I 
109TH CONGRESS 
2D SESSION 
H. R. 5962 
To amend title XVIII of the Social Security Act to establish additional 
provisions to combat waste, fraud, and abuse within the Medicare Pro-
gram, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 28, 2006 
Mrs. BIGGERT introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committees on Energy 
and Commerce and Judiciary, for a period to be subsequently determined 
by the Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
additional provisions to combat waste, fraud, and abuse 
within the Medicare Program, 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 
‘‘Medicare Fraud Prevention and Enforcement Act of 
2006’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
Sec. 2. Site inspections and background checks. 
Sec. 3. Registration of billing agencies. 
Sec. 4. Expanded access to the health integrity protection database (HIPDB). 
Sec. 5. Liability of medicare carriers and fiscal intermediaries for claims sub-
mitted by excluded providers. 
Sec. 6. Community mental health centers. 
Sec. 7. Limiting the use of discharge in bankruptcy proceedings for provider li-
ability for health care fraud. 
Sec. 8. Illegal distribution of a medicare or medicaid beneficiary identification 
or provider number. 
Sec. 9. Treatment of certain Social Security Act crimes as Federal health care 
offenses. 
Sec. 10. Authority of Office of Inspector General of the Department of Health 
and Human Services. 
Sec. 11. Universal product numbers on claims forms for reimbursement under 
the medicare program. 
SEC. 2. SITE INSPECTIONS AND BACKGROUND CHECKS. 
(a) SITE INSPECTIONS FOR DME SUPPLIERS, COM-
MUNITY MENTAL HEALTH CENTERS, AND OTHER PRO-
VIDER GROUPS.—Title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) is amended by adding at the end 
the following: 
‘‘SITE INSPECTIONS FOR DME SUPPLIERS, COMMUNITY 
MENTAL HEALTH CENTERS, AND OTHER PROVIDER 
GROUPS 
‘‘SEC. 1898. (a) SITE INSPECTIONS.— 
‘‘(1) IN GENERAL.—The Secretary shall con-
duct a site inspection for each applicable provider 
(as defined in paragraph (2)) that applies for a pro-
vider number in order to provide items or services 
under this title. Such site inspection shall be in addi-
tion to any other site inspection that the Secretary 
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would otherwise conduct with regard to an applica-
ble provider. 
‘‘(2) APPLICABLE PROVIDER DEFINED.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), in this section the term ‘ap-
plicable provider’ means— 
‘‘(i) a supplier of durable medical 
equipment (including items described in 
section 1834(a)(13)); 
‘‘(ii) 
a 
supplier 
of 
prosthetics, 
orthotics, or supplies (including items de-
scribed in paragraphs (8) and (9) of sec-
tion 1861(s)); 
‘‘(iii) a community mental health cen-
ter; or 
‘‘(iv) any other provider group, as de-
termined by the Secretary. 
‘‘(B) EXCEPTION.—In this section, the 
term ‘applicable provider’ does not include— 
‘‘(i) a physician that provides durable 
medical equipment (as described in sub-
paragraph (A)(i)) or prosthetics, orthotics, 
or supplies (as described in subparagraph 
(A)(ii)) to an individual as incident to an 
office visit by such individual; or 
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‘‘(ii) a hospital that provides durable 
medical equipment (as described in sub-
paragraph (A)(i)) or prosthetics, orthotics, 
or supplies (as described in subparagraph 
(A)(ii)) to an individual as incident to an 
emergency room visit by such individual. 
‘‘(b) STANDARDS
AND REQUIREMENTS.—In con-
ducting the site inspection pursuant to subsection (a), the 
Secretary shall ensure that the site being inspected is in 
full compliance with all the conditions and standards of 
participation and requirements for obtaining medicare bill-
ing privileges under this title. 
‘‘(c) TIME.—The Secretary shall conduct the site in-
spection for an applicable provider prior to the issuance 
of a provider number to such provider. 
‘‘(d) TIMELY REVIEW.—The Secretary shall provide 
for procedures to ensure that the site inspection required 
under this section does not unreasonably delay the 
issuance of a provider number to an applicable provider.’’. 
