMENDATIONS.—In 
establishing 
protocols 
under subparagraph (A), the Secretary shall 
take into account recommendations submitted 
to the Secretary by the Inspector General of the 
Department of Health and Human Services 
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with respect to the secure transfer and storage 
of such data. 
(h) GAO STUDY AND REPORT ON USE OF FEDERA-
TION OF STATE MEDICAL BOARDS TO STRENGTHEN EN-
ROLLMENT INTEGRITY PROCESSES.— 
(1) STUDY.—The Comptroller General of the 
United States shall, in consultation with the Federa-
tion of State Medical Boards, conduct a study on 
whether and, if so, to what degree, such Federation 
may be useful to the Secretary in further strength-
ening the integrity of processes for enrolling pro-
viders of services and suppliers under Federal health 
care programs. 
(2) REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Comptroller Gen-
eral of the United States shall submit to Congress 
a report containing the results of the study con-
ducted under paragraph (1), together with rec-
ommendations for such legislation and administra-
tive action as the Comptroller General determines 
appropriate. 
(i) DEFINITIONS.—In this section: 
(1) ADMINISTRATOR.—The term ‘‘Adminis-
trator’’ means the Administrator of the Centers for 
Medicare & Medicaid Services. 
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(2) CHIP.—The term ‘‘CHIP’’ means the 
State Children’s Health Insurance Program under 
title XXI of the Social Security Act (42 U.S.C. 
1397aa et seq.). 
(3) FEDERAL HEALTH CARE PROGRAM.—The 
term ‘‘Federal health care program’’ has the mean-
ing given such term in section 1128B(f) of the So-
cial Security Act (42 U.S.C. 1320a–7b(f)). 
(4) HHS OIG.—The term ‘‘HHS OIG’’ means 
the Inspector General of the Department of Health 
and Human Services. 
(5) MEDICARE ADMINISTRATIVE CONTRACTORS, 
FISCAL
INTERMEDIARIES, 
AND
CARRIERS.—The 
term ‘‘Medicare administrative contractors, fiscal 
intermediaries, and carriers’’ includes zone program 
integrity contractors, program safeguard or integrity 
contractors, recovery audit contractors under section 
1893(h) of the Social Security Act (42 U.S.C. 
1395ddd(h)), and special investigative units at Medi-
care contractors (as defined in section 1889(g) of 
the Social Security Act (42 U.S.C. 1395zz(g))). 
(6) MEDICARE PROGRAM.—The term ‘‘Medicare 
program’’ means the program under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.). 
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(7) PROVIDER OF SERVICES.—The term ‘‘pro-
vider of services’’ has the meaning given such term 
in section 1861(u) of the Social Security Act (42 
U.S.C. 1395x(u)). 
(8) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(9) STATE.—The term ‘‘State’’ includes the 
District of Columbia, the Commonwealth of Puerto 
Rico, the Virgin Islands, Guam, and American 
Samoa. 
(10) SUPPLIER.—The term ‘‘supplier’’ has the 
meaning given such term in section 1861(d) of the 
Social Security Act (42 U.S.C. 1395x(d)). 
SEC. 4. ACCESS FOR PRIVATE SECTOR AND GOVERN-
MENTAL ENTITIES. 
(a) IN GENERAL.—Title XI of the Social Security Act 
(42 U.S.C. 1301 et seq.), as amended by section 6402(a) 
of the Patient Protection and Affordable Care Act (Public 
Law 111–148), is amended by inserting after section 
1128J the following new section: 
‘‘EXPANDED ACCESS TO THE NATIONAL PRACTITIONER 
DATA BANK 
‘‘SEC. 1128K. (a) EXPANDED ACCESS.— 
‘‘(1) IN GENERAL.—The information in the Na-
tional Practitioner Data Bank established pursuant 
to the Health Care Quality Improvement Act of 
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1986 (42 U.S.C. 11101 et seq.) may be made avail-
able on a real-time basis, in accordance with proto-
cols established by the Secretary under subsection 
(b), to— 
‘‘(A) Federal and State government agen-
cies and health plans, commercial health plans, 
and any health care provider, supplier, or prac-
titioner entering an employment or contractual 
relationship with an individual or entity who 
has been subject to a final adverse action in the 
past 10 years, where the contract involves the 
furnishing of items or services reimbursed by 
one or more Federal health care programs (re-
gardless of whether the individual or entity is 
paid by the programs directly, or whether the 
items or services are reimbursed directly or in-
directly through the claims of a direct pro-
vider); and 
‘‘(B) utilization and quality control peer 
review organizations and accreditation entities 
as defined by the Secretary, including but not 
limited to organizations described in part B of 
this title and in section 1154(a)(4)(C). 
‘‘(2) NO EFFECT ON ACCESS UNDER OTHER AP-
PLICABLE
LAW; 
APPROPRIATE
COORDINATION.— 
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Nothing in this section shall affect the availability of 
information in the National Practitioner Data Bank 
under other applicable law, including the availability 
of such information to entities or individuals under 
part B of the Health Care Quality Improvement Act 
of 1986 (42 U.S.C. 11131 et seq.). In implementing 
this section, the Secretary shall provide for the max-
imum appropriate coordination with such part. 
