H. R. 3590—638 
Medicare Advantage organization (as defined in section 
1859(a)(1)), or PDP sponsor (as defined in section 
1860D–41(a)(13)). 
‘‘(ii) EXCLUSION.—Such term does not include a 
beneficiary. 
‘‘(e) INCLUSION
OF NATIONAL PROVIDER IDENTIFIER
ON ALL 
APPLICATIONS AND CLAIMS.—The Secretary shall promulgate a regu-
lation that requires, not later than January 1, 2011, all providers 
of medical or other items or services and suppliers under the 
programs under titles XVIII and XIX that qualify for a national 
provider identifier to include their national provider identifier on 
all applications to enroll in such programs and on all claims for 
payment submitted under such programs.’’. 
(b) ACCESS TO DATA.— 
(1) MEDICARE PART D.—Section 1860D–15(f)(2) of the Social 
Security Act (42 U.S.C. 1395w–116(f)(2)) is amended by striking 
‘‘may be used by’’ and all that follows through the period 
at the end and inserting ‘‘may be used— 
‘‘(A) by officers, employees, and contractors of the 
Department of Health and Human Services for the pur-
poses of, and to the extent necessary in— 
‘‘(i) carrying out this section; and 
‘‘(ii) conducting oversight, evaluation, and enforce-
ment under this title; and 
‘‘(B) by the Attorney General and the Comptroller Gen-
eral of the United States for the purposes of, and to the 
extent necessary in, carrying out health oversight activi-
ties.’’. 
(2) DATA
MATCHING.—Section 552a(a)(8)(B) of title 5, 
United States Code, is amended— 
(A) in clause (vii), by striking ‘‘or’’ at the end; 
(B) in clause (viii), by inserting ‘‘or’’ after the semicolon; 
and 
(C) by adding at the end the following new clause: 
‘‘(ix) matches performed by the Secretary of Health 
and Human Services or the Inspector General of the 
Department of Health and Human Services with 
respect to potential fraud, waste, and abuse, including 
matches of a system of records with non-Federal 
records;’’. 
(3) MATCHING AGREEMENTS WITH THE COMMISSIONER OF 
SOCIAL
SECURITY.—Section 205(r) of the Social Security Act 
(42 U.S.C. 405(r)) is amended by adding at the end the following 
new paragraph: 
‘‘(9)(A) The Commissioner of Social Security shall, upon 
the request of the Secretary or the Inspector General of the 
Department of Health and Human Services— 
‘‘(i) enter into an agreement with the Secretary or 
such Inspector General for the purpose of matching data 
in the system of records of the Social Security Administra-
tion and the system of records of the Department of Health 
and Human Services; and 
‘‘(ii) include in such agreement safeguards to assure 
the maintenance of the confidentiality of any information 
disclosed.
H. R. 3590—639 
‘‘(B) For purposes of this paragraph, the term ‘system of 
records’ has the meaning given such term in section 552a(a)(5) 
of title 5, United States Code.’’. 
(c) WITHHOLDING OF FEDERAL MATCHING PAYMENTS FOR STATES 
THAT FAIL TO REPORT ENROLLEE ENCOUNTER DATA IN THE MED-
ICAID STATISTICAL INFORMATION SYSTEM.—Section 1903(i) of the 
Social Security Act (42 U.S.C. 1396b(i)) is amended— 
(1) in paragraph (23), by striking ‘‘or’’ at the end; 
(2) in paragraph (24), by striking the period at the end 
and inserting ‘‘; or’’; and 
(3) by adding at the end the following new paragraph:. 
‘‘(25) with respect to any amounts expended for medical 
assistance for individuals for whom the State does not report 
enrollee encounter data (as defined by the Secretary) to the 
Medicaid Statistical Information System (MSIS) in a timely 
manner (as determined by the Secretary).’’. 
