[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 418 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 418
To reduce Medicare waste, fraud, and abuse by providing for enhanced
penalties to combat Medicare and Medicaid fraud, for a Medicare data-
mining system, for a study on applying biometric technology, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 25, 2013
Ms. Ros-Lehtinen introduced the following bill; which was referred to
the Committee on Energy and Commerce, and in addition to the Committee
on Ways and Means, 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 reduce Medicare waste, fraud, and abuse by providing for enhanced
penalties to combat Medicare and Medicaid fraud, for a Medicare data-
mining system, for a study on applying biometric technology, 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.
This Act may be cited as the ``Medicare Fraud Enforcement and
Prevention Act of 2013''.
SEC. 2. ENHANCED CRIMINAL PENALTIES TO COMBAT MEDICARE AND MEDICAID
FRAUD.
(a) In General.--Section 1128B of the Social Security Act (42
U.S.C. 1320a-7b) is amended--
(1) in subsection (a), by striking ``$10,000 or imprisoned
for not more than one year'' and inserting ``$20,000 or
imprisoned for not more than two years''; and
(2) in each of subsections (a), (b)(1), (b)(2), (c), and
(d), by striking ``$25,000 or imprisoned for not more than five
years'' and inserting ``$50,000 or imprisoned for not more than
10 years''.
(b) Illegal Distribution of Medicare or Medicaid Beneficiary
Identification or Billing Privileges.--Section 1128B of the Social
Security Act (42 U.S.C. 1320a-7b) is amended by adding at the end the
following new subsection:
``(h) Whoever knowingly purchases, sells, or unlawfully
distributes, or arranges for the purchase, sale, or unlawful
distribution of two or more Medicare or Medicaid beneficiary
identification numbers or billing privileges under title XVIII or title
XIX shall be imprisoned for not more than 10 years or fined under title
18, United States Code (or, if greater, an amount equal to the monetary
loss to the Federal and any State government as a result of such acts),
or both.''.
(c) Effective Date.--The amendments made by this section shall
apply to acts committed on or after the date of the enactment of this
Act.
SEC. 3. ENHANCED CIVIL AUTHORITIES TO COMBAT MEDICARE AND MEDICAID
FRAUD.
(a) Civil Monetary Penalties Law Alignment and Other Changes.--
(1) Section 1128A(a) of the Social Security Act (42 U.S.C.
1320a-7a(a)) is amended--
(A) in paragraph (1), by striking ``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 subsection (i)(1)),'';
(B) by inserting after paragraph (10), as added by
section 6402(d)(2) of the Patient Protection and
Affordable Care Act (Public Law 111-148) the following
new paragraphs:
``(11) conspires to commit a violation of this section; or
``(12) knowingly makes, uses, or causes to be made or used,
a false record or statement material to an obligation to pay or
transmit money or property to a Federal health care program, or
knowingly conceals or knowingly and improperly avoids or
decreases an obligation to pay or transmit money or property to
a Federal health care program;'';
(C) in the first sentence--
(i) by striking ``or in cases under
paragraph (9)'' and inserting ``in cases under
paragraph (9)''; and
(ii) by striking ``fact)'' and inserting
``fact), in cases under paragraph (11), $50,000
for any violation described in this section
committed in furtherance of the conspiracy
involved, and in cases under paragraph (12),
$50,000 for each false record or statement, or
concealment, avoidance, or decrease''; and
(D) in the second sentence, by striking ``material
fact).'' and inserting ``material fact); or in cases
under paragraph (11), an assessment of not more than 3
times the total amount that would otherwise apply for
any violation described in this section committed in
furtherance of the conspiracy involved; or in cases
under paragraph (12), an assessment of not more than 3
times the total amount of the obligation to which the
false record or statement was material or that was
avoided or decreased.''.
(2) Section 1128A(c)(1) of the Social Security Act (42
U.S.C. 1320a-7a(c)(1)) is amended by striking ``six years'' and
inserting ``10 years''.
(3) Section 1128A(i) of the Social Security Act (42 U.S.C.
