1713 
•AMDT. NO. 2786 
the Medicaid program under title XIX, or 
under the CHIP program under title XXI if the 
Secretary determines such moratorium is nec-
essary to prevent or combat fraud, waste, or 
abuse under either such program. 
‘‘(B) LIMITATION
ON
REVIEW.—There 
shall be no judicial review under section 1869, 
section 1878, or otherwise, of a temporary mor-
atorium imposed under subparagraph (A). 
‘‘(7) COMPLIANCE PROGRAMS.— 
‘‘(A) IN GENERAL.—On or after the date 
of implementation determined by the Secretary 
under subparagraph (C), a provider of medical 
or other items or services or supplier within a 
particular industry sector or category shall, as 
a condition of enrollment in the program under 
this title, title XIX, or title XXI, establish a 
compliance program that contains the core ele-
ments established under subparagraph (B) with 
respect to that provider or supplier and indus-
try or category. 
‘‘(B) ESTABLISHMENT
OF
CORE
ELE-
MENTS.—The Secretary, in consultation with 
the Inspector General of the Department of 
Health and Human Services, shall establish 
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•AMDT. NO. 2786 
core elements for a compliance program under 
subparagraph (A) for providers or suppliers 
within a particular industry or category. 
‘‘(C) TIMELINE FOR IMPLEMENTATION.— 
The Secretary shall determine the timeline for 
the establishment of the core elements under 
subparagraph (B) and the date of the imple-
mentation of subparagraph (A) for providers or 
suppliers within a particular industry or cat-
egory. The Secretary shall, in determining such 
date of implementation, consider the extent to 
which the adoption of compliance programs by 
a provider of medical or other items or services 
or supplier is widespread in a particular indus-
try sector or with respect to a particular pro-
vider or supplier category.’’. 
(b) MEDICAID.— 
(1) 
STATE
PLAN
AMENDMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)), as amended by section 4302(b), is 
amended— 
(A) in subsection (a)— 
(i) by striking ‘‘and’’ at the end of 
paragraph (75); 
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•AMDT. NO. 2786 
(ii) by striking the period at the end 
of paragraph (76) and inserting a semi-
colon; and 
(iii) by inserting after paragraph (76) 
the following: 
‘‘(77) provide that the State shall comply with 
provider and supplier screening, oversight, and re-
porting requirements in accordance with subsection 
(ii);’’; and 
(B) by adding at the end the following: 
‘‘(ii) PROVIDER AND SUPPLIER SCREENING, OVER-
SIGHT, AND REPORTING REQUIREMENTS.—For purposes 
of subsection (a)(77), the requirements of this subsection 
are the following: 
‘‘(1) SCREENING.—The State complies with the 
process for screening providers and suppliers under 
this title, as established by the Secretary under sec-
tion 1886(j)(2). 
‘‘(2) PROVISIONAL
PERIOD
OF
ENHANCED 
OVERSIGHT FOR NEW PROVIDERS AND SUPPLIERS.— 
The State complies with procedures to provide for a 
provisional period of enhanced oversight for new pro-
viders and suppliers under this title, as established 
by the Secretary under section 1886(j)(3). 
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•AMDT. NO. 2786 
‘‘(3) DISCLOSURE REQUIREMENTS.—The State 
requires providers and suppliers under the State 
plan or under a waiver of the plan to comply with 
the disclosure requirements established by the Sec-
retary under section 1886(j)(4). 
‘‘(4) TEMPORARY
MORATORIUM
ON
ENROLL-
MENT OF NEW PROVIDERS OR SUPPLIERS.— 
‘‘(A) TEMPORARY MORATORIUM IMPOSED 
BY THE SECRETARY.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the State complies with any temporary 
moratorium on the enrollment of new pro-
viders or suppliers imposed by the Sec-
retary under section 1886(j)(6). 
‘‘(ii) EXCEPTION.—A State shall not 
be required to comply with a temporary 
moratorium described in clause (i) if the 
State determines that the imposition of 
such temporary moratorium would ad-
versely impact beneficiaries’ access to med-
ical assistance. 
