2134 
ders and certifications made on or after July 
1, 2010. 
SEC. 1638. REQUIREMENT FOR PHYSICIANS TO PROVIDE 
DOCUMENTATION ON REFERRALS TO PRO-
GRAMS AT HIGH RISK OF WASTE AND ABUSE. 
(a) PHYSICIANS
AND OTHER SUPPLIERS.— 
Section 1842(h) of the Social Security Act, is 
amended by adding at the end the following 
new paragraph 
‘‘(10) The Secretary may disenroll, for a 
period of not more than one year for each act, 
a physician or supplier under section 1866(j) 
if such physician or supplier fails to maintain 
and, upon request of the Secretary, provide 
access to documentation relating to written 
orders or requests for payment for durable 
medical equipment, certifications for home 
health services, or referrals for other items or 
services written or ordered by such physician 
or supplier under this title, as specified by the 
Secretary.’’. 
(b) 
PROVIDERS
OF
SERVICES.—Section 
1866(a)(1) of such Act (42 U.S.C. 1395cc), is 
amended— 
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(1) in subparagraph (U), by striking 
at the end ‘‘and’’; 
(2) in subparagraph (V), by striking 
the period at the end and adding ‘‘; and’’; 
and 
(3) by adding at the end the following 
new subparagraph: 
‘‘(W) maintain and, upon request 
of the Secretary, provide access to 
documentation relating to written or-
ders or requests for payment for du-
rable 
medical 
equipment, 
certifi-
cations for home health services, or 
referrals for other items or services 
written or ordered by the provider 
under this title, as specified by the 
Secretary.’’. 
(c) OIG PERMISSIVE EXCLUSION AUTHOR-
ITY.—Section 1128(b)(11) of the Social Security 
Act (42 U.S.C. 1320a–7(b)(11)) is amended by 
inserting ‘‘, ordering, referring for furnishing, 
or certifying the need for’’ after ‘‘furnishing’’. 
(d) EFFECTIVE
DATE.—The amendments 
made by this section shall apply to orders, 
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certifications, and referrals made on or after 
January 1, 2010. 
SEC. 1639. FACE TO FACE ENCOUNTER WITH PATIENT RE-
QUIRED BEFORE PHYSICIANS MAY CERTIFY 
ELIGIBILITY FOR HOME HEALTH SERVICES 
OR DURABLE MEDICAL EQUIPMENT UNDER 
MEDICARE. 
(a) CONDITION
OF
PAYMENT
FOR
HOME 
HEALTH SERVICES.— 
(1) PART
A.—Section 1814(a)(2)(C) of 
such Act is amended— 
(A) by striking ‘‘and such serv-
ices’’ and inserting ‘‘such services’’; 
and 
(B) by inserting after ‘‘care of a 
physician’’ the following: ‘‘, and, in 
the case of a certification or recertifi-
cation made by a physician after Jan-
uary 1, 2010, prior to making such 
certification the physician must docu-
ment that the physician has had a 
face-to-face 
encounter 
(including 
through use of telehealth and other 
than with respect to encounters that 
are incident to services involved) 
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with the individual during the 6- 
month period preceding such certifi-
cation, or other reasonable timeframe 
as determined by the Secretary’’. 
(2) PART
B.—Section 1835(a)(2)(A) of 
the Social Security Act is amended— 
(A) by striking ‘‘and’’ before ‘‘(iii)’’; 
and 
(B) by inserting after ‘‘care of a 
physician’’ the following: ‘‘, and (iv) in 
the case of a certification or recertifi-
cation after January 1, 2010, prior to 
making such certification the physi-
cian must document that the physi-
cian has had a face-to-face encounter 
(including through use of telehealth 
and other than with respect to en-
counters that are incident to services 
involved) with the individual during 
the 6-month period preceding such 
certification 
or 
recertification, 
or 
other reasonable timeframe as deter-
mined by the Secretary’’. 
(b) CONDITION OF PAYMENT FOR DURABLE 
MEDICAL EQUIPMENT.—Section 1834(a)(11)(B) 
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of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(a)(11)(B)) is amended by adding before 
the period at the end the following: ‘‘and shall 
require that such an order be written pursu-
ant to the physician documenting that the 
physician has had a face-to-face encounter 
(including through use of telehealth and 
other than with respect to encounters that 
are incident to services involved) with the in-
dividual involved during the 6-month period 
preceding such written order, or other rea-
sonable timeframe as determined by the Sec-
retary’’. 