1320a-7a(i)) is amended--
(A) by amending paragraph (2) to read as follows:
``(2) The term `claim' means any application, request, or
demand, whether under contract, or otherwise, for money or
property for items and services under a Federal health care
program (as defined 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 subsection (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 program's behalf or to
advance a Federal health care program interest, and if
the Federal health care program--
``(i) provides or has provided any portion
of the money or property requested or demanded;
or
``(ii) will reimburse such contractor,
grantee, or other recipient 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 Federal health care program.'';
(C) in paragraph (7)--
(i) by striking ``term `should know'
means'' and inserting ``terms `knowing',
`knowingly', and `should know' mean'';
(ii) by redesignating subparagraphs (A) and
(B) as subparagraphs (B) and (C), respectively;
(iii) by inserting before subparagraph (B),
as redesignated by clause (ii), the following
new subparagraph:
``(A) has actual knowledge of the information;'';
and
(iv) in the matter following subparagraph
(C), as redesignated by clause (ii)--
(I) by inserting ``require'' after
``and''; and
(II) by striking ``is required'';
and
(D) by adding at the end the following new
paragraphs:
``(8) The term `obligation' means an established duty,
whether or not fixed, arising from an express or implied
contractual, grantor-grantee, or licensor licensee
relationship, from a fee-based or similar relationship, from
statute or regulation, or from the retention of any
overpayment.
``(9) The term `material' means having a natural tendency
to influence, or be capable of influencing, the payment or
receipt of money or property.''.
(b) Exclusion of Responsible Corporate Officials.--Section 1128(b)
of the Social Security Act (42 U.S.C. 1320a-7(b)) is amended by
striking clauses (i) and (ii) of paragraph (15)(A) and inserting the
following:
``(i) who has or had a direct or indirect
ownership or control interest in a sanctioned
entity at the time of and who knew or should
have known (as defined in section 1128(i)(7))
of any of the conduct that formed a basis for
the conviction or exclusion described in
subparagraph (B); or
``(ii) who is or was an officer or managing
employee (as defined in section 1126(b)) of
such an entity at the time of any of the
conduct that formed a basis for the conviction
or exclusion so described.''.
(c) Payment Suspensions.--Subsection (o)(1) of section 1862 of the
Social Security Act (42 U.S.C. 1395y) is amended by striking ``may''
and inserting ``shall''.
(d) Civil Monetary Penalties for False Statements or Delaying
Inspections.--Paragraph (9) of section 1128A(a) of the Social Security
Act (42 U.S.C. 1320a-7a(a)) is amended by inserting ``or to timely
provide information in response to a request authorized by section
1128J(b),'' after ``regulations),''.
SEC. 4. ENHANCED SCREENING, MEDICARE DATA-MINING SYSTEM; BIOMETRIC
TECHNOLOGY STUDY.
(a) Enhanced Screening.--Section 1866(j)(2)(B)(ii) of the Social
Security Act (42 U.S.C. 1395cc(j)(2)(B)(ii)) is amended by striking
``may'' and inserting ``shall''.
(b) Access to Real Time Claims and Payment Data.--Section
1128J(a)(2) of the Social Security Act is amended--
(1) by inserting ``including real time claims and payment
data,'' after ``access to claims and payment data''; and
(2) by adding at the end the following sentence: ``In
carrying out this section, the Inspector General of the
Department of Health and Human Services, in consultation with
the Attorney General, shall implement mechanisms for the
sharing of information about suspected fraud relating to the
Federal health care programs under titles XVIII, XIX, and XXI
with other appropriate law enforcement officials.''.
(c) Study on Use of Biometric Technology.--
(1) In general.--The Secretary of Health and Human Services
shall provide for a study that analyzes the feasibility and
benefits in reducing waste, fraud, and abuse of carrying out a
program (in this subsection referred to as a ``biometric
technology program'') that implements biometric technology to
ensure that individuals entitled to benefits under part A of
title XVIII of the Social Security Act or enrolled under part B
of such title are physically present at the time and place of
receipt of certain items and services (specified by the
Secretary) for which payment may be made under such title. Such
a program may provide for financial incentives to encourage
voluntary participation of providers of services (as defined in
section 1861(u) of such Act) and suppliers (as defined in
section 1861(d) of such Act).
(2) Report.--Not later than 6 months after the date of the
enactment of this Act, the Secretary shall submit to the
Congress a report on the study conducted under paragraph (1).
Such report shall include an analysis of the likely
effectiveness of a biometric technology program on reducing
waste, fraud, and abuse under the Medicare program and may
include recommendations with regard to whether such a program,
on a pilot or other basis, should be implemented.
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