I 
110TH CONGRESS 
1ST SESSION H. R. 4105 
To impose a moratorium on the use of recovery audit contractors under 
the Medicare Integrity Program. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 7, 2007 
Mrs. CAPPS introduced the following bill; which was referred to the Committee 
on Ways and Means, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To impose a moratorium on the use of recovery audit 
contractors under the Medicare Integrity Program. 
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 ‘‘Medicare Recovery 
Audit Contractor Program Moratorium Act of 2007’’. 
SEC. 2. MEDICARE RECOVERY AUDIT CONTRACTOR PRO-
GRAM MORATORIUM. 
(a) IN GENERAL.—Except as provided in subsection 
(c), the Secretary of Health and Human Services— 
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(1) shall suspend all further activities under the 
Medicare recovery audit contractor program (as de-
fined in subsection (e)(2)); 
(2) shall not permit recovery audit contrac-
tors— 
(A) to identify any additional underpay-
ments or overpayments; or 
(B) to effect any additional recoupments; 
and 
(3) shall not enter into any new contracts under 
the program. 
(b) TERMINATION.—The moratorium effected under 
subsection (a) shall end one year after the date of the en-
actment of this Act. 
(c) APPLICABILITY.— 
(1) PROTECTION
OF
APPEAL
RIGHTS.—Sub-
section (a) shall not affect appeals under the Medi-
care recovery audit contractor program. 
(2) MEDICARE
SECONDARY
PAYER
ACTIVI-
TIES.—Subsection (a) shall not affect Medicare sec-
ondary payer activities performed by recovery audit 
contractors. 
(d) REPORTS.— 
(1) CMS 
REPORT
EVALUATING
THE
PRO-
GRAM.— 
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(A) IN GENERAL.—Not later than 90 days 
after the date of the enactment of this Act, the 
Administrator of the Centers for Medicare & 
Medicaid Services shall submit to the Congress 
a report evaluating the Medicare recovery audit 
contractor program. 
(B) CONTENTS OF REPORT.—Such report 
shall include the following information, with re-
spect to the Medicare recovery audit contractor 
program: 
(i) The number of claims provided by 
the Centers for Medicare & Medicaid Serv-
ices to recovery audit contractors. 
(ii) The number of claims requested 
by recovery audit contractors. 
(iii) The number of claims reviewed by 
recovery audit contractors. 
(iv) The number of claims described 
in clause (iii) reviewed through an auto-
mated process and the number of such 
claims otherwise reviewed by recovery 
audit contractors. 
(v) The number and dollar amount of 
claims that recovery audit contractors 
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sought to recoup after identifying such 
claims as overpayments. 
(vi) The number of appeals made by 
providers and suppliers in response to 
recoupment of payments by a recovery 
audit contractor. 
(vii) The outcome of such appeals. 
(C) FORM OF DATA.— 
(i) The information described in sub-
paragraph (B) shall be reported— 
(I) for activities under the Medi-
care recovery audit contractor pro-
gram in each calendar quarter; and 
(II) on a national, State, and 
county basis and according to provider 
group. 
(ii) Information described in subpara-
graph (B) concerning appeals shall be re-
ported by appeal level. 
(2) GAO REPORT.— 
(A) IN GENERAL.—Not later than 60 days 
after the date the report is submitted to the 
Congress under paragraph (1), the Comptroller 
General of the United States shall submit a re-
port to the Congress regarding the use of recov-
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ery audit contractors in the Medicare Integrity 
program. 
(B) CONTENTS OF REPORT.—Such report 
shall include the following: 
(i) An examination of the information 
described in each of clauses (i) through 
(vi) of paragraph (1)(B). 
(ii) An examination of the role of re-
covery audit contractors in the Medicare 
oversight process. 
(iii) A comparison of the roles of re-
covery audit contractors with the roles of 
quality improvement organizations and 
Medicare administrative contractors. 
(iv) An examination of the extent to 
which the process used by recovery audit 
contractors is consistent with Medicare 
policy regarding claims denials and ap-
peals. 
(C) 
RECOMMENDATIONS.—Such 
report 
shall include recommendations— 
(i) to improve the accuracy and effi-
ciency of recovery audit contractors; and 
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(ii) to ensure compliance of recovery 
audit contractors with Medicare policy con-
cerning denials and appeals. 
(3) QUARTERLY REPORTS.— 
(A) IN GENERAL.—Not later than 60 days 
after the end of each calendar quarter begin-
ning after the end of the moratorium under 
subsection (a), the Administrator of the Centers 
for Medicare & Medicaid Services shall submit 
to the Congress a report on the conduct of the 
Medicare recovery audit contractor program 
during the quarter. 
(B) CONTENTS OF REPORT.—Each report 
under subparagraph (A) shall include, with re-
spect to a quarter, the information described in 
each of clauses (i) through (vi) of paragraph 
(1)(B) for such quarter. 
(C) FORM OF DATA.—The information re-
quired under subparagraph (B) shall be re-
ported on a national, State, and county basis 
and according to provider group. 
(e) DEFINITIONS.—For the purposes of this section: 
(1) 
MEDICARE
ADMINISTRATIVE
CON-
TRACTOR.—The term ‘‘Medicare administrative con-
tractor’’ has the meaning given such term in section 
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1874A of the Social Security Act (42 U.S.C. 
1395kk–1). 
(2) MEDICARE RECOVERY AUDIT CONTRACTOR 
PROGRAM.—The term ‘‘Medicare recovery audit con-
tractor program’’ means recovery audit contractor— 
(A) activities under section 306 of the 
Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108– 
173); and 
(B) activities under section 1893(h) of the 
Social Security Act (42 U.S.C. 1395ddd(h)). 
(3) MEDICARE
SECONDARY
PAYER
ACTIVI-
TIES.—The term ‘‘Medicare secondary payer activi-
ties’’ means an activity undertaken to obtain compli-
ance with, and enforce, section 1862(b) of the Social 
Security Act. 
(4) PROVIDER.—The term ‘‘provider’’ means a 
provider of services as defined in section 1861(n) of 
the Social Security Act (42 U.S.C. 1395x(n)). 
(5) QUALITY IMPROVEMENT ORGANIZATION.— 
The 
term 
‘‘quality 
improvement 
organization’’ 
means a utilization and quality control peer review 
organization as defined in section 1152 of the Social 
Security Act (42 U.S.C. 1320c–1). 
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