(d) PERMISSIVE EXCLUSIONS AND CIVIL MONETARY PENALTIES.— 
(1) PERMISSIVE EXCLUSIONS.—Section 1128(b) of the Social 
Security Act (42 U.S.C. 1320a–7(b)) is amended by adding 
at the end the following new paragraph: 
‘‘(16) MAKING FALSE STATEMENTS OR MISREPRESENTATION 
OF MATERIAL FACTS.—Any individual or entity that knowingly 
makes or causes to be made any false statement, omission, 
or misrepresentation of a material fact in any application, 
agreement, bid, or contract to participate or enroll as a provider 
of services or supplier under a Federal health care program 
(as defined in section 1128B(f)), including Medicare Advantage 
organizations under part C of title XVIII, prescription drug 
plan sponsors under part D of title XVIII, medicaid managed 
care organizations under title XIX, and entities that apply 
to participate as providers of services or suppliers in such 
managed care organizations and such plans.’’. 
(2) CIVIL MONETARY PENALTIES.— 
(A) IN GENERAL.—Section 1128A(a) of the Social Secu-
rity Act (42 U.S.C. 1320a–7a(a)) is amended— 
(i) in paragraph (1)(D), by striking ‘‘was excluded’’ 
and all that follows through the period at the end 
and inserting ‘‘was excluded from the Federal health 
care program (as defined in section 1128B(f)) under 
which the claim was made pursuant to Federal law.’’; 
(ii) in paragraph (6), by striking ‘‘or’’ at the end; 
(iii) by inserting after paragraph (7), the following 
new paragraphs: 
‘‘(8) orders or prescribes a medical or other item or service 
during a period in which the person was excluded from a 
Federal health care program (as so defined), in the case where 
the person knows or should know that a claim for such medical 
or other item or service will be made under such a program; 
‘‘(9) knowingly makes or causes to be made any false state-
ment, omission, or misrepresentation of a material fact in any 
application, bid, or contract to participate or enroll as a provider 
of services or a supplier under a Federal health care program 
(as so defined), including Medicare Advantage organizations 
under part C of title XVIII, prescription drug plan sponsors 
under part D of title XVIII, medicaid managed care organiza-
tions under title XIX, and entities that apply to participate
H. R. 3590—640 
as providers of services or suppliers in such managed care 
organizations and such plans; 
‘‘(10) knows of an overpayment (as defined in paragraph 
(4) of section 1128J(d)) and does not report and return the 
overpayment in accordance with such section;’’; 
(iv) in the first sentence— 
(I) by striking the ‘‘or’’ after ‘‘prohibited rela-
tionship occurs;’’; and 
(II) by striking ‘‘act)’’ and inserting ‘‘act; or 
in cases under paragraph (9), $50,000 for each 
false statement or misrepresentation of a material 
fact)’’; and 
(v) in the second sentence, by striking ‘‘purpose)’’ 
and inserting ‘‘purpose; or in cases under paragraph 
(9), an assessment of not more than 3 times the total 
amount claimed for each item or service for which 
payment was made based upon the application con-
taining the false statement or misrepresentation of 
a material fact)’’. 