(c) APPLICATION TO OTHER AREAS UNDER 
MEDICARE.—The Secretary may apply the 
face-to-face encounter requirement described 
in the amendments made by subsections (a) 
and (b) to other items and services for which 
payment is provided under title XVIII of the 
Social Security Act based upon a finding that 
such an decision would reduce the risk of 
waste, fraud, or abuse. 
(d) APPLICATION TO MEDICAID AND CHIP.— 
The requirements pursuant to the amend-
ments made by subsections (a) and (b) shall 
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apply in the case of physicians making certifi-
cations for home health services under title 
XIX or XXI of the Social Security Act, in the 
same manner and to the same extent as such 
requirements apply in the case of physicians 
making such certifications under title XVIII 
of such Act. 
SEC. 1640. EXTENSION OF TESTIMONIAL SUBPOENA AU-
THORITY TO PROGRAM EXCLUSION INVES-
TIGATIONS. 
(a) IN GENERAL.—Section 1128(f) of the So-
cial Security 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 section to the same extent as they are ap-
plicable with respect to title II. The Secretary 
may delegate the authority granted by section 
205(d) (as made applicable to this section) to 
the Inspector General of the Department of 
Health and Human Services or the Adminis-
trator of the Centers for Medicare & Medicaid 
Services for purposes of any investigation 
under this section.’’. 
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(b) EFFECTIVE
DATE.—The amendment 
made by subsection (a) shall apply to inves-
tigations beginning on or after January 1, 
2010. 
SEC. 1641. REQUIRED REPAYMENTS OF MEDICARE AND 
MEDICAID OVERPAYMENTS. 
Section 1128G of the Social Security Act, 
as inserted by section 1631 and amended by 
section 1632, is further amended by adding at 
the end the following new subsection: 
‘‘(c) REPORTS ON AND REPAYMENT OF OVER-
PAYMENTS IDENTIFIED THROUGH INTERNAL AU-
DITS AND REVIEWS.— 
‘‘(1) REPORTING AND RETURNING OVER-
PAYMENTS.—If a person knows of an over-
payment, the person must— 
‘‘(A) report and return the over-
payment to the Secretary, the State, 
an intermediary, a carrier, or a con-
tractor, as appropriate, at the correct 
address, and 
‘‘(B) notify the Secretary, the 
State, intermediary, carrier, or con-
tractor to whom the overpayment 
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was returned in writing of the reason 
for the overpayment. 
‘‘(2) TIMING.—An overpayment must 
be reported and returned under para-
graph (1)(A) by not later than the date 
that is 60 days after the date the person 
knows of the overpayment. 
Any known overpayment retained later 
than the applicable date specified in this 
paragraph creates an obligation as de-
fined in section 3729(b)(3) of title 31 of 
the United States Code. 
‘‘(3) 
CLARIFICATION.—Repayment 
of 
any overpayments (or refunding by with-
holding of future payments) by a pro-
vider of services or supplier does not oth-
erwise limit the provider or supplier’s po-
tential liability for administrative obliga-
tions such as applicable interests, fines, 
and specialties or civil or criminal sanc-
tions involving the same claim if it is de-
termined later that the reason for the 
overpayment was related to fraud by the 
provider or supplier or the employees or 
agents of such provider or supplier. 
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‘‘(4) DEFINITIONS.—In this subsection: 
‘‘(A) KNOWS.—The term ‘knows’ 
has the meaning given the terms 
‘knowing’ and ‘knowingly’ in section 
3729(b) of title 31 of the United States 
Code. 
‘‘(B) 
OVERPAYMENT.—The 
term 
‘‘overpayment’’ means any finally de-
termined funds that a person receives 
or retains under title XVIII, XIX, or 
XXI to which the person, after appli-
cable reconciliation, is not entitled 
under such title. 
‘‘(C) PERSON.—The term ‘person’ 
means a provider of services, sup-
plier, Medicaid managed care organi-
zation 
(as 
defined 
in 
section 
1903(m)(1)(A)), Medicare Advantage 
organization (as defined in section 
1859(a)(1)), or PDP sponsor (as de-
fined in section 1860D–41(a)(13)), but 
excluding a beneficiary.’’. 
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SEC. 1642. EXPANDED APPLICATION OF HARDSHIP WAIV-
ERS 
FOR 
OIG 
EXCLUSIONS 
TO 
BENE-
FICIARIES OF ANY FEDERAL HEALTH CARE 
PROGRAM. 
