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H.R. 1900 (ih) To expand the use of competitive bidding under the Medicare Program. [Introduced in House] ...
108th CONGRESS 1st Session H. R. 18 To amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES January 7, 2003 Mrs. Biggert introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and the Judiciary, 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 to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) Short Title.--This Act may be cited as the ``Medicare Fraud Prevention and Enforcement Act of 2003''. (b) Table of Contents.--The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Site inspections and background checks. Sec. 3. Registration of billing agencies. Sec. 4. Expanded access to the health integrity protection database (HIPDB). Sec. 5. Liability of medicare carriers and fiscal intermediaries for claims submitted by excluded providers. Sec. 6. Community mental health centers. Sec. 7. Limiting the use of discharge in bankruptcy proceedings for provider liability for health care fraud. Sec. 8. Illegal distribution of a medicare or medicaid beneficiary identification or provider number. Sec. 9. Treatment of certain Social Security Act crimes as Federal health care offenses. Sec. 10. Authority of Office of Inspector General of the Department of Health and Human Services. Sec. 11. Universal product numbers on claims forms for reimbursement under the medicare program. SEC. 2. SITE INSPECTIONS AND BACKGROUND CHECKS. (a) Site Inspections for DME Suppliers, Community Mental Health Centers, and Other Provider Groups.--Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following: ``site inspections for dme suppliers, community mental health centers, and other provider groups ``Sec. 1897. (a) Site Inspections.-- ``(1) In general.--The Secretary shall conduct a site inspection for each applicable provider (as defined in paragraph (2)) that applies for a provider number in order to provide items or services under this title. Such site inspection shall be in addition to any other site inspection that the Secretary would otherwise conduct with regard to an applicable provider. ``(2) Applicable provider defined.-- ``(A) In general.--Except as provided in subparagraph (B), in this section the term `applicable provider' means-- ``(i) a supplier of durable medical equipment (including items described in section 1834(a)(13)); ``(ii) a supplier of prosthetics, orthotics, or supplies (including items described in paragraphs (8) and (9) of section 1861(s)); ``(iii) a community mental health center; or ``(iv) any other provider group, as determined by the Secretary. ``(B) Exception.--In this section, the term `applicable provider' does not include-- ``(i) a physician that provides durable medical equipment (as described in subparagraph (A)(i)) or prosthetics, orthotics, or supplies (as described in subparagraph (A)(ii)) to an individual as incident to an office visit by such individual; or ``(ii) a hospital that provides durable medical equipment (as described in subparagraph (A)(i)) or prosthetics, orthotics, or supplies (as described in subparagraph (A)(ii)) to an individual as incident to an emergency room visit by such individual. ``(b) Standards and Requirements.--In conducting the site inspection pursuant to subsection (a), the Secretary shall ensure that the site being inspected is in full compliance with all the conditions and standards of participation and requirements for obtaining medicare billing privileges under this title. ``(c) Time.--The Secretary shall conduct the site inspection for an applicable provider prior to the issuance of a provider number to such provider. ``(d) Timely Review.--The Secretary shall provide for procedures to ensure that the site inspection required under this section does not unreasonably delay the issuance of a provider number to an applicable provider.''. (b) Background Checks.--Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (as amended by subsection (a)) is amended by adding at the end the following: ``background checks ``Sec. 1898. (a) Background Check Required.--Except as provided in subsection (b), the Secretary shall conduct a background check on any individual or entity that applies to the Secretary for a provider number for the purpose of furnishing any item or service under this title. In performing the background check, the Secretary shall-- ``(1) conduct the background check before issuing a provider number to an individual or entity; ``(2) include a search of criminal records in the background check; and ``(3) provide for procedures that ensure the background check does not unreasonably delay the issuance of a provider number to an eligible individual or entity. ``(b) Use of State Licensing Procedure.--The Secretary may use the results of a State licensing procedure as a background check under subsection (a) if the State licensing procedure meets the requirements of subsection (a). ``(c) Attorney General Required To Provide Information.-- ``(1) In general.--Upon request of the Secretary, the Attorney General shall provide the criminal background check information referred to in subsection (a)(2) to the Secretary. ``(2) Restriction on use of disclosed information.--The Secretary may only use the information disclosed under subsection (a) for the purpose of carrying out the Secretary's responsibilities under this title. ``(d) Refusal To Issue Provider Number.-- ``(1) Authority.--In addition to any other remedy available to the Secretary, the Secretary may refuse to issue a provider number to an individual or entity if the Secretary determines, after a background check conducted under this section, that such individual or entity has a history of acts that indicate issuance of a provider number to such individual or entity would be detrimental to the best interests of the program or program beneficiaries. Such acts may include, but are not limited to-- ``(A) any bankruptcy; ``(B) any act resulting in a civil judgment against such individual or entity; or ``(C) any felony conviction under Federal or State law. ``(2) Reporting of refusal to issue provider number to the health integrity protection database (hipdb).