zli12321/Bills huggingface dataset:
Family Health Care Accessibility Act of 2011 - Amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients. Sets forth conditions for such liability protection, including: (1) the service is provided to the individual at a community health center or through offsite programs or events carried out by such center; and (2) the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses. Considers an entity as sponsoring the health care practitioner if the entity submits an application to the Secretary of Health and Human Services (HHS), and the Secretary determines that the health care practitioner is deemed to be an employee of the Public Health Service. Requires the Attorney General to submit to Congress an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the actions or omissions of health professional volunteers, will be paid pursuant to this Act annually. Requires the Secretary to transfer such estimated amount from the claims fund to the appropriate accounts in the Treasury, subject to the extent of amounts in the fund. Makes this Act effective on October 1, 2012.

Date: 2011-04-15
Topic: Health (Medical Liability)
Subject: Health
Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 - Sets conditions for lawsuits arising from health care liability claims regarding health care goods or services or any medical product affecting interstate commerce. Provides for periodic payment of future damages. Makes each party liable only for the amount of damages directly proportional to such party's percentage of responsibility. Requires the dismissal of any lawsuit for which a qualified specialist does not submit an affidavit to the court as to whether there is a reasonable and meritorious cause for filing the action. Requires the claimant to pay the defendant's reasonable costs and attorney fees, under certain circumstances. Absolves health care providers from liability if such providers acted consistent with accepted clinical practice guidelines. Amends the Public Health Service Act to extend liability protections for employees of the Public Health Service to certain emergency medical personnel and health center volunteer practitioners. Protects disaster relief volunteers, nonprofit organizations, and other entities from civil liability for injuries related to disaster relief services or donated goods, except for injuries caused by willful, wanton, or reckless misconduct. Makes a state that has enacted and is implementing an alternative medical liability law eligible to receive an incentive payment from the Secretary of Health and Human Services (HHS). Subjects health care lawsuits in a state receiving an incentive payment to liability limits and other provisions governing health care liability claims if the state's alternative medical liability laws have not brought about a reduction in the number of health care lawsuits in the state, a reduction in the amount of time required to resolve lawsuits in the state, and a reduction in the cost of malpractice insurance in the state.

Date: 2011-06-16
Topic: Health (Medical Liability)
Subject: Health
Medicare Common Access Card Act of 2011 - Establishes a pilot program under title XVIII (Medicare) of the Social Security Act in order to utilize smart card technology for Medicare beneficiary and provider identification cards.

Date: 2011-09-14
Topic: Health (Medical Liability)
Subject: Health
Requires any employee of the Veterans Health Administration who, while working in a Department of Veterans Affairs (VA) medical facility, intentionally fails to follow infection control practices to be fined in accordance with the federal criminal code or imprisoned for up to one year, or both. Directs the Secretary of Veterans Affairs to establish infection control practices.

Date: 2011-09-19
Topic: Health (Medical Liability)
Subject: Armed forces and national security
Cardiac Arrest Survival Act of 2011 - Amends the Public Health Service Act to expand immunity from civil liability related to automated external defibrillator devices (AEDs), including by giving immunity to: (1) a person who owns, occupies, or manages the premises from which an AED is taken or at which an AED is used or attempted to be used on a victim of a perceived medical emergency; and (2) the owner-acquirer of an AED for any harm resulting from the use or attempted use of such device, unless the harm was proximately caused by the failure of the owner-acquirer to properly maintain the device according to the guidelines of the device manufacturer. Applies immunity regardless of whether: (1) the AED is marked with cautionary signage or registered with any government; or (2) the person who used or attempted to use the AED complied with such signage, had received training on such use, or was assisted or supervised by any other person, including a licensed physician.

Date: 2011-11-29
Topic: Health (Medical Liability)
Subject: Health
Good Samaritan Health Professionals Act of 2011 - Amends the Public Health Service Act to provide that a health care professional shall not be liable under federal or state law for harm caused by any act or omission if: (1) the professional is serving as a volunteer for purposes of responding to a disaster; and (2) the act or omission occurs during the period of the disaster, in the professional's capacity as such a volunteer, and in a good faith belief that the individual being treated is in need of health care services. Makes exceptions where: (1) the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed; or (2) the professional rendered the health care services under the influence of intoxicating alcohol or an intoxicating drug.

