S.Amdt. 3198

SA 3198. Mr. CORNYN (for himself and Mr. LeMieux) submitted an
amendment intended to be proposed to

[[Page S13059]]

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:

Strike all after the first word and insert the following:

1. SHORT TITLE.

This Act may be cited as the ``Seniors and Taxpayers
Obligation Protection Act of 2009''.

SEC. 2. REQUIRING THE SECRETARY OF HEALTH AND HUMAN SERVICES
TO CHANGE THE MEDICARE BENEFICIARY IDENTIFIER
USED TO IDENTIFY MEDICARE BENEFICIARIES UNDER
THE MEDICARE PROGRAM.

(a) Procedures.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, in order to protect beneficiaries from
identity theft, the Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
establish and implement procedures to change the Medicare
beneficiary identifier used to identify individuals entitled
to benefits under part A of title XVIII of the Social
Security Act or enrolled under part B of such title so that
such an individual's social security account number is not
used.
(2) Maintaining existing hicn structure.--In order to
minimize the impact of the change under paragraph (1) on
systems that communicate with Medicare beneficiary
eligibility systems, the procedures under paragraph (1) shall
provide that the new Medicare beneficiary identifier maintain
the existing Health Insurance Claim Number structure.
(3) Protection against fraud.--The procedures under
paragraph (1) shall provide for a process for changing the
Medicare beneficiary identifier for an individual to a
different identifier in the case of the discovery of fraud,
including identity theft.
(4) Phase-in authority.--
(A) In general.--Subject to subparagraphs (B) and (C), the
Secretary may phase in the change under paragraph (1) in such
manner as the Secretary determines appropriate.
(B) Limit.--The phase-in period under subparagraph (A)
shall not exceed 10 years.
(C) Newly entitled and enrolled individuals.--The Secretary
shall ensure that the change under paragraph (1) is
implemented not later than January 1, 2010, with respect to
any individual who first becomes entitled to benefits under
part A of title XVIII of the Social Security Act or enrolled
under part B of such title on or after such date.
(b) Education and Outreach.--The Secretary shall establish
a program of education and outreach for individuals entitled
to, or enrolled for, benefits under part A of title XVIII of
the Social Security Act or enrolled under part B of such
title, providers of services (as defined in subsection (u) of
section 1861 of such Act (42 U.S.C. 1395x)), and suppliers
(as defined in subsection (d) of such section) on the change
under paragraph (1).
(c) Data Matching.--
(1) Access to certain information.--Section 205(r) of the
Social Security Act (42 U.S.C. 405(r)) is amended by adding
at the end the following new paragraph:
``(9)(A) The Commissioner of Social Security shall, upon
the request of the Secretary--
``(i) enter into an agreement with the Secretary for the
purpose of matching data in the system of records of the
Commissioner with data in the system of records of the
Secretary, so long as the requirements of subparagraphs (A)
and (B) of paragraph (3) are met, in order to determine--
``(I) whether a beneficiary under the program under title
XVIII, XIX, or XXI is dead, imprisoned, or otherwise not
eligible for benefits under such program; and
``(II) whether a provider of services or a supplier under
the program under title XVIII, XIX, or XXI is dead,
imprisoned, or otherwise not eligible to furnish or receive
payment for furnishing items and services under such program;
and
``(ii) include in such agreement safeguards to assure the
maintenance of the confidentiality of any information
disclosed and procedures to permit the Secretary to use such
information for the purpose described in clause (i).
``(B) Information provided pursuant to an agreement under
this paragraph shall be provided at such time, in such place,
and in such manner as the Commissioner determines
appropriate.
``(C) Information provided pursuant to an agreement under
this paragraph shall include information regarding whether--
``(i) the name (including the first name and any family
name or surname), the date of birth (including the month,
day, and year), and social security number of an individual
provided to the Commissioner match the information contained
in the Commissioner's records, and
``(ii) such individual is shown on the records of the
Commissioner as being deceased.''.
(2) Investigation based on certain information.--Title XI
of the Social Security Act (42 U.S.C. 1301 et seq.) is
amended by inserting after section 1128F the following new
section:

``SEC. 1128G. ACCESS TO CERTAIN DATA AND INVESTIGATION OF
CLAIMS INVOLVING INDIVIDUALS WHO ARE NOT
ELIGIBLE FOR BENEFITS OR ARE NOT ELIGIBLE
PROVIDERS OF SERVICES OR SUPPLIERS.

