263 
the Department of Health and Human Services for fraud 
prevention activities under the Medicare and Medicaid 
programs. 
SEC. 1322. IMPROVED ENFORCEMENT OF THE MEDICARE 
SECONDARY PAYOR PROVISIONS. 
(a) IN GENERAL.—The Secretary, in coordination 
with the Inspector General of the Department of Health 
and Human Services, shall provide through the Coordina-
tion of Benefits Contractor for the identification of in-
stances where the Medicare program should be, but is not, 
acting as a secondary payer to an individual’s private 
health benefits coverage under section 1862(b) of the So-
cial Security Act (42 U.S.C. 1395y(b)). 
(b) UPDATING PROCEDURES.—The Secretary shall 
update procedures for identifying and resolving credit bal-
ance situations which occur under the Medicare program 
when payment under such title and from other health ben-
efit plans exceed the providers’ charges or the allowed 
amount. 
(c) REPORT
ON IMPROVED ENFORCEMENT.—Not 
later than 1 year after the date of the enactment of this 
Act, the Secretary shall submit a report to Congress on 
progress made in improved enforcement of the Medicare 
secondary payor provisions, including recoupment of credit 
balances. 
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264 
SEC. 1323. STRENGTHEN MEDICARE PROVIDER ENROLL-
MENT STANDARDS AND SAFEGUARDS. 
(a) STRENGTHENING MEDICARE PROVIDER NUM-
BERS.— 
(1) SCREENING NEW PROVIDERS.—As a condi-
tion of a provider of services or a supplier, including 
durable medical equipment suppliers and home 
health agencies, applying for the first time for a pro-
vider number under the Medicare program under 
title XVIII of the Social Security Act and before 
granting billing privileges under such title, the Sec-
retary of Health and Human Services (referred to in 
this section as the ‘‘Secretary’’) shall screen the pro-
vider or supplier for a criminal background or other 
financial 
or 
operational 
irregularities 
through 
fingerprinting, licensure checks, site-visits, and other 
database checks. 
(2) APPLICATION FEES.—The Secretary shall 
impose an application charge on such a provider or 
supplier in order to cover the Secretary’s costs in 
performing the screening required under paragraph 
(1). 
(3) PROVISIONAL APPROVAL.—During an ini-
tial, provisional period (specified by the Secretary) 
in which such a provider or supplier has been issued 
such a number, the Secretary shall provide enhanced 
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oversight of the activities of such provider or sup-
plier under the Medicare program, such as through 
prepayment review and payment limitations. 
(4) PENALTIES FOR FALSE STATEMENTS.—In 
the case of a provider or supplier that knowingly 
makes a false statement in an application for such 
a number, the Secretary may exclude the provider or 
supplier from participation under the Medicare pro-
gram, or may impose a civil money penalty (in the 
amount described in section 1128A(a)(4) of the So-
cial Security Act), in the same manner as the Sec-
retary may impose such an exclusion or penalty 
under sections 1128 and 1128A, respectively, of 
such Act in the case of knowing presentation of a 
false claim described in section 1128A(a)(1)(A) of 
such Act. 
(5) DISCLOSURE
REQUIREMENTS.—With re-
spect to approval of such an application, the Sec-
retary— 
(A) shall require applicants to disclose pre-
vious affiliation with enrolled entities that have 
uncollected debt related to the Medicare or 
Medicaid programs; 
(B) may deny approval if the Secretary de-
termines that these affiliations pose undue risk 
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266 
to the Medicare or Medicaid program, subject 
to an appeals process for the applicant as deter-
mined by the Secretary; and 
(C) may implement enhanced safeguards 
(such as surety bonds). 
(b) MORATORIA.—The Secretary may impose mora-
toria on approval of provider and supplier numbers under 
the Medicare program for new providers of services and 
suppliers as determined necessary to prevent or combat 
fraud a period of delay for any one applicant cannot ex-
ceed 30 days unless cause is shown by the Secretary. 
(c) FUNDING.—There are authorized to be appro-
priated to carry out this section such sums as may be nec-
essary. 
SEC. 1324. TRACKING BANNED PROVIDERS ACROSS STATE 
LINES. 
(a) GREATER COORDINATION.—The Secretary of 
Health and Human Services (in this section referred to 
as the ‘‘Secretary’’) shall provide for increased coordina-
tion between the Administrator of the Centers for Medi-
care & Medicaid Services (in this section referred to as 
‘‘CMS’’) and its regional offices to ensure that providers 
of services and suppliers that have operated in one State 
and are excluded from participation in the Medicare pro-
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gram are unable to begin operation and participation in 
the Medicare program in another State. 
(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 and Medicaid program and other Fed-
eral health care programs; and 
(B) such information can be shared across 
Federal health care programs and agencies, in-
cluding between the Departments of Health and 
Human Services, the Social Security Adminis-
tration, the Department of Veterans Affairs, 
the Department of Defense, the Department of 
Justice, and the Office of Personnel Manage-
ment. 
(c) MEDICARE/MEDICAID ‘‘ONE PI’’ DATABASE.— 
The Secretary shall implement a database that includes 
claims and payment data for all components of the Medi-
care program and the Medicaid program. 
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269 
tionships, history of adverse actions, results of site 
visits or other monitoring by any program. 
(2) USE.—Prior to issuing a provider or sup-
plier number for an entity under the Medicare pro-
gram, the Secretary shall obtain information on the 
entity from such database to assure the entity quali-
fies for the issuance of such a number. 
(g) COMPREHENSIVE SANCTIONS DATABASE.—The 
Secretary shall establish a comprehensive sanctions data-
base on sanctions imposed on providers of services, sup-
pliers, and related entities. Such database shall be over-
seen by the Inspector General of the Department of 
Health and Human Services and shall be linked to related 
databases maintained by State licensure boards and by 
Federal or State law enforcement agencies. 
(h) ACCESS
TO
CLAIMS
AND
PAYMENT
DATA-
BASES.—The Secretary shall ensure that the Inspector 
General of the Department of Health and Human Services 
and Federal law enforcement agencies have direct access 
to all claims and payment databases of the Secretary 
under the Medicare or Medicaid programs. 
(i) CIVIL MONEY PENALTIES FOR SUBMISSION OF 
ERRONEOUS INFORMATION.—In the case of a provider of 
services, supplier, or other entity that knowingly submits 
erroneous information that serves as a basis for payment 
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of any entity under the Medicare or Medicaid program, 
the Secretary may impose a civil money penalty of not to 
exceed $50,000 for each such erroneous submission. A 
civil money penalty under this subsection shall be imposed 
and collected in the same manner as a civil money penalty 
under subsection (a) of section 1128A of the Social Secu-
rity Act is imposed and collected under that section. 
Æ 
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