Date: 2011-12-07
Topic: Health (Medical Liability)
Subject: Health
Medicare Fraud Enforcement and Prevention Act of 2011 - Amends title XI of the Social Security Act (SSA) to increase criminal penalties for both felony and misdemeanor fraud under SSA titles XVIII (Medicare) and XIX (Medicaid). Adds a new offense of distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges with the intent to defraud. Applies civil monetary penalties to: (1) conspiracy to make false statements or commit other specified offenses with respect to Medicare or Medicaid claims; and (2) knowing creation or use of false records or statements with respect to the transmission of money or property to a federal health care program. Extends the statute of limitations from six to 10 years after presentation of a claim. Amends SSA title XVIII (Medicare), as amended by the Patient Protection and Affordable Care Act (PPACA), to revise screening requirements. Amends SSA title XI, as amended by PPACA, to require the access to claims and payment data granted to Inspector General of the Department of Health and Human Services (HHS) and the Attorney General to include access to real time claims and payment data. Requires the HHS Inspector General to implement mechanisms for the sharing of information about suspected fraud relating to the federal health care programs under Medicare, Medicaid, and SSA title XXI (Children's Health Insurance Program) (CHIP) with other appropriate law enforcement officials. Directs the HHS Secretary to carry out a five-year pilot program that implements biometric technology to ensure that individuals entitled to benefits under Medicare part A or enrolled under Medicare part B are physically present at the time and place of receipt of certain items and services for which payment may be made.

Date: 2011-12-19
Topic: Health (Medical Liability)
Subject: Health
Strengthening and Focusing Enforcement to Deter Organized Stealing and Enhance Safety Act of 2012 or the SAFE DOSES Act - Amends the federal criminal code to prohibit, in or using any means or facility of interstate or foreign commerce: (1) embezzling, stealing, obtaining by fraud or deception, or knowingly and unlawfully taking, carrying away, or concealing a medical product that has not yet been made available for retail purchase by a consumer (pre-retail medical product); (2) knowingly and falsely making, altering, forging, or counterfeiting the labeling or documentation of such a product; (3) knowingly possessing, transporting, or trafficking in a product involved in such a violation; (4) buying or otherwise obtaining, or selling or distributing, with intent to defraud, such a product that has expired or been stolen; or (5) attempting or conspiring to commit such a violation. Makes such a violation an aggravated offense if: (1) the defendant is employed by, or is an agent of, an organization in the supply chain for the product; or (2) the violation involves the use of violence, force, a threat of violence or force, or the use of a deadly weapon, results in serious bodily injury or death, or is subsequent to a prior conviction for an offense under this Act. Prescribes criminal and civil penalties for violations, including a civil penalty of up to the greater of 3 times the economic loss attributable to the violation or $1 million. Provides for civil forfeiture for any property which constitutes or is derived from proceeds traceable to such a violation. Requires the penalties under this Act to apply for the following offenses involving a pre-retail medical product: (1) interstate and foreign travel or transportation in aid of racketeering enterprises; (2) engaging in monetary transactions in property derived from specified unlawful activity; (3) breaking into or entering carrier facilities with intent to commit larceny; and (4) the transportation, sale, or receipt of stolen property. Directs the Attorney General to give increased priority to efforts to investigate and prosecute offenses involving pre-retail medical products. Extends provisions authorizing wiretapping and requiring victim restitution to offenses relating to theft of a pre-retail medical product. Directs the U.S. Sentencing Commission to review and, if appropriate, amend the sentencing guidelines and policy statements applicable to offenses related to pre-retail medical product theft or robberies and burglaries involving controlled substances to reflect congressional intent that penalties are sufficient to deter and punish such offenses and to appropriately account for actual harm to the public.

Date: 2012-03-20
Topic: Health (Medical Liability)
Subject: Crime and law enforcement
Stop Medicare Fraud Act of 2012 - Amends title XI of the Social Security Act (SSA) to increase the civil and criminal penalty levels for fraud under SSA title XVIII (Medicare).

Date: 2012-07-11
Topic: Health (Medical Liability)
Subject: Health
Local Medicaid Enforcement Incentives Act of 2012 - Directs the Secretary of Health and Human Services (HHS) to establish a grant program to provide states with funds to: (1) detect and prevent Medicaid fraud, waste, and abuse; (2) recover overpayments to individuals or entities receiving Medicaid funds that result from such fraud, waste, or abuse; and (3) share with localities within the state that assist in such detection and prevention, or the recovery of such overpayments, at least 50% of the state's share of the total overpayments recovered during a period, minus administrative costs.

