I 
113TH CONGRESS 
1ST SESSION H. R. 2828 
To amend titles XI and XVIII of the Social Security Act to prevent fraud 
and abuse under the Medicare program and to require National Provider 
Identifiers for reimbursement of prescriptions under part D of the Medi-
care program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 25, 2013 
Mr. BILIRAKIS introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, 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 titles XI and XVIII of the Social Security Act 
to prevent fraud and abuse under the Medicare program 
and to require National Provider Identifiers for reim-
bursement of prescriptions under part D of 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. 
This Act may be cited as the ‘‘Medicare Abuse Pre-
vention Act of 2013’’ or the ‘‘MAP Act of 2013’’. 
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SEC. 2. INCREASED CIVIL AND CRIMINAL PENALTIES. 
(a) INCREASED
CIVIL
MONEY
PENALTIES
AND 
CRIMINAL FINES FOR FEDERAL HEALTH CARE PROGRAM 
FRAUD AND ABUSE.— 
(1) INCREASED CIVIL MONEY PENALTIES.—Sec-
tion 1128A of the Social Security Act (42 U.S.C. 
1320a–7a) is amended— 
(A) in subsection (a), in the matter fol-
lowing paragraph (10)— 
(i) by striking ‘‘$10,000’’ and insert-
ing ‘‘$20,000’’ each place it appears; 
(ii) by striking ‘‘$15,000’’ and insert-
ing ‘‘$30,000’’; and 
(iii) by striking ‘‘$50,000’’ and insert-
ing ‘‘$100,000’’ each place it appears; and 
(B) in subsection (b)— 
(i) in paragraph (1), in the flush text 
following subparagraph (B), by striking 
‘‘$2,000’’ and inserting ‘‘$4,000’’; 
(ii) in paragraph (2), by striking 
‘‘$2,000’’ and inserting ‘‘$4,000’’; and 
(iii) in paragraph (3)(A)(i), by strik-
ing ‘‘$5,000’’ and inserting ‘‘$10,000’’. 
(2) 
INCREASED
CRIMINAL
FINES.—Section 
1128B of such Act (42 U.S.C. 1320a–7b) is amend-
ed— 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to acts committed after the date 
of the enactment of this Act. 
SEC. 3. ANNUAL MEDICARE, MEDICAID, AND CHIP FRAUD 
REPORTS. 
(a) IN GENERAL.—By not later than July 1, 2014, 
and each subsequent year, the Secretary of Health and 
Human Services shall submit to the Committees on Ways 
and Means and Energy and Commerce of the House of 
Representatives and the Committee on Finance of the 
Senate a report that contains the following: 
(1) AMOUNT OF FRAUD.—The amount, as esti-
mated by the Secretary— 
(A) of total suspected fraud committed 
against the Medicare program under title XVIII 
of the Social Security Act, the Medicaid pro-
gram under title XIX of such Act, and the Chil-
dren’s Health Insurance Program under title 
XXI of such Act; and 
(B) the amount of such suspected fraud 
that is committed by employees of the Depart-
ment of Health and Human Services who have 
access to data from any of the programs under 
subparagraph (A). 
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(2) DATA ACCESS IMPLEMENTATION.—Informa-
tion on implementation of the data access require-
ment under section 1128J(a)(2) of the Social Secu-
rity Act (42 U.S.C. 1320a–7k(a)(2)). 
(b) USE OF AUDITS.— 
(1) ESTIMATE BASED ON AUDITED CLAIMS.— 
The Secretary shall base the estimate of suspected 
fraud under subsection (a)(1)(A) on an audit of a 
random sample of at least 10,000 claims for pay-
ment made under the programs under title XVIII, 
XIX, or XXI of the Social Security Act. 
(2) AUTHORITY OF THE SECRETARY.—For pur-
poses of conducting the audits under paragraph (1), 
the Secretary may— 
(A) request that a health care provider or 
supplier submit documentation relating to the 
claim being audited and review such docu-
mentation; 
(B) conduct unannounced onsite visits; and 
(C) interview patients. 