--A determination to refuse to issue a provider number to an individual or entity as a result of a background check conducted under this section shall be reported to the health integrity protection database established under section 1128E in accordance with the procedures for reporting final adverse actions taken against a health care provider, supplier, or practitioner under that section.''. (c) Regulations; Effective Date.-- (1) Regulations.--Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall promulgate such regulations as are necessary to implement the amendments made by subsections (a) and (b). (2) Effective date.--The amendments made by subsections (a) and (b) shall apply to applications received by the Secretary of Health and Human Services on or after January 1, 2004. (d) Use of Medicare Integrity Program Funds.--The Secretary of Health and Human Services may use funds appropriated or transferred for purposes of carrying out the medicare integrity program established under section 1893 of the Social Security Act (42 U.S.C. 1395ddd) to carry out the provisions of sections 1897 and 1898 of that Act (as added by subsections (a) and (b)). SEC. 3. REGISTRATION OF BILLING AGENCIES. (a) Registration of Billing Agencies and Individuals.--Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (as amended by section 2(b)) is amended by adding at the end the following: ``registration of billing agencies and individuals ``Sec. 1899. (a) Registration.--The Secretary shall establish procedures for the registration of all applicable persons. ``(b) Required Application.--Each applicable person shall submit a registration application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may require. ``(c) Identification Number.--If the Secretary approves an application submitted under subsection (b), the Secretary shall assign a unique identification number to the applicable person. ``(d) Requirement.--Every claim for reimbursement under this title that is compiled and submitted by an applicable person shall contain the identification number that is assigned to the applicable person pursuant to subsection (c). ``(e) Timely Review.--The Secretary shall provide for procedures that ensure the timely consideration and determination regarding approval of applications under this section. ``(f) Definition of Applicable Person.--In this section, the term `applicable person' means an individual or an entity that compiles and submits claims for reimbursement under this title to the Secretary on behalf of any individual or entity.''. (b) Permissive Exclusion.--Section 1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b)) is amended by adding at the end the following: ``(16) Fraud by applicable person.--An applicable person (as defined in section 1899(f)) that the Secretary determines knowingly submitted or caused to be submitted a claim for reimbursement under title XVIII that the applicable person knows or should know is false or fraudulent.''. (c) Regulations; Effective Date.-- (1) Regulations.--Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall promulgate such regulations as are necessary to implement the amendment made by subsections (a) and (b). (2) Effective date.--The amendment made by subsections (a) and (b) shall take effect on January 1, 2004. SEC. 4. EXPANDED ACCESS TO THE HEALTH INTEGRITY PROTECTION DATABASE (HIPDB). (a) In General.--Section 1128E(d)(1) of the Social Security Act (42 U.S.C. 1320a-7e(d)(1)) is amended to read as follows: ``(1) Availability.--The information in the database maintained under this section shall be available to-- ``(A) Federal and State government agencies and health plans, and any health care provider, supplier, or practitioner entering an employment or contractual relationship with an individual or entity who could potentially be the subject of a final adverse action, where the contract involves the furnishing of items or services reimbursed by 1 or more Federal health care programs (regardless of whether the individual or entity is paid by the programs directly, or whether the items or services are reimbursed directly or indirectly through the claims of a direct provider); and ``(B) utilization and quality control peer review organizations and accreditation entities as defined by the Secretary, including but not limited to organizations described in part B of this title and in section 1154(a)(4)(C).''. (b) Criminal Penalty for Misuse of Information.--Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) is amended by adding at the end the following: ``(4) Whoever knowingly uses information maintained in the health integrity protection database maintained in accordance with section 1128E for a purpose other than a purpose authorized under that section shall be imprisoned for not more than 3 years or fined under title 18, United States Code, or both.''. (c) Effective Date.--The amendments made by this section shall take effect on the date of enactment of this Act. SEC. 5. LIABILITY OF MEDICARE CARRIERS AND FISCAL INTERMEDIARIES FOR CLAIMS SUBMITTED BY EXCLUDED PROVIDERS. (a) Reimbursement to the Secretary for Amounts Paid to Excluded Providers.-- (1) Requirements for fiscal intermediaries.-- (A) In general.--Section 1816 of the Social Security Act (42 U.S.C. 1395h) is amended by adding at the end the following: ``(m) An agreement with an agency or organization under this section shall require that such agency or organization reimburse the Secretary for any amounts paid by the agency or organization for a service under this title which is furnished by an individual or entity during any period for which the individual or entity is excluded, pursuant to section 1128, 1128A, or 1156, from participation in the health care program under this title if the amounts are paid after the 60-day period beginning on the date the Secretary provides notice of the exclusion to the agency or organization, unless the payment was made as a result of incorrect information provided by the Secretary or the individual or entity excluded from participation has concealed or altered their identity.''. (B) Conforming amendment.--Section 1816(i) of the Social Security Act (42 U.S.C. 1395h(i)) is amended by adding at the end the following: ``(4) Nothing in this subsection shall be construed to prohibit reimbursement by an agency or organization pursuant to subsection (m).''.
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