Date: 2012-08-02
Topic: Health (Medical Liability)
Subject: Health
Medical Care Access Protection Act of 2011 or the MCAP Act - Sets forth provisions regulating lawsuits for health care liability claims related to the provision of health care services. Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions. Requires a court to impose sanctions for the filing of frivolous lawsuits. Limits noneconomic damages to $250,000 from the provider or health care institution, but no more than $500,000 from multiple health care institutions. Makes each party liable only for the amount of damages directly proportional to such party's percentage of responsibility. Allows the court to restrict the payment of attorney contingency fees. Limits the fees to a decreasing percentage based on the increasing value of the amount awarded. Prescribes qualifications for expert witnesses. Requires the court to reduce damages received by the amount of collateral source benefits to which a claimant is entitled, unless the payor of such benefits has the right to reimbursement or subrogation under federal or state law. Authorizes the award of punitive damages only where: (1) it is proven by clear and convincing evidence that a person acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury the claimant was substantially certain to suffer, and (2) compensatory damages are awarded. Limits punitive damages to the greater of two times the amount of economic damages or $250,000. Prohibits a health care provider from being named as a party in a product liability or class action lawsuit for prescribing or dispensing a Food and Drug Administration (FDA)-approved prescription drug, biological product, or medical device for an approved indication. Provides for periodic payments of future damage awards.

Date: 2011-01-26
Topic: Health (Medical Liability)
Subject: Law
Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 - Sets conditions for lawsuits arising from health care liability claims regarding health care goods or services or any medical product affecting interstate commerce. Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions. Limits noneconomic damages to $250,000. Makes each party liable only for the amount of damages directly proportional to such party's percentage of responsibility. Allows the court to restrict the payment of attorney contingency fees. Limits the fees to a decreasing percentage based on the increasing value of the amount awarded. Allows the introduction of collateral source benefits and the amount paid to secure such benefits as evidence. Prohibits a provider of such benefits from recovering any amount from an award in a health care lawsuit involving injury or wrongful death. Authorizes the award of punitive damages only where: (1) it is proven by clear and convincing evidence that a person acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury the claimant was substantially certain to suffer; and (2) compensatory damages are awarded. Limits punitive damages to the greater of two times the amount of economic damages or $250,000. Denies punitive damages in the case of products approved, cleared, or licensed by the Food and Drug Administration (FDA), or otherwise considered in compliance with FDA standards. Provides for periodic payments of future damages.

Date: 2011-01-27
Topic: Health (Medical Liability)
Subject: Health
Strengthening Program Integrity and Accountability in Health Care Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) change from discretionary to mandatory the authority of the Secretary of Health and Human Services (HHS) to suspend Medicare and Medicaid payments pending investigation of credible allegations of fraud; and (2) require the Secretary to extend to up to 365 calendar days for particular categories of service providers or suppliers in which fraud, waste, or abuse is likely the number of days in which Medicare claims are required to be paid in order to ensure that they are clean claims. Requires the Inspector General of HHS to notify the relevant congressional committees within 30 days after transmitting to another HHS agency a management implication report (which details investigative findings about the possible implication of agency management in prohibited or otherwise inappropriate transactions). Directs the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, to establish an information sharing program regarding beneficiary medical ID theft under the programs under SSA titles XVIII (Medicare), XIX (Medicaid), and XXI (State Children's Health Insurance) (CHIP). Amends SSA title XI to authorize the Secretary to exclude from federal health care programs entities affiliated with a sanctioned entity, as well as any officer or managing employee of an affiliated entity (currently, only individuals with an ownership or control interest in a sanctioned entity), if the affiliated entity was so affiliated at the time of any of the conduct forming the basis for the conviction or exclusion of the sanctioned entity. Directs the Secretary to make available to the public Medicare claims and payment data. Amends SSA title XIX to require a state Medicaid agency to exclude from program participation with respect to a particular period any individual or entity which owns, controls, or manages an entity that: (1) has delinquent unpaid overpayments during such period; (2) is suspended or excluded from Medicaid participation or whose participation is terminated; or (3) is affiliated with an individual or entity that has been suspended or excluded from Medicaid participation or whose participation is terminated. Amends the Federal Food, Drug, and Cosmetic Act to require the Secretary to list on the Food and Drug Administration (FDA) Internet website certain new drugs (for human consumption) or new animal drugs that have not been approved by the FDA, together with the name of the person who listed such drug and the authority under such Act that does not require such drug to be subject to FDA approval. Amends SSA title XIX to prohibit a state from making a Medicaid payment for a covered outpatient drug which has not been FDA-approved. Amends SSA title XI to require individuals or entities that participate in or conduct activities under federal health care programs to comply with certain congressional requests for documents, information, or interviews.