‘‘(B) MORATORIUM ON ENROLLMENT OF 
PROVIDERS AND SUPPLIERS.—At the option of 
the State, the State imposes, for purposes of 
entering into participation agreements with pro-
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1717 
•AMDT. NO. 2786 
viders or suppliers under the State plan or 
under a waiver of the plan, periods of enroll-
ment moratoria, or numerical caps or other lim-
its, for providers or suppliers identified by the 
Secretary as being at high-risk for fraud, waste, 
or abuse as necessary to combat fraud, waste, 
or abuse, but only if the State determines that 
the imposition of any such period, cap, or other 
limits would not adversely impact beneficiaries’ 
access to medical assistance. 
‘‘(5) COMPLIANCE PROGRAMS.—The State re-
quires providers and suppliers under the State plan 
or under a waiver of the plan to establish, in accord-
ance with the requirements of section 1866(j)(7), a 
compliance program that contains the core elements 
established under subparagraph (B) of that section 
1866(j)(7) for providers or suppliers within a par-
ticular industry or category. 
‘‘(6) REPORTING OF ADVERSE PROVIDER AC-
TIONS.—The State complies with the national sys-
tem for reporting criminal and civil convictions, 
sanctions, negative licensure actions, and other ad-
verse provider actions to the Secretary, through the 
Administrator of the Centers for Medicare & Med-
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•AMDT. NO. 2786 
icaid Services, in accordance with regulations of the 
Secretary. 
‘‘(7) ENROLLMENT AND NPI OF ORDERING OR 
REFERRING PROVIDERS.—The State requires— 
‘‘(A) all ordering or referring physicians or 
other professionals to be enrolled under the 
State plan or under a waiver of the plan as a 
participating provider; and 
‘‘(B) the national provider identifier of any 
ordering or referring physician or other profes-
sional to be specified on any claim for payment 
that is based on an order or referral of the phy-
sician or other professional. 
‘‘(8) OTHER
STATE
OVERSIGHT.—Nothing in 
this subsection shall be interpreted to preclude or 
limit the ability of a State to engage in provider and 
supplier screening or enhanced provider and supplier 
oversight activities beyond those required by the Sec-
retary.’’. 
(2) DISCLOSURE
OF
MEDICARE
TERMINATED 
PROVIDERS AND SUPPLIERS TO STATES.—The Ad-
ministrator of the Centers for Medicare & Medicaid 
Services shall establish a process for making avail-
able to the each State agency with responsibility for 
administering a State Medicaid plan (or a waiver of 
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1722 
•AMDT. NO. 2786 
viduals described in clause (ii) under which 
such individuals share and match data in 
the system of records of the respective 
agencies of such individuals with data in 
the system of records of the Department of 
Health and Human Services for the pur-
pose of identifying potential fraud, waste, 
and abuse under the programs under titles 
XVIII and XIX. 
‘‘(ii) INDIVIDUALS
DESCRIBED.—The 
following individuals are described in this 
clause: 
‘‘(I) The Commissioner of Social 
Security. 
‘‘(II) The Secretary of Veterans 
Affairs. 
‘‘(III) The Secretary of Defense. 
‘‘(IV) The Director of the Indian 
Health Service. 
‘‘(iii) DEFINITION
OF
SYSTEM
OF 
RECORDS.—For purposes of this para-
graph, the term ‘system of records’ has the 
meaning given such term in section 
552a(a)(5) of title 5, United States Code. 
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•AMDT. NO. 2786 
‘‘(2) ACCESS TO CLAIMS AND PAYMENT DATA-
BASES.—For purposes of conducting law enforce-
ment and oversight activities and to the extent con-
sistent with applicable information, privacy, security, 
and disclosure laws, including the regulations pro-
mulgated under the Health Insurance Portability 
and Accountability Act of 1996 and section 552a of 
title 5, United States Code, and subject to any infor-
mation systems security requirements under such 
laws or otherwise required by the Secretary, the In-
spector General of the Department of Health and 
Human Services and the Attorney General shall 
have access to claims and payment data of the De-
partment of Health and Human Services and its 
contractors related to titles XVIII, XIX, and XXI. 