(b) BACKGROUND CHECKS.—Title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) (as amended 
by subsection (a)) is amended by adding at the end the 
following: 
‘‘BACKGROUND CHECKS 
‘‘SEC. 1899. (a) BACKGROUND CHECK REQUIRED.— 
Except as provided in subsection (b), the Secretary shall 
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conduct a background check on any individual or entity 
that applies to the Secretary for a provider number for 
the purpose of furnishing any item or service under this 
title. In performing the background check, the Secretary 
shall— 
‘‘(1) conduct the background check before 
issuing a provider number to an individual or entity; 
‘‘(2) include a search of criminal records in the 
background check; and 
‘‘(3) provide for procedures that ensure the 
background check does not unreasonably delay the 
issuance of a provider number to an eligible indi-
vidual or entity. 
‘‘(b) USE OF STATE LICENSING PROCEDURE.—The 
Secretary may use the results of a State licensing proce-
dure as a background check under subsection (a) if the 
State licensing procedure meets the requirements of sub-
section (a). 
‘‘(c) ATTORNEY GENERAL REQUIRED TO PROVIDE 
INFORMATION.— 
‘‘(1) IN GENERAL.—Upon request of the Sec-
retary, the Attorney General shall provide the crimi-
nal background check information referred to in sub-
section (a)(2) to the Secretary. 
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‘‘(2) RESTRICTION ON USE OF DISCLOSED IN-
FORMATION.—The Secretary may only use the infor-
mation disclosed under subsection (a) for the pur-
pose of carrying out the Secretary’s responsibilities 
under this title. 
‘‘(d) REFUSAL TO ISSUE PROVIDER NUMBER.— 
‘‘(1) AUTHORITY.—In addition to any other 
remedy available to the Secretary, the Secretary may 
refuse to issue a provider number to an individual 
or entity if the Secretary determines, after a back-
ground check conducted under this section, that 
such individual or entity has a history of acts that 
indicate issuance of a provider number to such indi-
vidual or entity would be detrimental to the best in-
terests of the program or program beneficiaries. 
Such acts may include— 
‘‘(A) any bankruptcy; 
‘‘(B) any act resulting in a civil judgment 
against such individual or entity; or 
‘‘(C) any felony conviction under Federal 
or State law. 
‘‘(2) REPORTING OF REFUSAL TO ISSUE PRO-
VIDER NUMBER TO THE HEALTH INTEGRITY PRO-
TECTION
DATABASE
(HIPDB).—A determination to 
refuse to issue a provider number to an individual 
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or entity as a result of a background check con-
ducted under this section shall be reported to the 
health integrity protection database established 
under section 1128E in accordance with the proce-
dures for reporting final adverse actions taken 
against a health care provider, supplier, or practi-
tioner under that section.’’. 
(c) REGULATIONS; EFFECTIVE DATE.— 
(1) REGULATIONS.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall promul-
gate such regulations as are necessary to implement 
the amendments made by subsections (a) and (b). 
(2) EFFECTIVE DATE.—The amendments made 
by subsections (a) and (b) shall apply to applications 
for a provider number received by the Secretary of 
Health and Human Services on or after the first day 
of the first year beginning after the date of the en-
actment of this Act. 
(d) USE
OF
MEDICARE
INTEGRITY
PROGRAM 
FUNDS.—The Secretary of Health and Human Services 
may use funds appropriated or transferred for purposes 
of carrying out the medicare integrity program established 
under section 1893 of the Social Security Act (42 U.S.C. 
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1395ddd) to carry out the provisions of sections 1898 and 
1899 of that Act (as added by subsections (a) and (b)). 
SEC. 3. REGISTRATION OF BILLING AGENCIES. 
(a) REGISTRATION OF BILLING AGENCIES AND INDI-
VIDUALS.—Title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) (as amended by section 2(b)) is 
amended by adding at the end the following: 
‘‘REGISTRATION OF BILLING AGENCIES AND INDIVIDUALS 
‘‘SEC. 1899A. (a) REGISTRATION.—The Secretary 
shall establish procedures for the registration of all appli-
cable persons. 