Date: 2011-03-02
Topic: Health (Medical Liability)
Subject: Health
Medicare Spending Transparency Act of 2011 - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), consistent with applicable information, privacy, security, and disclosure laws, to make public on the Internet website of the Centers for Medicare and Medicaid Services the following data with respect to SSA title XVIII (Medicare): (1) a complete list of service providers and suppliers participating in the Medicare program, including their business addresses; and (2) certain aggregate information about each provider and supplier. Entitles a qualified individual or group, for health research and fraud detection purposes, to access to Medicare claims and payment data of both HHS and its contractors. Directs the Secretary to establish procedures for the storage and use of data provided to such an individual or group.

Date: 2011-04-14
Topic: Health (Medical Liability)
Subject: Health
Family Health Care Accessibility Act of 2011 - Amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients. Sets forth conditions for such liability protection, including: (1) the service is provided to the individual at a community health center or through offsite programs or events carried out by such center; and (2) the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses. Considers an entity as sponsoring the health care practitioner if the entity submits an application to the Secretary of Health and Human Services (HHS), and the Secretary determines that the health care practitioner is deemed to be an employee of the Public Health Service. Requires the Attorney General to submit to Congress an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the actions or omissions of health professional volunteers, will be paid pursuant to this Act annually. Requires the Secretary to transfer such estimated amount from the claims fund to the appropriate accounts in the Treasury, subject to the extent of amounts in the fund. Makes this Act effective on October 1, 2012.

Date: 2011-05-25
Topic: Health (Medical Liability)
Subject: Health
Medicare Fraud Enforcement and Prevention Act of 2013 - Amends title XI of the Social Security Act (SSA) to increase criminal penalties for both felony and misdemeanor fraud under SSA titles XVIII (Medicare) and XIX (Medicaid).

Adds a new offense of distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges.

Applies civil monetary penalties to: (1) conspiracy to make false statements or commit other specified offenses with respect to Medicare or Medicaid claims; and (2) knowing creation or use of false records or statements with respect to the transmission of money or property to a federal health care program. Extends the statute of limitations from six to 10 years after presentation of a claim.

Amends SSA title XVIII (Medicare), as amended by the Patient Protection and Affordable Care Act (PPACA), to revise screening requirements.

Amends SSA title XI, as amended by PPACA, to require the access to claims and payment data granted to Inspector General of the Department of Health and Human Services (HHS) and the Attorney General to include access to real time claims and payment data.

Requires the HHS Inspector General to implement mechanisms for the sharing of information about suspected fraud relating to the federal health care programs under Medicare, Medicaid, and SSA title XXI (Children's Health Insurance Program) (CHIP) with other appropriate law enforcement officials.

Directs the HHS Secretary to provide for a study that analyzes the feasibility and benefits in reducing waste, fraud, and abuse of carrying out a program that implements biometric technology to ensure that individuals entitled to benefits under Medicare part A or enrolled under Medicare part B are physically present at the time and place of receipt of certain items and services for which payment may be made.

Date: 2013-01-25
Topic: Health (Medical Liability)
Subject: Health
Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.

Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.

Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.

Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.

Directs the Secretary to publish on the Internet website of the Centers for Medicare & Medicaid Services information on recovery audit contractor performance regarding: (1) audit rates, denials, and appeals outcomes; and (2) independent performance evaluations.

Deems to be an original claim for Medicare part B (Supplementary Medical Insurance) payment a resubmitted hospital claim for Medicare part A payment for inpatient hospital services which a recovery audit contractor determines: (1) were not medically necessary and reasonable based on the site of service, but (2) would be medically necessary and reasonable in an outpatient setting of the hospital. Requires payment to be made for such a resubmitted claim for all furnished items and services for which payment may be made under Medicare part B.

Deems to be a reopened claim, for purposes of a hospital's ability to resubmit a claim for Medicare payment in timely fashion, any claim that is the subject of an audit by a recovery audit contractor or a Medicare administrative contractor.

Requires contracts for a recovery audit contractor to require that a physician review each denial of a claim for medical necessity made by an employee of the contractor who is not a physician.