‘‘(b) PROTOCOLS.—The Secretary shall establish pro-
tocols to ensure the secure transfer and storage of data 
made available under this section. In establishing such 
protocols the Secretary shall take into account rec-
ommendations submitted to the Secretary by the Inspector 
General of the Department of Health and Human Services 
and the National Association of Insurance Commissioners 
with respect to the secure transfer and storage of such 
data, the establishment or approval of a fee structure 
under subsection (c), and the establishment of user access 
protocols. 
‘‘(c) FEES FOR DISCLOSURE.— 
‘‘(1) IN GENERAL.— 
‘‘(A) FEES.—Subject to paragraph (2), the 
Secretary may establish or approve reasonable 
fees for the disclosure of information under this 
section, including with respect to requests by 
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Federal agencies or other entities, such as fiscal 
intermediaries and carriers, acting under con-
tract on behalf of such agencies. 
‘‘(B) ESTABLISHMENT
OR
APPROVAL
OF 
FEE
AMOUNTS.—In establishing or approving 
the amount of such fees, the Secretary shall en-
sure that the total amount of the fees to be col-
lected is equal to the total costs of processing 
the requests for disclosure and of providing 
such information. Such fees shall be available to 
the Secretary to cover such costs. 
‘‘(C) FOR-PROFIT
ENTITIES.—The Sec-
retary may allow for-profit entities to receive 
data under this section for a fee that is com-
parable to the fee charged to a Federal agency 
or other entity under subparagraph (A) with re-
spect to a similar request. 
‘‘(2) FREE ACCESS TO CERTAIN DATA.— 
‘‘(A) IN GENERAL.—Not later than 1 year 
after the date of enactment of the Fighting 
Fraud and Abuse to Save Taxpayers’ Dollars 
Act, for purposes of identifying additional strat-
egies and tools to combat waste, fraud, and 
abuse, the Secretary— 
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‘‘(i) shall establish protocols to ensure 
the secure transmission of data under this 
section; and 
‘‘(ii) may ensure nonprofit academic, 
policy, and research institutions have ac-
cess to data from the National Practitioner 
Data Bank. 
‘‘(B) ACCESS
FREE
OF
CHARGE.—Data 
shall be provided under subparagraph (A)(ii) 
free of charge to academic, policy, and research 
institutions. 
‘‘(C) REQUIREMENT.—Any academic, pol-
icy, or research institution that is provided data 
under subparagraph (A)(ii) shall, as a condition 
of receiving such data, be required to share 
with the Secretary any findings using such data 
to combat waste, fraud, and abuse (in a form 
and manner of the academic, policy, or research 
institution’s choosing). 
‘‘(d) ESTABLISHMENT OF APPEALS PROCESS.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a transparent and responsive appeals process 
under which a provider of services or supplier may 
have their name removed from the National Practi-
tioner Data Bank. Under such process, appeals shall 
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be conducted in a timely manner (not more than 90 
days after the earlier of the date of the listing in the 
National Practitioner Data Bank or the issuance of 
any penalty involved) in order to minimize the time 
that providers of services or suppliers who success-
fully appeal are excluded from participation under 
the programs under titles XVIII and XIX. 
‘‘(2) CONSULTATION.—The Secretary shall con-
sult with major colleges of medical practice in the 
United States, commercial health plans, the Inspec-
tor General of the Department of Health and 
Human Services, the National Association of Insur-
ance Commissioners, and the Federation of State 
Medical Boards in establishing the appeals process 
under paragraph (1). 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) COMMERCIAL HEALTH PLAN.—The term 
‘commercial health plan’ means health insurance 
coverage (as defined in section 2791 of the Public 
Health Service Act and including group health 
plans). 
‘‘(2) FINAL ADVERSE ACTION.—The term ‘final 
adverse action’ means one or more of the following 
actions: 
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‘‘(A) A Medicare-imposed revocation of any 
Medicare billing privileges. 
‘‘(B) Suspension or revocation of a license 
to provide health care by any State licensing 
authority. 
‘‘(C) A conviction of a Federal or State fel-
ony offense within the last 10 years preceding 
enrollment, revalidation, or re-enrollment. 
‘‘(D) An exclusion or debarment from par-
ticipation in a Federal or State health care pro-
gram.’’. 
(b) CRIMINAL PENALTY FOR MISUSE OF INFORMA-
TION DISCLOSED.—Section 1128B(b) of the Social Secu-
rity Act (42 U.S.C. 1320a–7b(b)) is amended by adding 
at the end the following: 
‘‘(4) Whoever knowingly uses information dis-
closed from the National Practitioner Data Bank 
under section 1128K for a purpose other than those 
authorized under that section shall be imprisoned for 
not more than 3 years or fined under title 18, 
United States Code, or both.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. 
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(3) RECOVERY OF OVERPAYMENT OF BENEFITS 
UNDER PART B.—Section 1833(j) of the Social Secu-
rity Act (42 U.S.C. 1395l(j)) is amended— 
(A) by inserting ‘‘(1)’’ after ‘‘(j)’’; 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.’’. 
(4) COLLECTION
OF
PAST-DUE
OBLIGATIONS 
ARISING FROM BREACH OF SCHOLARSHIP AND LOAN 
CONTRACT.—Section 1892(a) of the Social Security 
Act (42 U.S.C. 1395ccc(a)) is amended by adding at 
the end the following: 
‘‘(5) 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.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to bankruptcy petitions filed 
after the date of enactment of this Act. 
VerDate Mar 15 2010 
02:02 Oct 15, 2010
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