(3) SUBMISSION OF INFORMATION.—Not later 
than 30 days after receiving a request for docu-
mentation under paragraph (2)(A), the health care 
provider or supplier shall provide to the Secretary all 
requested documentation related to such claim. 
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(4) INTERNAL
AUDIT.—The Secretary shall 
base the estimate of suspected fraud committed by 
employees of the Department of Health and Human 
Services under subsection (a)(1)(B) on an internal 
audit. 
(c) FRAUD DEFINED.—In this section, the term 
‘‘fraud’’ has the meaning given such term in section 455.2 
of title 42, Code of Federal Regulations. 
SEC. 
4. 
PROTECTING 
PREDICTIVE 
ANALYTICS 
TECH-
NOLOGIES FROM COMPELLED DISCLOSURE 
UNDER THE FREEDOM OF INFORMATION 
ACT. 
Section 4241 of the Small Business Jobs Act of 2010 
(42 U.S.C. 1320a–7m) is amended by adding at the end 
the following: 
‘‘(j) EXEMPTION FROM FOIA.—The algorithms used 
in predictive modeling and other analytics technologies 
under this section are exempt from disclosure under sec-
tion 552(b)(3) of title 5, United States Code. 
‘‘(k) AUDIT AND REVIEW.—The Inspector General of 
the Department of Health and Human Services and the 
Comptroller General of the United States shall, beginning 
on January 1, 2015, and annually thereafter, complete an 
audit and review of the implementation of this section, in-
cluding the effectiveness of the algorithms used in pre-
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dictive modeling and other analytics technologies under 
this section.’’. 
SEC. 5. REQUIRING VALID NATIONAL PROVIDER IDENTI-
FIERS FOR PRESCRIBERS ON PHARMACY 
CLAIMS AND LIMITING ACCESS TO THE NA-
TIONAL PROVIDER IDENTIFIER REGISTRY. 
(a) REQUIRING VALID NATIONAL PROVIDER IDENTI-
FIERS OF PRESCRIBERS ON PHARMACY CLAIMS.— 
(1) IN
GENERAL.—Section 1860D–2(e)(2) of 
the Social Security Act (42 U.S.C. 1395w– 
102(e)(2)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) DRUGS
PRESCRIBED
BY
NONVALID 
PRESCRIBERS.—For plan years that begin on or 
after January 1, 2015, such term does not in-
clude a drug prescribed by an individual who 
does not have a valid National Provider Identi-
fier, as determined through procedures estab-
lished by the Secretary.’’. 
(2) IDENTIFYING
AND
REPORTING
INVALID 
PRESCRIBERS.— 
(A) TRANSFER OF INFORMATION TO THE 
INSPECTOR
GENERAL.—In the case that the 
procedures established by the Secretary of 
Health and Human Services under section 
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1860D–2(e)(2) of the Social Security Act (42 
U.S.C. 1395w–102(e)(2)) result in a PDP 
sponsor identifying a claim for reimbursement 
under a prescription drug plan under part D of 
title XVIII of such Act as being for a drug that 
was prescribed by an individual who did not 
have a valid National Provider Identifier, the 
PDP sponsor shall submit to the Inspector 
General of the Department of Health and 
Human Services any information on such in-
valid prescribers on pharmacy claims, including 
any invalid national provider identifiers being 
used to submit such claims and any records re-
lated to such claims. 
(B) RESPONSIBILITY OF THE INSPECTOR 
GENERAL.—The Inspector General of the De-
partment of Health and Human Services shall 
provide to the appropriate law enforcement 
agencies information submitted under subpara-
graph (A). 
(C) REPORT
TO
CONGRESS.—Not later 
than January 1, 2016, the Inspector General of 
the Department of Health and Human Services 
shall submit to Congress a report on the effec-
tiveness of the procedures established under 
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