Subjects to administrative and judicial review the Secretary's compliance with guidelines for reopening and revising benefit determinations.

Date: 2013-03-19
Topic: Health (Medical Liability)
Subject: Health
Standard of Care Protection Act of 2013 - Declares that the development, recognition, or implementation of any guideline or other standard under any provision of the Patient Protection and Affordable Care Act (PPACA) or titles XVIII (Medicare) or XIX (Medicaid) of the Social Security Act shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice case.

Declares also that no provision of PPACA or amendments made by it shall be construed to preempt any state law governing medical professional liability cases.

Date: 2013-04-10
Topic: Health (Medical Liability)
Subject: Health
Improved Health Care at Lower Cost Act of 2013 - Amends title XVIII (Medicare) and XI of the Social Security Act with respect to the prohibition against certain (potential financial conflict-of-interest) physician referrals.

Excepts from the physician self-referral prohibition any monetary incentive payments made by hospitals to physicians under certain incentive payment programs designed to align incentives among hospitals and physicians (through techniques such as product standardization, the substitution of lower cost products, and care coordination initiatives that encourage medically appropriate decreases in length of stay) to improve efficiency and decrease costs while maintaining or improving quality.

Exempts such monetary incentive payments (creates a safe harbor for them) from federal criminal antikickback and other sanctions.

Date: 2013-04-11
Topic: Health (Medical Liability)
Subject: Health
Good Samaritan Health Professionals Act of 2013 - Amends the Public Health Service Act to shield a health care professional from liability under federal or state law for harm caused by any act or omission if: (1) the professional is serving as a volunteer in response to a disaster; and (2) the act or omission occurs during the period of the disaster, in the professional's capacity as such a volunteer, and in a good faith belief that the individual being treated is in need of health care services.

Makes exceptions where: (1) the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed; or (2) the professional rendered the health care services under the influence of intoxicating alcohol or an intoxicating drug.

Date: 2013-04-25
Topic: Health (Medical Liability)
Subject: Health
State Leadership in Health Care Act - Amends the Patient Protection and Affordable Care Act (PPACA) to allow states to apply for a waiver of specified requirements under PPACA with respect to health insurance coverage within that state due to implementation of a state plan that provides comparable coverage for plan years beginning in 2015 (currently, 2017). Permits the Secretary of Health and Human Services (HHS) or the Secretary of the Treasury to deny waivers only if: (1) the state plan does not meet requirements for granting a waiver, (2) the Secretary of HHS or the Treasury notifies the state in writing of the requirements that the state plan did not meet and provides the state with information used in making such a determination, and (3) the state is given an opportunity to appeal.

Requires the Secretary of HHS or the Treasury to reconsider the determination in the event of an appeal and issue a written decision within 60 days.

Date: 2013-05-06
Topic: Health (Medical Liability)
Subject: Health
Family Health Care Accessibility Act of 2013 - Amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients. Sets forth conditions for such liability protection, including: (1) the service is provided to the individual at a community health center or through offsite programs or events carried out by such center; and (2) the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses.

Considers an entity as sponsoring the health care practitioner if the entity submits an application to the Secretary of Health and Human Services (HHS), and the Secretary determines that the health care practitioner is deemed to be an employee of the Public Health Service.

Requires the Attorney General to submit to Congress an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the actions or omissions of health professional volunteers, will be paid pursuant to this Act annually. Requires the Secretary to transfer such estimated amount from the claims fund to the appropriate accounts in the Treasury, subject to the extent of amounts in the fund.

Makes this Act effective on October 1, 2014.

Date: 2013-07-17
Topic: Health (Medical Liability)
Subject: Health
Medicare Data Access for Transparency and Accountability Act - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to make available to the public HHS claims and payment data related to SSA title XVIII (Medicare), including data on payments made to any service provider or supplier.

Date: 2013-07-25
Topic: Health (Medical Liability)
Subject: Health
Fairness in Health Care Claims, Guidance, and Investigations Act - Amends the False Claims Act to set forth special rules for the investigation and prosecution of false claims submitted with respect to a federal health care program (i.e., a health care program funded by the federal government, a state health care program defined by the Social Security Act, or a health plan offered under the Patient Protection and Affordable Care Act).