``(a) Data Agreement.--The Secretary shall enter into an
agreement with the Commissioner of Social Security pursuant
to section 205(r)(9).
``(b) Investigation of Claims Involving Certain Individuals
Who Are Not Eligible for Benefits or Are Not Eligible
Providers of Services or Suppliers.--
``(1) In general.--The Secretary shall, in the case where a
provider of services or a supplier under the program under
title XVIII, XIX, or XXI submits a claim for payment for
items or services furnished to an individual who the
Secretary determines, as a result of information provided
pursuant to such agreement, 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, conduct an investigation
with respect to the provider of services or supplier. If the
Secretary determines further action is appropriate, the
Secretary shall refer the investigation to the Inspector
General of the Department of Health and Human Services.
``(2) Assessment of implementation and effectiveness by the
oig.--The Inspector General of the Department of Health and
Human Services shall test the implementation of the
provisions of this section (including the implementation of
the agreement under section 205(r)(9)) and conduct such
period assessments of such implementation as the Inspector
General determines necessary to determine the effectiveness
of such implementation.''.
(d) Authorization of Appropriations.--There are authorized
to be appropriated such sums as may be necessary to carry out
this section.

SEC. 3. MONTHLY VERIFICATION OF ACCURACY OF CLAIMS FOR
PAYMENT FOR PHYSICIANS' SERVICES.

(a) In General.--Section 1893 of the Social Security Act
(42 U.S.C. 1395ddd) is amended--
(1) in subsection (b), by adding at the end the following
new paragraph:
``(7) The monthly verification of the accuracy of claims
for payment for physicians' services under the system under
subsection (i).''; and
(2) by adding at the end the following new subsection:
``(i) Monthly Verification of Accuracy of Claims for
Payment for Physicians' Services.--
``(1) System.--
``(A) In general.--Not later than 1 year after the date of
the enactment of this subsection, the Secretary shall
establish and implement a system to verify (electronically or
otherwise, taking into consideration the administrative
burden of such verification on physicians and group
practices) on a monthly basis that the claims for payment
under part B for physicians' services furnished in high risk
areas are--
``(i) for physicians' services actually furnished by the
physician or the physician's group practice; and
``(ii) otherwise accurate.
``(B) No determination of medical necessity.--In no case
shall any verification conducted under the system established
under subparagraph (A) include a determination of the medical
necessity of the physicians' service.
``(2) Verification.--Under the system, the Secretary, at
the end of each month, shall provide the physician or the
group practice with a detailed list of such claims for
payment that were submitted during the month in order for the
physician or the group practice to review and verify the
list. In providing the detailed list, the Secretary shall use
the provider number of the physician or the group practice.
``(3) Audits.--The Secretary shall conduct audits of the
review and verification by physicians and group practices of
the detailed list provided under paragraph (2). Such audits
shall assess whether the physician or group practice
conducted such review and verification in a fraudulent
manner. In the case where the Secretary determines such
review and verification was conducted in a fraudulent manner,
the Secretary shall recoup any payments resulting from the
fraudulent review and verification and impose a civil money
penalty in an amount determined appropriate by the Secretary
on the physician or group practice who conducted the
fraudulent review and verification. The provisions of section
1128A (other than subsections (a) and (b)) shall apply to a
civil money penalty under the previous sentence in the same
manner as such provisions apply to a penalty or proceeding
under section 1128A(a).
``(4) High risk areas defined.--In this subsection, the
term `high risk area' means a county designated as a high
risk area under subsection (j)(1).
``(5) Report by the secretary.--Not later than 1 year after
implementation of the system established under paragraph (1),
the Secretary shall submit a report to Congress on the
progress of such implementation. Such report shall include
recommendations--
``(A) on how to improve such implementation, including
whether the system should be expanded to include verification
of claims for payment under part B for physicians' services
furnished in additional areas; and