Section 1128(c)(3)(B) of the Social Secu-
rity Act (42 U.S.C. 1320a–7(c)(3)(B)) is amend-
ed by striking ‘‘individuals entitled to benefits 
under part A of title XVIII or enrolled under 
part B of such title, or both’’ and inserting 
‘‘beneficiaries 
(as 
defined 
in 
section 
1128A(i)(5)) of that program’’. 
SEC. 1643. ACCESS TO CERTAIN INFORMATION ON RENAL 
DIALYSIS FACILITIES. 
Section 1881(b) of the Social Security Act 
(42 U.S.C. 1395rr(b)) is amended by adding at 
the end the following new paragraph: 
‘‘(15) For purposes of evaluating or audit-
ing payments made to renal dialysis facilities 
for items and services under this section 
under paragraph (1), each such renal dialysis 
facility, upon the request of the Secretary, 
shall provide to the Secretary access to infor-
mation relating to any ownership or com-
pensation arrangement between such facility 
and the medical director of such facility or be-
tween such facility and any physician.’’. 
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SEC. 1644. BILLING AGENTS, CLEARINGHOUSES, OR OTHER 
ALTERNATE PAYEES REQUIRED TO REG-
ISTER UNDER MEDICARE. 
(a) MEDICARE.—Section 1866(j)(1) of the 
Social Security Act (42 U.S.C. 1395cc(j)(1)) is 
amended by adding at the end the following 
new subparagraph: 
‘‘(D) BILLING
AGENTS
AND
CLEAR-
INGHOUSES REQUIRED TO BE REGISTERED 
UNDER
MEDICARE.—Any agent, clear-
inghouse, or other alternate payee 
that submits claims on behalf of a 
health care provider must be reg-
istered with the Secretary in a form 
and manner specified by the Sec-
retary.’’. 
(b) MEDICAID.—For a similar provision 
with respect to the Medicaid program under 
title XIX of the Social Security Act, see section 
1759. 
(c) 
EFFECTIVE
DATE.—The 
amendment 
made by subsection (a) shall apply to claims 
submitted on or after January 1, 2012. 
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SEC. 1645. CONFORMING CIVIL MONETARY PENALTIES TO 
FALSE CLAIMS ACT AMENDMENTS. 
Section 1128A of the Social Security Act, 
as amended by sections 1611, 1612, 1613, and 
1615, is further amended— 
(1) in subsection (a)— 
(A) in paragraph (1), by striking 
‘‘to an officer, employee, or agent of 
the United States, or of any depart-
ment or agency thereof, or of any 
State agency (as defined in sub-
section (i)(1))’’; 
(B) in paragraph (4)— 
(i) in the matter preceding 
subparagraph 
(A), 
by 
striking 
‘‘participating in a program under 
title XVIII or a State health care 
program’’ and inserting ‘‘partici-
pating in a Federal health care 
program (as defined in section 
1128B(f))’’; and 
(ii) in subparagraph (A), by 
striking ‘‘title XVIII or a State 
health care program’’ and insert-
ing ‘‘a Federal health care pro-
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(3) in subsection (i)— 
(A) by amending paragraph (2) to 
read as follows: 
‘‘(2) The term ‘claim’ means any appli-
cation, request, or demand, whether 
under contract, or otherwise, for money 
or property for items and services under 
a Federal health care program (as de-
fined in section 1128B(f)), whether or not 
the United States or a State agency has 
title to the money or property, that— 
‘‘(A) is presented or caused to be 
presented to an officer, employee, or 
agent of the United States, or of any 
department or agency thereof, or of 
any State agency (as defined in sub-
section (i)(1)); or 
‘‘(B) is made to a contractor, 
grantee, or other recipient if the 
money or property is to be spent or 
used on the Federal health care pro-
gram’s behalf or to advance a Federal 
health care program interest, and if 
the Federal health care program— 
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‘‘(i) provides or has provided 
any portion of the money or prop-
erty requested or demanded; or 
‘‘(ii) will reimburse such con-
tractor, grantee, or other recipi-
ent for any portion of the money 
or property which is requested or 
demanded.’’; 
(B) by amending paragraph (3) to 
read as follows: 
‘‘(3) The term ‘item or service’ means, 
without limitation, any medical, social, 
management, administrative, or other 
item or service used in connection with 
or directly or indirectly related to a Fed-
eral health care program.’’; 
(C) in paragraph (6)— 
(i) in subparagraph (C), by 
striking at the end ‘‘or’’; 
(ii) in the first subparagraph 
(D), by striking at the end the pe-
riod and inserting ‘‘; or’’; and 
(iii) by redesignating the sec-
ond subparagraph (D) as a sub-
paragraph (E); 
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(D) by amending paragraph (7) to 
read as follows: 
‘‘(7) The terms ‘knowing’, ‘knowingly’, 
and ‘should know’ mean that a person, 
with respect to information— 
‘‘(A) has actual knowledge of the 
information; 
‘‘(B) acts in deliberate ignorance 
of the truth or falsity of the informa-
tion; or 
‘‘(C) acts in reckless disregard of 
the truth or falsity of the information; 
and require no proof of specific intent to 
defraud.’’; and 
(E) by adding at the end the fol-
lowing new paragraphs: 
‘‘(8) The term ‘obligation’ means an 
established duty, whether or not fixed, 
arising from an express or implied con-
tractual, grantor-grantee, or licensor-li-
censee relationship, from a fee-based or 
similar relationship, from statute or regu-
lation, or from the retention of any over-
payment. 