Requires the Attorney General to certify in writing, prior to requesting any information from a physician, hospital, or other provider or supplier of health care services in connection with an investigation reasonably expected to concern 10 or more claims submitted to a federal health care program by or on behalf of a single entity, that: (1) each agency responsible for promulgating relevant regulations, guidelines, and billing instructions relevant to any allegations of fraud has examined such regulations, guidelines, and instructions, all communications between the alleged perpetrator of the fraud and the agency, and each of the allegedly false claims; (2) the allegations under investigation are viewed as viable based on unambiguous regulations, guidelines, and billing instructions issued during the relevant time period; and (3) if proven to be true, the allegations will be pursued under the False Claims Act.

Prohibits an action against a health care provider or supplier under the False Claims Act: (1) unless the amount of damages alleged to have been sustained by the government is a material amount, (2) if a claim is submitted in good faith reliance on erroneous information or written statements of federal policy provided by a federal agency or in good faith reliance on an audit or review by an agency of the entity submitting the claim or retaining an overpayment, or (3) if a claim is submitted in substantial compliance with a model compliance plan issued by the Secretary of Health and Human Services (HHS).

Establishes the standard of proof necessary for a civil prosecution of a claim submitted with respect to a federal health care program as clear and convincing evidence (currently, a preponderance of the evidence is required for all other claims).

Date: 2013-08-01
Topic: Health (Medical Liability)
Subject: Health
Medicare Prescription Drug Integrity Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to require a prescription drug plan (PDP) sponsor to have in place procedures designed to prevent fraud and abuse in PDPs.

Authorizes the Secretary of Health and Human Services (HHS), with respect to establishing special enrollment periods for full-benefit dual eligible individuals, to set coverage limits for individuals who have obtained coverage for a covered Medicare part D drug at a frequency or amount not medically necessary.

Amends SSA title IX to allow the Secretary to exclude from participation in any federal health care program any individual or entity that has engaged in the inappropriate prescribing or dispensing of a covered Medicare part D drug.

Amends SSA title XVIII part D to allow a PDP or a MedicareAdvantage-PD (MA-PD) plan to exclude from qualified prescription drug coverage, and deny payment for, any covered part D drug: (1) prescribed or dispensed inappropriately to an individual under a PDP or a MA-PD plan that could not have been prescribed or dispensed to the individual on the date of such prescribing or dispensing; or (2) any drug at a frequency or amount that represents a practice or pattern of abusive prescribing or dispensing, or presents a risk to enrollee health or safety.

Amends the Controlled Substances Act to direct the Attorney General to: (1) compile a list of the unique health identifiers of prescribers and dispensers that are members of a group practice registered and authorized to prescribe or dispense controlled substances in schedules II and III, and (2) make the list available to all PDP sponsors.

Amends SSA title XVIII with respect to the use of recovery audit contractors under the Medicare Integrity Program to identify underpayments and overpayments and recoup the latter. Authorizes the Secretary to retain an additional portion of up to 25% of the amounts recovered for purposes of carrying out this Act.

Date: 2013-08-01
Topic: Health (Medical Liability)
Subject: Health
Medicare Established Provider Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to develop a system to designate service providers and suppliers who meet specified criteria representing a low risk for submitting fraudulent Medicare claims as established providers afforded certain special treatment in the claim review process.

Date: 2013-09-20
Topic: Health (Medical Liability)
Subject: Health
Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to establish a safe pharmacy access program under which a prescription drug plan (PDP) sponsor (or a Medicare Advantage (MA) organization offering an MA-PD plan) shall have in place procedures designed to prevent fraud and abuse in the dispensing of certain controlled substances under Medicare part D.

Allows a PDP sponsor to suspend payments and clean claim notifications to a pharmacy pending an investigation of a credible allegation of fraud against the pharmacy, unless the Secretary determines there is a good cause not to suspend payments.

Directs the Secretary of Health and Human Services (HHS), under contracts entered into under the Medicare integrity program with Medicare drug integrity contractors (MEDICs), to authorize such MEDICs to obtain prescription and medical records directly from entities such as pharmacies, PDPs, and physicians. Requires a MEDIC to acknowledge receipt of a PDP sponsor referral of information for investigation, report back to the sponsor the investigation results within 45 days, and share them with appropriate agencies.

Requires electronic transmission (e-prescribing) of prescriptions for certain covered Medicare part D controlled substances.

Date: 2013-10-30
Topic: Health (Medical Liability)
Subject: Health
Protecting Seniors from Health Care Fraud Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), acting through the HHS Office of Inspector General, and the Attorney General to report annually to Congress and the public on health care fraud schemes targeted to seniors and steps being taken to combat such schemes and to educate seniors about them.

