S.Amdt. 2966

SA 2966. Mr. COBURN submitted an amendment intended to be proposed to
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

Beginning on page 621, strike line 10 and all that follows
through page 1134, line 3, and insert the following:

TITLE III--REDUCING WASTE, FRAUD, AND ABUSE IN MEDICARE AND MEDICAID

SEC. 3001. PREVENTION AND DETECTION OF WASTE, FRAUD, AND
ABUSE WITHIN THE MEDICARE AND MEDICAID
PROGRAMS.

(a) In General.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall develop and
implement innovative technologies, systems, and procedures
(as described under subsection (b)) to reduce waste, fraud,
and abuse under the Medicare and Medicaid programs and ensure
that amounts attributed to waste, fraud, and abuse constitute
an amount not greater than 5 percent of all funds expended
under the Medicare program.
(b) Prevention and Detection Measures.--For purposes of
subsection (a), the technologies, systems, and procedures to
be developed and implemented by the Secretary shall include
the following:

[[Page S12629]]

(1) Improving the Medicare beneficiary identifier (MBI)
used to identify beneficiaries under the Medicare program
to--
(A) ensure that the social security account numbers
assigned to such beneficiaries are not used;
(B) provide such beneficiaries with machine-readable
identification cards that employ a unique patient number; and
(C) establish a process for changing the MBI for an
individual to a different identifier in the case of the
discovery of fraud, including identity theft.
(2) Comprehensive real-time data matching across Federal
agencies (similar to measures employed by the credit card
industry) that is able to determine--
(A) whether a beneficiary under the Medicare or Medicaid
programs is dead, imprisoned, or otherwise not eligible for
benefits under such programs; and
(B) whether a provider of services or a supplier under the
Medicare or Medicaid programs is dead, imprisoned, or
otherwise not eligible to furnish or receive payment for
furnishing items and services under such programs.
(3) Imposition of direct financial penalties to facilities
receiving funds under the Medicare or Medicaid programs that
employ any physician, executive, or administrator that has
been convicted of an offense involving fraud relating to the
Medicare or Medicaid programs or reached a settlement
relating to such an offense with the Federal Government or
any State government.
(4) Use of procedures and technology (including front-end,
pre-payment technology similar to that used by hedge funds,
investment funds, and banks) to provide real-time data
analysis of claims for payment under the Medicare program to
identify and investigate unusual billing or order practices
that could indicate fraud or abuse.
(c) Investigation.--The Secretary shall, in the case where
a provider of services or a supplier under the Medicare or
Medicaid programs submits a claim for payment for items or
services furnished to an individual who the Secretary
determines, as a result of information obtained pursuant to
subsection (b), is not eligible for benefits under such
program, or where the Secretary determines, as a result of
such information, that such provider of services or supplier
is not eligible to furnish or receive payment for furnishing
such items or services, refer the matter to the Inspector
General of the Department of Health and Human Services for
investigation not later than 14 days after the Secretary has
made such a determination.
(d) Definitions.--In this title:
(1) Medicaid.--The term ``Medicaid'' means the program for
medical assistance established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(2) Medicare.--The term ``Medicare'' means the program for
medical assistance established under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.

SEC. 3002. REINVESTMENT OF SAVINGS INTO MEDICARE PROGRAM.

Any savings achieved under the Medicare program pursuant to
the measures developed and implemented by the Secretary under
section 3001 shall be reinvested into the Federal Hospital
Insurance Trust Fund, as established under section 1817 of
the Social Security Act (42 U.S.C. 1395i), or the Federal
Supplementary Medical Insurance Trust Fund, as established
under section 1841 of such Act (42 U.S.C. 1395t).

SEC. 3003. USING HEALTH CARE PROFESSIONALS TO REDUCE FRAUD.

(a) In General.--The Secretary shall establish a
demonstration project that uses practicing health care
professionals to conduct undercover investigations of other
health care professionals.
(b) Demonstration Project.--
(1) In general.--The Secretary, in coordination with the
Office of the Inspector General of the Department of Health
and Human Services (referred to in this section as the
``Inspector General''), shall establish a demonstration
project in which the Secretary enters into contracts with
practicing health care professionals to conduct
investigations of health care providers that receive
reimbursements through any Federal public health care
program.
(2) Scope.--The Secretary shall conduct the demonstration
project under this section in States or regions that have--
(A) above-average rates of Medicare fraud; or
(B) any level of Medicaid fraud.
(c) Eligibility.--To be eligible to receive a contract
under subsection (b)(1), a health care professional shall--
(1) be a licensed and practicing medical professional who
holds an advanced medical degree from an accredited American
university or college and has experience within the health
care industry; and
(2) submit to the Secretary such information, at such time,
and in such manner, as the Secretary may require.
(d) Activities.--Each health care professional awarded a
contract under subsection (b)(1) shall assist the Secretary
and the Inspector General in conducting random audits of the
practices of health care providers that receive
reimbursements through any Federal public health care
program. Such audits may include--
(1) statistically random visits to the practices of such
health care providers;
(2) attempts to purchase pharmaceutical products illegally
from such health care providers;
(3) purchasing durable medical equipment from such health
care providers;
(4) hospital visits; and
(5) other activities, as the Secretary determines
appropriate.
(e) Follow-up by the Inspector General.--The Inspector
General shall follow up on any notable findings of the
investigations conducted under subsection (d) in order to
report fraudulent practices and refer individual cases to the
appropriate State and local authorities.
(f) Limitation.--The Secretary shall not contract with a
health care professional if, due to physical proximity or a
personal, familial, proprietary, or monetary relationship
with such health care professional to individuals that such
professional would be investigating, a conflict of interest
could be inferred.
(g) Funding.--To carry out this section, the Secretary and
the Inspector General are each authorized to reserve, from
amounts appropriated to the Department of Health and Human
Services and the Office of the Inspector General of the
Department of Health and Human Services, respectively,
$500,000 for each of fiscal years 2010 through 2014.
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