I 
111TH CONGRESS 
2D SESSION 
H. R. 4796 
To amend title XVIII of the Social Security Act with respect to the 
application of Medicare secondary payer rules for certain claims. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 9, 2010 
Mr. PATRICK J. MURPHY of Pennsylvania (for himself and Mr. TIM MURPHY 
of Pennsylvania) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on En-
ergy and Commerce, 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 with respect 
to the application of Medicare secondary payer rules 
for certain claims. 
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 Secondary 
Payer Enhancement Act of 2010’’. 
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SEC. 2. CALCULATION AND DIRECT PAYMENT OF MSP 
CLAIMS. 
(a) CALCULATION AND DIRECT REIMBURSEMENT OF 
CONDITIONAL PAYMENT FOR SETTLEMENT PURPOSES.— 
(1) Section 1862(b)(2)(B) of the Social Secu-
rity Act (42 U.S.C. 1395y(b)(2)(B)) is amended by 
adding at the end the following new clause: 
‘‘(vii)(I) VOLUNTARY
CALCULATION 
AND
PAYMENT
OF
CONDITIONAL
PAY-
MENT.—In the case of a settlement, judg-
ment, award, or other payment between a 
claimant and an applicable plan (as de-
fined in paragraph (8)(F)) involving a pay-
ment made by the Secretary pursuant to 
clause (i) for items and services provided 
to the claimant, for purposes of deter-
mining the amount of reimbursement re-
quired under clause (ii) to the appropriate 
Trust Fund during the 90-day period pre-
ceding the reasonably expected date of 
such settlement, judgment, award, or other 
payment, the claimant and plan may— 
‘‘(aa) in good faith calculate the 
amount of such reimbursement re-
quired based upon available billing 
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data for such items and services pro-
vided; and 
‘‘(bb) reimburse such amount to 
the appropriate Trust Fund, in ac-
cordance with regulations promul-
gated by the Secretary. 
With respect to a payment made 
under clause (i) for items and services 
provided to a claimant and subject to 
subclause (II), any reimbursement 
made in accordance with this sub-
clause shall satisfy any obligation of 
the claimant and the applicable plan 
under this subsection. 
‘‘(II) SECRETARY’S ABILITY TO CON-
TEST AMOUNT OF PAYMENT.—In the case 
of a reimbursement made to the appro-
priate Trust Fund under subclause (I), 
during the 75-day period beginning on the 
date of such reimbursement, if the Sec-
retary determines such reimbursement 
made is not the total amount owed under 
this subparagraph the Secretary shall have 
the right to contest the amount of such re-
imbursement made and to serve upon the 
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claimant and applicable plan a final de-
mand for the balance of the remaining 
amount so owed. The claimant or applica-
ble plan may make a reimbursement to the 
appropriate Trust Fund in the amount of 
such balance determined by the Secretary 
or may pursue appeal of the amount of the 
reimbursement determined by the Sec-
retary pursuant to the appeals process 
under clause (ix). In any such appeal, the 
burden of proof shall be on the claimant or 
applicable plan to demonstrate that the re-
imbursement made to the appropriate 
Trust fund under subclause (I) was cor-
rect. 
‘‘(viii)(I) REQUEST
FOR
FINAL
DE-
MAND FOR REIMBURSEMENT.—In the case 
of a settlement, judgment, award, or other 
payment between a claimant and an appli-
cable plan (as defined in paragraph 
(8)(F)) involving a payment made by the 
Secretary pursuant to clause (i) for items 
and services provided to the claimant, the 
claimant or applicable plan may at any 
time beginning 120 days prior to the rea-
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