[[Page S13060]]

``(B) for such legislation and administrative action as the
Secretary determines appropriate.''.
(b) Authorization of Appropriations.--To carry out the
amendments made by this section, there are authorized to be
appropriated such sums as may be necessary for each of fiscal
years 2010 through 2014.

SEC. 4. DETECTION OF MEDICARE FRAUD AND ABUSE.

(a) In General.--Section 1893 of the Social Security Act
(42 U.S.C. 1395ddd), as amended by section 3, is amended--
(1) in subsection (b), by adding at the end the following
new paragraph:
``(8) Implementation of fraud and abuse detection methods
under subsection (j).'';
(2) in subsection (c), by adding at the end of the flush
matter following paragraph (4), the following new sentence
``In the case of an activity described in subsection (b)(8),
an entity shall only be eligible to enter into a contract
under the Program to carry out the activity if the entity is
selected through a competitive bidding process in accordance
with subsection (j)(3).''; and
(3) by adding at the end the following new subsection:
``(j) Detection of Medicare Fraud and Abuse.--
``(1) Establishment of system to identify counties most
vulnerable to fraud.--Not later than 6 months after the date
of enactment of this subsection, the Secretary shall
establish a system to identify the 50 counties most
vulnerable to fraud with respect to items and services
furnished by providers of services (other than hospitals and
critical access hospitals) and suppliers based on the degree
of county-specific reimbursement and analysis of payment
trends under this title. The Secretary shall designate the
counties identified under the preceding sentence as `high
risk areas'.
``(2) Fraud and abuse detection.--
``(A) Initial implementation.--The Secretary shall
establish procedures for the implementation of fraud and
abuse detection methods under this title with respect to
items and services furnished by such providers of services
and suppliers in high risk areas designated under paragraph
(1) (and, beginning not later than 18 months after the date
of enactment of this subsection, with respect to items and
services furnished by such providers of services and
suppliers in areas not so designated) including the
following:
``(i) In the case of a new applicant to be a supplier, a
background check, a pre-enrollment site visit, and random
unannounced site visits after enrollment.
``(ii) Not less than 5 years after the date of enactment of
this subsection, in the case of a supplier who is not a new
applicant, re-enrollment under this title, including a
background check and a site-visit as part of the application
process for such re-enrollment, and random unannounced site
visits after such re-enrollment.
``(iii) Data analysis to establish prepayment claim edits
designed to target the claims for payment under this title
for such items and services that are most likely to be
fraudulent.
``(iv) Prepayment benefit integrity reviews for claims for
payment under this title for such items and services that are
suspended as a result of such edits.
``(B) Requirement for participation.--In no case may a
provider of services or supplier who does not meet the
requirements under subparagraph (A) (including, in the case
of a supplier, the requirement of a background check)
participate in the program under this title.
``(C) Background checks.--The Secretary shall determine the
extent of the background check conducted under subparagraph
(A), including whether--
``(i) a fingerprint check is necessary;
``(ii) a background check shall be conducted with respect
to additional employees, board members, contractors or other
interested parties of the supplier; and
``(iii) any additional national background checks regarding
exclusion from participation in Federal programs (such as the
program under this title, title XIX, or title XXI), adverse
actions taken by State licensing boards, bankruptcies,
outstanding taxes, or other indications identified by the
Inspector General of the Department of Health and Human
Services are necessary.
``(D) Expanded implementation.--Not later than 24 months
after the date of enactment of this subsection, the Secretary
shall establish procedures for the implementation of such
fraud and abuse detection methods under this title with
respect to items and services furnished by all providers of
services and suppliers, including those not in high risk
areas designated under paragraph (1).
``(3) Competitive bidding.--In selecting entities to carry
out this subsection, the Secretary shall use a competitive
bidding process.
``(4) Report to congress.--The Secretary shall submit to
Congress an annual report on the effectiveness of activities
conducted under this subsection, including a description of
any savings to the program under this title as a result of
such activities and the overall administrative cost of such
activities and a determination as to the amount of funding
needed to carry out this subsection for subsequent fiscal
years, together with recommendations for such legislation and
administrative action as the Secretary determines
appropriate.''.
(b) Authorization of Appropriations.--To carry out the
amendments made by this section, there are authorized to be
appropriated--
(1) such sums as may be necessary, not to exceed
$50,000,000, for each of fiscal years 2010 through 2014; and
(2) such sums as may be necessary, not to exceed an amount
the Secretary determines appropriate in the most recent
report submitted to Congress under section 1893(j)(4) of the
Social Security Act, as added by subsection (a), for each
subsequent fiscal year.