‘‘(b) OIG AUTHORITY TO OBTAIN INFORMATION.— 
‘‘(1) IN GENERAL.—Notwithstanding and in ad-
dition to any other provision of law, the Inspector 
General of the Department of Health and Human 
Services may, for purposes of protecting the integ-
rity of the programs under titles XVIII and XIX, 
obtain information from any individual (including a 
beneficiary provided all applicable privacy protec-
tions are followed) or entity that— 
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•AMDT. NO. 2786 
‘‘(A) is a provider of medical or other 
items or services, supplier, grant recipient, con-
tractor, or subcontractor; or 
‘‘(B) directly or indirectly provides, orders, 
manufactures, distributes, arranges for, pre-
scribes, supplies, or receives medical or other 
items or services payable by any Federal health 
care program (as defined in section 1128B(f)) 
regardless of how the item or service is paid 
for, or to whom such payment is made. 
‘‘(2) INCLUSION OF CERTAIN INFORMATION.— 
Information which the Inspector General may obtain 
under paragraph (1) includes any supporting docu-
mentation necessary to validate claims for payment 
or payments under title XVIII or XIX, including a 
prescribing physician’s medical records for an indi-
vidual who is prescribed an item or service which is 
covered under part B of title XVIII, a covered part 
D drug (as defined in section 1860D–2(e)) for which 
payment is made under an MA–PD plan under part 
C of such title, or a prescription drug plan under 
part D of such title, and any records necessary for 
evaluation of the economy, efficiency, and effective-
ness of the programs under titles XVIII and XIX. 
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•AMDT. NO. 2786 
‘‘(c) ADMINISTRATIVE REMEDY FOR KNOWING PAR-
TICIPATION BY BENEFICIARY IN HEALTH CARE FRAUD 
SCHEME.— 
‘‘(1) IN GENERAL.—In addition to any other 
applicable remedies, if an applicable individual has 
knowingly participated in a Federal health care 
fraud offense or a conspiracy to commit a Federal 
health care fraud offense, the Secretary shall impose 
an appropriate administrative penalty commensurate 
with the offense or conspiracy. 
‘‘(2) APPLICABLE INDIVIDUAL.—For purposes 
of paragraph (1), the term ‘applicable individual’ 
means an individual— 
‘‘(A) entitled to, or enrolled for, benefits 
under part A of title XVIII or enrolled under 
part B of such title; 
‘‘(B) eligible for medical assistance under 
a State plan under title XIX or under a waiver 
of such plan; or 
‘‘(C) eligible for child health assistance 
under a child health plan under title XXI. 
‘‘(d) REPORTING
AND RETURNING
OF OVERPAY-
MENTS.— 
‘‘(1) IN GENERAL.—If a person has received an 
overpayment, the person shall— 
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•AMDT. NO. 2786 
‘‘(A) report and return the overpayment to 
the Secretary, the State, an intermediary, a 
carrier, or a contractor, as appropriate, at the 
correct address; and 
‘‘(B) notify the Secretary, State, inter-
mediary, carrier, or contractor to whom the 
overpayment was returned in writing of the rea-
son for the overpayment. 
‘‘(2) DEADLINE FOR REPORTING AND RETURN-
ING OVERPAYMENTS.—An overpayment must be re-
ported and returned under paragraph (1) by the 
later of— 
‘‘(A) the date which is 60 days after the 
date on which the overpayment was identified; 
or 
‘‘(B) the date any corresponding cost re-
port is due, if applicable. 
‘‘(3) ENFORCEMENT.—Any overpayment re-
tained by a person after the deadline for reporting 
and returning the overpayment under paragraph (2) 
is an obligation (as defined in section 3729(b)(3) of 
title 31, United States Code) for purposes of section 
3729 of such title. 
‘‘(4) DEFINITIONS.—In this subsection: 
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1727 
•AMDT. NO. 2786 
‘‘(A) KNOWING
AND
KNOWINGLY.—The 
terms ‘knowing’ and ‘knowingly’ have the mean-
ing given those terms in section 3729(b) of title 
31, United States Code. 
‘‘(B) OVERPAYMENT.—The term ‘‘overpay-
ment’’ means any funds that a person receives 
or retains under title XVIII or XIX to which 
the person, after applicable reconciliation, is not 
entitled under such title. 