(B) CLARIFICATION OF TREATMENT OF CERTAIN CHARI-
TABLE
AND
OTHER
INNOCUOUS
PROGRAMS.—Section 
1128A(i)(6) of the Social Security Act (42 U.S.C. 1320a– 
7a(i)(6)) is amended— 
(i) in subparagraph (C), by striking ‘‘or’’ at the 
end; 
(ii) in subparagraph (D), as redesignated by section 
4331(e) of the Balanced Budget Act of 1997 (Public 
Law 105–33), by striking the period at the end and 
inserting a semicolon; 
(iii) by redesignating subparagraph (D), as added 
by section 4523(c) of such Act, as subparagraph (E) 
and striking the period at the end and inserting ‘‘; 
or’’; and 
(iv) by adding at the end the following new sub-
paragraphs: 
‘‘(F) any other remuneration which promotes access 
to care and poses a low risk of harm to patients and 
Federal health care programs (as defined in section 
1128B(f) and designated by the Secretary under regula-
tions); 
‘‘(G) the offer or transfer of items or services for free 
or less than fair market value by a person, if— 
‘‘(i) the items or services consist of coupons, 
rebates, or other rewards from a retailer; 
‘‘(ii) the items or services are offered or transferred 
on equal terms available to the general public, regard-
less of health insurance status; and 
‘‘(iii) the offer or transfer of the items or services 
is not tied to the provision of other items or services 
reimbursed in whole or in part by the program under 
title XVIII or a State health care program (as defined 
in section 1128(h)); 
‘‘(H) the offer or transfer of items or services for free 
or less than fair market value by a person, if— 
‘‘(i) the items or services are not offered as part 
of any advertisement or solicitation;
H. R. 3590—641 
‘‘(ii) the items or services are not tied to the provi-
sion of other services reimbursed in whole or in part 
by the program under title XVIII or a State health 
care program (as so defined); 
‘‘(iii) there is a reasonable connection between the 
items or services and the medical care of the individual; 
and 
‘‘(iv) the person provides the items or services after 
determining in good faith that the individual is in 
financial need; or 
‘‘(I) effective on a date specified by the Secretary (but 
not earlier than January 1, 2011), the waiver by a PDP 
sponsor of a prescription drug plan under part D of title 
XVIII or an MA organization offering an MA–PD plan 
under part C of such title of any copayment for the first 
fill of a covered part D drug (as defined in section 1860D– 
2(e)) that is a generic drug for individuals enrolled in 
the prescription drug plan or MA–PD plan, respectively.’’. 
(e) TESTIMONIAL SUBPOENA AUTHORITY
IN EXCLUSION-ONLY 
CASES.—Section 1128(f) of the Social Security Act (42 U.S.C. 1320a– 
7(f)) is amended by adding at the end the following new paragraph: 
‘‘(4) The provisions of subsections (d) and (e) of section 
205 shall apply with respect to this section to the same extent 
as they are applicable with respect to title II. The Secretary 
may delegate the authority granted by section 205(d) (as made 
applicable to this section) to the Inspector General of the 
Department of Health and Human Services for purposes of 
any investigation under this section.’’. 
(f) HEALTH CARE FRAUD.— 
(1) KICKBACKS.—Section 1128B of the Social Security Act 
(42 U.S.C. 1320a–7b) is amended by adding at the end the 
following new subsection: 
‘‘(g) In addition to the penalties provided for in this section 
or section 1128A, a claim that includes items or services resulting 
from a violation of this section constitutes a false or fraudulent 
claim for purposes of subchapter III of chapter 37 of title 31, 
United States Code.’’. 
(2) REVISING
THE
INTENT
REQUIREMENT.—Section 1128B 
of the Social Security Act (42 U.S.C. 1320a–7b), as amended 
by paragraph (1), is amended by adding at the end the following 
new subsection: 
‘‘(h) With respect to violations of this section, a person need 
not have actual knowledge of this section or specific intent to 
commit a violation of this section.’’. 
(g) SURETY BOND REQUIREMENTS.— 
(1) DURABLE MEDICAL EQUIPMENT.—Section 1834(a)(16)(B) 
of the Social Security Act (42 U.S.C. 1395m(a)(16)(B)) is 
amended by inserting ‘‘that the Secretary determines is 
commensurate with the volume of the billing of the supplier’’ 
before the period at the end. 
(2) HOME HEALTH AGENCIES.—Section 1861(o)(7)(C) of the 
Social Security Act (42 U.S.C. 1395x(o)(7)(C)) is amended by 
inserting ‘‘that the Secretary determines is commensurate with 
the volume of the billing of the home health agency’’ before 
the semicolon at the end. 
(3) REQUIREMENTS FOR CERTAIN OTHER PROVIDERS OF SERV-
ICES AND SUPPLIERS.—Section 1862 of the Social Security Act