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‘‘(9) The term ‘material’ means having 
a natural tendency to influence, or be ca-
pable of influencing, the payment or re-
ceipt of money or property.’’. 
Subtitle D—Access to Information 
Needed 
to 
Prevent 
Fraud, 
Waste, and Abuse 
SEC. 1651. ACCESS TO INFORMATION NECESSARY TO IDEN-
TIFY FRAUD, WASTE, AND ABUSE. 
Section 1128G of the Social Security Act, 
as added by section 1631 and amended by sec-
tions 1632 and 1641, is further amended by 
adding at the end the following new sub-
section; 
‘‘(d) ACCESS TO INFORMATION NECESSARY TO 
IDENTIFY FRAUD, WASTE, AND ABUSE.—For pur-
poses of law enforcement activity, and to the 
extent consistent with applicable disclosure, 
privacy, and security laws, including the 
Health Insurance Portability and Account-
ability Act of 1996 and the Privacy Act of 1974, 
and subject to any information systems secu-
rity requirements enacted by law or other-
wise required by the Secretary, the Attorney 
General shall have access, facilitation by the 
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Inspector General of the Department of 
Health and Human Services, to claims and 
payment data relating to titles XVIII and XIX, 
in consultation with the Centers for Medicare 
& Medicaid Services or the owner of such 
data.’’. 
SEC. 1652. ELIMINATION OF DUPLICATION BETWEEN THE 
HEALTHCARE INTEGRITY AND PROTECTION 
DATA BANK AND THE NATIONAL PRACTI-
TIONER DATA BANK. 
(a) IN GENERAL.—To eliminate duplication 
between the Healthcare Integrity and Protec-
tion Data Bank (HIPDB) established under 
section 1128E of the Social Security Act and 
the National Practitioner Data Bank (NPBD) 
established under the Health Care Quality Im-
provement Act of 1986, section 1128E of the 
Social Security Act (42 U.S.C. 1320a-7e) is 
amended— 
(1) in subsection (a), by striking ‘‘Not 
later than’’ and inserting ‘‘Subject to sub-
section (h), not later than’’; 
(2) in the first sentence of subsection 
(d)(2), by striking ‘‘(other than with re-
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spect to requests by Federal agencies)’’; 
and 
(3) by adding at the end the following 
new subsection: 
‘‘(h) SUNSET OF THE HEALTHCARE INTEGRITY 
AND PROTECTION DATA BANK; TRANSITION PROC-
ESS.—Effective upon the enactment of this 
subsection, the Secretary shall implement a 
process to eliminate duplication between the 
Healthcare Integrity and Protection Data 
Bank (in this subsection referred to as the 
‘HIPDB’ established pursuant to subsection 
(a) and the National Practitioner Data Bank 
(in this subsection referred to as the ‘NPDB’) 
as implemented under the Health Care Qual-
ity Improvement Act of 1986 and section 1921 
of this Act, including systems testing nec-
essary to ensure that information formerly 
collected in the HIPDB will be accessible 
through the NPDB, and other activities nec-
essary to eliminate duplication between the 
two data banks. Upon the completion of such 
process, notwithstanding any other provision 
of law, the Secretary shall cease the operation 
of the HIPDB and shall collect information re-
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quired to be reported under the preceding 
provisions of this section in the NPDB. Except 
as otherwise provided in this subsection, the 
provisions of subsections (a) through (g) shall 
continue to apply with respect to the report-
ing of (or failure to report), access to, and 
other treatment of the information specified 
in this section.’’. 