‘‘(C) PERSON.— 
‘‘(i) IN GENERAL.—The term ‘person’ 
means a provider of services, supplier, 
medicaid managed care organization (as 
defined in section 1903(m)(1)(A)), Medi-
care 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 IDENTI-
FIER
ON ALL APPLICATIONS
AND CLAIMS.—The Sec-
retary shall promulgate a regulation 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 
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•AMDT. NO. 2786 
provider identifier to include their national provider identi-
fier 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 contrac-
tors of the Department of Health and Human 
Services for the purposes of, and to the extent 
necessary in— 
‘‘(i) carrying out this section; and 
‘‘(ii) conducting oversight, evaluation, 
and enforcement under this title; and 
‘‘(B) by the Attorney General and the 
Comptroller General of the United States for 
the purposes of, and to the extent necessary in, 
carrying out health oversight activities.’’. 
(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; 
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1729 
•AMDT. NO. 2786 
(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 Sec-
retary of Health and Human Services or 
the Inspector General of the Department 
of Health and Human Services with re-
spect to potential fraud, waste, and abuse, 
including matches of a system of records 
with non-Federal records;’’. 
(3) MATCHING AGREEMENTS WITH THE COM-
MISSIONER OF SOCIAL SECURITY.—Section 205(r) of 
the Social Security Act (42 U.S.C. 405(r)) is amend-
ed by adding at the end the following new para-
graph: 
‘‘(9)(A) The Commissioner of Social Security 
shall, upon the request of the Secretary or the In-
spector General of the Department of Health and 
Human Services— 
‘‘(i) enter into an agreement with the Sec-
retary or such Inspector General for the pur-
pose of matching data in the system of records 
of the Social Security Administration and the 
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•AMDT. NO. 2786 
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. 
‘‘(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 PAY-
MENTS FOR STATES THAT FAIL TO REPORT ENROLLEE 
ENCOUNTER DATA IN THE MEDICAID STATISTICAL IN-
FORMATION SYSTEM.—Section 1903(i) of the Social Secu-
rity 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 de-
fined by the Secretary) to the Medicaid Statistical 
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•AMDT. NO. 2786 
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
MIS-
REPRESENTATION OF MATERIAL FACTS.—Any indi-
vidual or entity that knowingly makes or causes to 
be made any false statement, omission, or misrepre-
sentation 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 organiza-
tions under part C of title XVIII, prescription drug 
plan sponsors under part D of title XVIII, medicaid 
managed care organizations under title XIX, and en-
tities that apply to participate as providers of serv-
ices or suppliers in such managed care organizations 
and such plans.’’. 
(2) CIVIL MONETARY PENALTIES.— 
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•AMDT. NO. 2786 
(A) IN
GENERAL.—Section 1128A(a) of 
the Social Security 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 insert-
ing ‘‘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 pro-
gram; 
‘‘(9) knowingly makes or causes to be made any 
false statement, omission, or misrepresentation of a 
material fact in any application, bid, or contract to 
participate or enroll as a provider of services or a 
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•AMDT. NO. 2786 
supplier under a Federal health care program (as so 
defined), including Medicare Advantage organiza-
tions under part C of title XVIII, prescription drug 
plan sponsors under part D of title XVIII, medicaid 
managed care organizations under title XIX, and en-
tities that apply to participate as providers of serv-
ices 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 re-
port and return the overpayment in accordance with 
such section;’’; 
(iv) in the first sentence— 
(I) by striking the ‘‘or’’ after 
‘‘prohibited relationship occurs;’’; and 
(II) by striking ‘‘act)’’ and in-
serting ‘‘act; or in cases under para-
graph (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 
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1734 
•AMDT. NO. 2786 
payment was made based upon the applica-
tion containing the false statement or mis-
representation of a material fact)’’. 
(B) CLARIFICATION
OF
TREATMENT
OF 
CERTAIN CHARITABLE 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 redesig-
nated by section 4331(e) of the Balanced 
Budget Act of 1997 (Public Law 105–33), 
by striking the period at the end and in-
serting 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 subparagraphs: 
‘‘(F) any other remuneration which pro-
motes access to care and poses a low risk of 
harm to patients and Federal health care pro-
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•AMDT. NO. 2786 
grams (as defined in section 1128B(f) and des-
ignated by the Secretary under regulations); 
‘‘(G) the offer or transfer of items or serv-
ices 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, regardless of health in-
surance 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 serv-
ices for free or less than fair market value by 
a person, if— 
‘‘(i) the items or services are not of-
fered as part of any advertisement or solic-
itation; 
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•AMDT. NO. 2786 
‘‘(ii) the items or services are not tied 
to the provision of other services reim-
bursed 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 med-
ical 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 pre-
scription 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 copay-
ment for the first fill of a covered part D drug 
(as defined in section 1860D–2(e)) that is a ge-
neric drug for individuals enrolled in the pre-
scription drug plan or MA–PD plan, respec-
tively.’’. 