‘‘(b) REQUIRED APPLICATION.—Each applicable per-
son shall submit a registration application to the Secretary 
at such time, in such manner, and accompanied by such 
information as the Secretary may require. 
‘‘(c) IDENTIFICATION NUMBER.—If the Secretary ap-
proves an application submitted under subsection (b), the 
Secretary shall assign a unique identification number to 
the applicable person. 
‘‘(d) REQUIREMENT.—Every claim for reimburse-
ment under this title that is compiled and submitted by 
an applicable person shall contain the identification num-
ber that is assigned to the applicable person pursuant to 
subsection (c). 
‘‘(e) TIMELY REVIEW.—The Secretary shall provide 
for procedures that ensure the timely consideration and 
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determination regarding approval of applications under 
this section. 
‘‘(f) DEFINITION OF APPLICABLE PERSON.—In this 
section, the term ‘applicable person’ means an individual 
or an entity that compiles and submits claims for reim-
bursement under this title to the Secretary on behalf of 
any individual or entity.’’. 
(b) PERMISSIVE EXCLUSION.—Section 1128(b) of 
the Social Security Act (42 U.S.C. 1320a–7(b)) is amend-
ed by adding at the end the following: 
‘‘(16) FRAUD BY APPLICABLE PERSON.—An ap-
plicable person (as defined in section 1899A(f)) that 
the Secretary determines knowingly submitted or 
caused to be submitted a claim for reimbursement 
under title XVIII that the applicable person knows 
or should know is false or fraudulent.’’. 
(c) REGULATIONS; EFFECTIVE DATE.— 
(1) REGULATIONS.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall promul-
gate such regulations as are necessary to implement 
the amendments made by subsections (a) and (b). 
(2) EFFECTIVE DATE.—The amendments made 
by subsections (a) and (b) shall take effect on the 
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first day of the first year beginning after the date 
of the enactment of this Act. 
SEC. 4. EXPANDED ACCESS TO THE HEALTH INTEGRITY 
PROTECTION DATABASE (HIPDB). 
(a) IN GENERAL.—Section 1128E(d)(1) of the Social 
Security Act (42 U.S.C. 1320a–7e(d)(1)) is amended to 
read as follows: 
‘‘(1) AVAILABILITY.—The information in the 
database maintained under this section shall be 
available to— 
‘‘(A) Federal and State government agen-
cies and health plans, and any health care pro-
vider, supplier, or practitioner entering an em-
ployment or contractual relationship with an in-
dividual or entity who could potentially be the 
subject of a final adverse action, where the con-
tract involves the furnishing of items or services 
reimbursed by one or more Federal health care 
programs (regardless of whether the individual 
or entity is paid by the programs directly, or 
whether the items or services are reimbursed di-
rectly or indirectly through the claims of a di-
rect provider); and 
‘‘(B) utilization and quality control peer 
review organizations and accreditation entities 
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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).’’. 
(b) CRIMINAL PENALTY FOR MISUSE OF INFORMA-
TION.—Section 1128B(b) of the Social Security Act (42 
U.S.C. 1320a–7b(b)) is amended by adding at the end the 
following: 
‘‘(4) Whoever knowingly uses information maintained 
in the health integrity protection database maintained in 
accordance with section 1128E for a purpose other than 
a purpose authorized under that section shall be impris-
oned for not more than three 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 the enactment 
of this Act. 
SEC. 5. LIABILITY OF MEDICARE ADMINISTRATIVE CON-
TRACTORS FOR CLAIMS SUBMITTED BY EX-
CLUDED PROVIDERS. 
(a) REIMBURSEMENT
TO
THE
SECRETARY
FOR 
AMOUNTS PAID
TO EXCLUDED PROVIDERS.—Section 
1874A(b) of the Social Security Act (42 U.S.C. 
1395kk(b)) is amended by adding at the end the following 
new paragraph: 
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