(b) ELIMINATION OF THE RESPONSIBILITY OF 
THE HHS OFFICE OF THE INSPECTOR GENERAL.— 
Section 1128C(a)(1) of the Social Security Act 
(42 U.S.C. 1320a-7c(a)(1)) is amended— 
(1) in subparagraph (C), by adding at 
the end ‘‘and’’; 
(2) in subparagraph (D), by striking 
at the end ‘‘, and’’ and inserting a period; 
and 
(3) by striking subparagraph (E). 
(c) SPECIAL PROVISION FOR ACCESS TO THE 
NATIONAL PRACTITIONER DATA BANK BY THE DE-
PARTMENT OF VETERANS AFFAIRS.— 
(1) IN GENERAL.—Notwithstanding any 
other provision of law, during the one 
year period that begins on the effective 
date specified in subsection (e)(1), the in-
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formation described in paragraph (2) 
shall be available from the National Prac-
titioner Data Bank (described in section 
1921 of the Social Security Act) to the 
Secretary of Veterans Affairs without 
charge. 
(2) INFORMATION DESCRIBED.—For pur-
poses of paragraph (1), the information 
described in this paragraph is the infor-
mation that would, but for the amend-
ments made by this section, have been 
available to the Secretary of Veterans Af-
fairs from the Healthcare Integrity and 
Protection Data Bank. 
(d) FUNDING.—Notwithstanding any provi-
sions of this Act, sections 1128E(d)(2) and 
1817(k)(3) of the Social Security Act, or any 
other provision of law, there shall be avail-
able for carrying out the transition process 
under section 1128E(h) of the Social Security 
Act over the period required to complete such 
process, and for operation of the National 
Practitioner Data Bank until such process is 
completed, without fiscal year limitation— 
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(1) any fees collected pursuant to sec-
tion 1128E(d)(2) of such Act; and 
(2) such additional amounts as nec-
essary, from appropriations available to 
the Secretary and to the Office of the In-
spector General of the Department of 
Health 
and 
Human 
Services 
under 
clauses (i) and (ii), respectively, of section 
1817(k)(3)(A) of such Act, for costs of such 
activities during the first 12 months fol-
lowing the date of the enactment of this 
Act. 
(e) EFFECTIVE
DATE.—The amendments 
made— 
(1) by subsection (a)(2) shall take ef-
fect on the first day after the Secretary of 
Health and Human Services certifies that 
the process implemented pursuant to sec-
tion 1128E(h) of the Social Security Act 
(as added by subsection (a)(3)) is com-
plete; and 
(2) by subsection (b) shall take effect 
on the earlier of the date specified in 
paragraph (1) or the first day of the sec-
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ond succeeding fiscal year after the fiscal 
year during which this Act is enacted. 
SEC. 1653. COMPLIANCE WITH HIPAA PRIVACY AND SECU-
RITY STANDARDS. 
The provisions of sections 262(a) and 264 
of the Health Insurance Portability and Ac-
countability Act of 1996 (and standards pro-
mulgated pursuant to such sections) and the 
Privacy Act of 1974 shall apply with respect 
to the provisions of this subtitle and amend-
ments made by this subtitle. 
øTITLE VII—MEDICAID AND 
CHIP¿ 
øFor title VII of division B, see text of bill 
as introduced on July 14, 2009.¿ 
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TITLE VIII—REVENUE-RELATED 
PROVISIONS 
SEC. 1801. DISCLOSURES TO FACILITATE IDENTIFICATION 
OF INDIVIDUALS LIKELY TO BE INELIGIBLE 
FOR THE LOW-INCOME ASSISTANCE UNDER 
THE MEDICARE PRESCRIPTION DRUG PRO-
GRAM TO ASSIST SOCIAL SECURITY ADMINIS-
TRATION’S OUTREACH TO ELIGIBLE INDIVID-
UALS. 
(a) IN GENERAL.—Paragraph (19) of section 
6103(l) of the Internal Revenue Code of 1986 
is amended to read as follows: 
‘‘(19) DISCLOSURES TO FACILITATE IDEN-
TIFICATION OF INDIVIDUALS LIKELY TO BE IN-
ELIGIBLE FOR LOW-INCOME SUBSIDIES UNDER 
MEDICARE PRESCRIPTION DRUG PROGRAM TO 
ASSIST
SOCIAL
SECURITY
ADMINISTRATION’S 
OUTREACH TO ELIGIBLE INDIVIDUALS.— 
‘‘(A) IN
GENERAL.—Upon written 
request from the Commissioner of So-
cial Security, the following return in-
formation (including such informa-
tion disclosed to the Social Security 
Administration under paragraph (1) 
or (5)) shall be disclosed to officers 
VerDate Nov 24 2008 
03:16 Oct 15, 2009
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