(e) TESTIMONIAL SUBPOENA AUTHORITY IN EXCLU-
SION-ONLY CASES.—Section 1128(f) of the Social Secu-
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1737 
•AMDT. NO. 2786 
rity 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 sec-
tion 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 appli-
cable to this section) to the Inspector General of the 
Department of Health and Human Services for pur-
poses 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 con-
stitutes a false or fraudulent claim for purposes of sub-
chapter 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 amend-
ed by adding at the end the following new sub-
section: 
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1738 
•AMDT. NO. 2786 
‘‘(h) With respect to violations of this section, a per-
son need not have actual knowledge of this section or spe-
cific 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 vol-
ume of the billing of the home health agency’’ before 
the semicolon at the end. 
(3) REQUIREMENTS FOR CERTAIN OTHER PRO-
VIDERS
OF
SERVICES
AND
SUPPLIERS.—Section 
1862 of the Social Security Act (42 U.S.C. 1395y) 
is amended by adding at the end the following new 
subsection: 
‘‘(n) REQUIREMENT OF A SURETY BOND FOR CER-
TAIN PROVIDERS OF SERVICES AND SUPPLIERS.— 
‘‘(1) IN GENERAL.—The Secretary may require 
a provider of services or supplier described in para-
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1739 
•AMDT. NO. 2786 
graph (2) to provide the Secretary on a continuing 
basis with a surety bond in a form specified by the 
Secretary in an amount (not less than $50,000) that 
the Secretary determines is commensurate with the 
volume of the billing of the provider of services or 
supplier. The Secretary may waive the requirement 
of a bond under the preceding sentence in the case 
of a provider of services or supplier that provides a 
comparable surety bond under State law. 
‘‘(2) PROVIDER OF SERVICES OR SUPPLIER DE-
SCRIBED.—A provider of services or supplier de-
scribed in this paragraph is a provider of services or 
supplier the Secretary determines appropriate based 
on the level of risk involved with respect to the pro-
vider of services or supplier, and consistent with the 
surety 
bond 
requirements 
under 
sections 
1834(a)(16)(B) and 1861(o)(7)(C).’’. 
(h) SUSPENSION OF MEDICARE AND MEDICAID PAY-
MENTS PENDING INVESTIGATION OF CREDIBLE ALLEGA-
TIONS OF FRAUD.— 
(1) MEDICARE.—Section 1862 of the Social Se-
curity Act (42 U.S.C. 1395y), as amended by sub-
section (g)(3), is amended by adding at the end the 
following new subsection: 
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1740 
•AMDT. NO. 2786 
‘‘(o) SUSPENSION OF PAYMENTS PENDING INVES-
TIGATION OF CREDIBLE ALLEGATIONS OF FRAUD.— 
‘‘(1) IN GENERAL.—The Secretary may suspend 
payments to a provider of services or supplier under 
this title pending an investigation of a credible alle-
gation of fraud against the provider of services or 
supplier, unless the Secretary determines there is 
good cause not to suspend such payments. 
‘‘(2) CONSULTATION.—The Secretary shall con-
sult with the Inspector General of the Department 
of Health and Human Services in determining 
whether there is a credible allegation of fraud 
against a provider of services or supplier. 
‘‘(3) PROMULGATION
OF
REGULATIONS.—The 
Secretary shall promulgate regulations to carry out 
this subsection and section 1903(i)(2)(C).’’. 