Directs the Secretary to: (1) disseminate such reports through mechanisms that reach the most Medicare beneficiaries, and (2) mail to each Medicare beneficiary a list of the top 10 most prevalent health care fraud schemes.

Date: 2013-11-21
Topic: Health (Medical Liability)
Subject: Health
Saving Lives, Saving Costs Act - Establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.

Requires the Secretary of Health and Human Services (HHS) to publish clinical practice guidelines that have been provided and maintained by national or state medical societies or medical specialty societies designated by the Secretary. Sets forth standards for the development of guidelines, including related to transparency, the composition of the panel, and the review of existing evidence.

Declares that this Act does not preempt or supersede any state or federal law that imposes greater procedural or substantive protections for health care providers and health care organizations from liability, loss, or damages than those provided under this Act nor does it create a cause of action or preempt any defenses otherwise available.

Allows a defendant to remove any health care liability action brought in a state court to a district court.

Requires an independent medical review in health care liability actions if the eligible professionals allege that they adhered to applicable clinical practice guideline. Sets forth procedures for the use of the panel's findings at trial. Enables defendants to recover costs and attorneys' fees from plaintiffs if the defendants prevail subsequent to preliminary findings in their favor.

Date: 2014-02-27
Topic: Health (Medical Liability)
Subject: Health
Generic Drug Pricing Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.

Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.

Date: 2014-04-09
Topic: Health (Medical Liability)
Subject: Health
Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare Administrative Contractor Payment Outreach and Education Program for DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) suppliers.

Requires each Medicare administrative contractor responsible for DMEPOS payments, in order to reduce improper payments to DMEPOS suppliers under Medicare part B (Supplementary Medical Insurance), to provide suppliers, physicians and practitioners who prescribe DMEPOS, and discharge planners and case managers who coordinate DMEPOS for individuals in the contractor's area with error rate reduction training as well as:

 a list of suppliers' most frequent payment errors and the most expensive payment errors over the last quarter, specific instructions regarding how to correct or avoid such errors in the future as well as to prevent future issues related to new audits, and a notice of all new topics that have been approved by the Secretary of Health and Human Services (HHS) for audits. Sets forth the structure for audits of DMEPOS suppliers, requiring a contractor to give priority to activities under the DMEPOS payment outreach and education program that will reduce improper Medicare payments based on technical errors, medical necessity, and fraud.

Requires annual reports to Congress on the use of recovery audit contractors under the Medicare Integrity Program to include certain information on the results of audit appeals related to DMEPOS.

Requires the Secretary to: (1) increase the maximum record requests made by Medicare DMEPOS contractors in auditing claims of suppliers with a relatively high audited claims error rate for DMEPOS payments, and (2) decrease the maximum record requests for suppliers with a relatively low error rate.

Directs the Secretary to limit the audit documentation review period for Medicare administrative contractors to three years.

Date: 2014-07-11
Topic: Health (Medical Liability)
Subject: Health
Fighting Medicare Fraud Act of 2014 - Amends title XI of the Social Security Act (SSA) with respect to the authority of the Secretary of Health and Human Services (HHS) to exclude from federal health programs certain individuals, including officers or managing employees, with an ownership or control interest in entities sanctioned for a criminal conviction relating to fraud, obstruction of an investigation or audit, or a misdemeanor related to a controlled substance.

Extends the permissive exclusion from federal health programs to persons, including officers or managing employees, with an ownership or control interest in entities affiliated with a sanctioned entity. Includes individuals with such connections at the time of the conduct that formed a basis for the conviction or exclusion of the sanctioned entity or the affiliated entity.

Establishes criminal penalties for anyone who knowingly and with intent to defraud purchases, sells, or distributes, or arranges for the purchase, sale, or distribution of two or more beneficiary identification or provider numbers under SSA titles XVIII (Medicare), XIX (Medicaid), or XXI (Children's Health Insurance Program [CHIP]).

Amends SSA title XVIII part C (Medicare+Choice) to require a contract with a Medicare Advantage (MA) organization offering an MA plan to require that the MA organization report to the Secretary any instances of probable fraud or abuse related to the payment or delivery of health benefits within 60 days after the organization identifies that instance.

Date: 2014-07-31
Topic: Health (Medical Liability)
Subject: Health
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.

Date: 2014-11-18
Topic: Health (Medical Liability)
Subject: Health