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H.R. 1900 (ih) To expand the use of competitive bidding under the Medicare Program. [Introduced in House] ...


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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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