(2) MEDICAID.—Section 1903(i)(2) of such Act 
(42 U.S.C. 1396b(i)(2)) is amended— 
(A) in subparagraph (A), by striking ‘‘or’’ 
at the end; and 
(B) by inserting after subparagraph (B), 
the following: 
‘‘(C) by any individual or entity to whom 
the State has failed to suspend payments under 
the plan during any period when there is pend-
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1741 
•AMDT. NO. 2786 
ing an investigation of a credible allegation of 
fraud against the individual or entity, as deter-
mined by the State in accordance with regula-
tions promulgated by the Secretary for pur-
poses of section 1862(o) and this subparagraph, 
unless the State determines in accordance with 
such regulations there is good cause not to sus-
pend such payments; or’’. 
(i) INCREASED FUNDING
TO FIGHT FRAUD
AND 
ABUSE.— 
(1) IN GENERAL.—Section 1817(k) of the So-
cial Security Act (42 U.S.C. 1395i(k)) is amended— 
(A) 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 additional 
$10,000,000 to such Account from such Trust Fund 
for each of fiscal years 2011 through 2020. The 
funds appropriated 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 allocated with respect to fiscal year 
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1742 
•AMDT. NO. 2786 
2010, and shall be available without further appro-
priation until expended.’’; and 
(B) in paragraph (4)(A), by inserting 
‘‘until expended’’ after ‘‘appropriation’’. 
(2) INDEXING OF AMOUNTS APPROPRIATED.— 
(A) DEPARTMENTS
OF
HEALTH
AND 
HUMAN
SERVICES
AND
JUSTICE.—Section 
1817(k)(3)(A)(i) of the Social Security Act (42 
U.S.C. 1395i(k)(3)(A)(i)) is amended— 
(i) in subclause (III), by inserting 
‘‘and’’ at the end; 
(ii) in subclause (IV)— 
(I) by striking ‘‘for each of fiscal 
years 2007, 2008, 2009, and 2010’’ 
and inserting ‘‘for each fiscal year 
after fiscal year 2006’’; and 
(II) by striking ‘‘; and’’ and in-
serting a period; and 
(iii) by striking subclause (V). 
(B) OFFICE OF THE INSPECTOR GENERAL 
OF THE DEPARTMENT OF HEALTH AND HUMAN 
SERVICES.—Section 1817(k)(3)(A)(ii) of such 
Act (42 U.S.C. 1395i(k)(3)(A)(ii)) is amend-
ed— 
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1743 
•AMDT. NO. 2786 
(i) in subclause (VIII), by inserting 
‘‘and’’ at the end; 
(ii) in subclause (IX)— 
(I) by striking ‘‘for each of fiscal 
years 2008, 2009, and 2010’’ and in-
serting ‘‘for each fiscal year after fis-
cal year 2007’’; and 
(II) by striking ‘‘; and’’ and in-
serting a period; and 
(iii) by striking subclause (X). 
(C) FEDERAL
BUREAU
OF
INVESTIGA-
TION.—Section 1817(k)(3)(B) of the Social Se-
curity Act (42 U.S.C. 1395i(k)(3)(B)) is 
amended— 
(i) in clause (vii), by inserting ‘‘and’’ 
at the end; 
(ii) in clause (viii)— 
(I) by striking ‘‘for each of fiscal 
years 2007, 2008, 2009, and 2010’’ 
and inserting ‘‘for each fiscal year 
after fiscal year 2006’’; and 
(II) by striking ‘‘; and’’ and in-
serting a period; and 
(iii) by striking clause (ix). 
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1761 
•AMDT. NO. 2786 
‘‘close of the calendar year following the 
year in which such service is furnished 
(deeming any service furnished in the last 
3 months of any calendar year to have 
been furnished in the succeeding calendar 
year)’’ and inserting ‘‘period ending 1 cal-
endar year after the date of service’’; and 
(ii) by adding at the end the following 
new sentence: ‘‘In applying subparagraph 
(B), the Secretary may specify exceptions 
to the 1 calendar year period specified in 
such subparagraph.’’ 
(B) Section 1835(a) of such Act (42 
U.S.C. 1395n(a)) is amended— 
(i) in paragraph (1), by striking ‘‘pe-
riod of 3 calendar years’’ and all that fol-
lows through the semicolon and inserting 
‘‘period ending 1 calendar year after the 
date of service;’’; and 
(ii) by adding at the end the following 
new sentence: ‘‘In applying paragraph (1), 
the Secretary may specify exceptions to the 
1 calendar year period specified in such 
paragraph.’’ 
(b) EFFECTIVE DATE.— 
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