Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act

Bill: 113-s-2361
Sponsor: Sen. Nelson, Bill [D-FL]
Introduced: 2014-05-20 in the Senate
Policy area: Health
Subjects: Administrative law and regulatory procedures
Civil actions and liability
Criminal justice information and records
Department of Health and Human Services
Fraud offenses and financial crimes
Government studies and investigations
Health care costs and insurance
Health information and medical records
Insurance industry and regulation
Medicare
Public-private cooperation

Summary:
action_date: 2014-05-20
text: 
Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act - Amends title XI of the Social Security Act with respect to standards for financial and administrative transactions and their data elements to enable the electronic exchange of health information.
 
Requires the Secretary of Health and Human Services (HHS) to adopt standards that: (1) ensure that any entity producing and transmitting valid transactions that include code sets for appropriate data elements is subject to a consistent, industry-wide framework that supports a seamless transition to new and modified code sets; and (2) establish an end-to-end testing procedure for new and modified code sets that shall require the participation of any entity producing and transmitting valid transactions that use the new or modified code set.
 
Prohibits the Secretary from adopting a new or modified code set unless the Secretary: (1) assesses its impact on fraud prevention and pre-payment review, determines that anti-fraud edits work as intended, and confirms that a plan is in place to ensure continuing effective detection of fraud following the adoption of the code set; (2) ensures that the end-to-end testing procedure established has been completed; and (3) completes end-to-end testing with any federal government entity that produces and transmits valid transactions that include the code set with private sector tracking partners. Exempts routine, regularly scheduled updates to existing code sets from such prohibition.
 
Directs the Secretary, with respect to information supplied to it by a disclosing entity about those with an ownership or control interest in the entity, to verify such information in a specified manner and confirm the accuracy of any Social Security account number or employer identification number.
 
Holds immune from civil liability (in a safe harbor) any non-governmental entity participating in a Healthcare Fraud Prevention Partnership, including private insurers, for sharing information about potentially fraudulent providers with each other, HHS, the Department of Justice (DOJ), any other federal or state law enforcement agency, any federal or state agency contractor, and another Partnership participant.
 
Directs the Medicare Payment Advisory Commission (MEDPAC) to study administrative efforts to strengthen program integrity in the Medicare program.
 
Amends the Small Business Jobs Act of 2010, with respect to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program, to require predictive analytics technologies to capture outcome information on civil recoveries, administrative actions, and criminal convictions for fraud.
 


Legislative actions:
action_date: 2014-05-20
text: Read twice and referred to the Committee on Finance.
action_date: 2014-05-20
text: Sponsor introductory remarks on measure. (CR S3190)
action_date: 2014-05-20
text: Introduced in Senate