SEC. 5. USE OF TECHNOLOGY FOR REAL-TIME DATA REVIEW.

Title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) is amended by adding at the end the following new
section:

``SEC. 1899. USE OF TECHNOLOGY FOR REAL-TIME DATA REVIEW.

``(a) In General.--The Secretary of Health and Human
Services shall establish procedures for the use of technology
(similar to that used with respect to the analysis of credit
card charging patterns) to provide real-time data analysis of
claims for payment under the Medicare program under title
XVIII of the Social Security Act to identify and investigate
unusual billing or order practices under the Medicare program
that could indicate fraud or abuse.
``(b) Competitive Bidding.--The procedures established
under subsection (a) shall ensure that the implementation of
such technology is conducted through a competitive bidding
process.''.

SEC. 6. EDITS ON 855S MEDICARE ENROLLMENT APPLICATION.

Section 1834(a) of the Social Security Act (42 U.S.C.
1395m(a)) is amended by adding at the end the following new
paragraph:
``(22) Confirmation with national supplier clearinghouse
prior to payment.--
``(A) In general.--Not later than 1 year after the date of
enactment of this paragraph, the Secretary shall establish
procedures to require carriers, prior to paying a claim for
payment for durable medical equipment, prosthetics,
orthotics, and supplies under this title, to confirm with the
National Supplier Clearinghouse--
``(i) that the National Provider Identifier of the
physician or practitioner prescribing or ordering the item or
service is valid and active;
``(ii) that the Medicare identification number of the
supplier is valid and active; and
``(iii) that the item or service for which the claim for
payment is submitted was properly identified on the CMS-855S
Medicare enrollment application.
``(B) Online database for implementation.--Not later than
18 months after the date of enactment of this paragraph, the
Secretary shall establish an online database similar to that
used for the National Provider Identifier to enable providers
of services, accreditors, carriers, and the National Supplier
Clearinghouse to view information on specialties and the
types of items and services each supplier has indicated on
the CMS-855S Medicare enrollment application submitted by the
supplier.
``(C) Notification of claim denial and resubmission.--In
the case where a claim for payment for durable medical
equipment, prosthetics, orthotics, and supplies under this
title is denied because the item or service furnished does
not correctly match up with the information on file with the
National Supplier Clearinghouse--
``(i) the National Supplier Clearinghouse shall--

``(I) provide the supplier written notification of the
reason for such denial; and
``(II) allow the supplier 60 days to provide the National
Supplier Clearinghouse with appropriate certification,
licensing, or accreditation; and

``(ii) the Secretary shall waive applicable requirements
relating to the time frame for the submission of claims for
payment under this title in order to permit the resubmission
of such claim if payment of such claim would otherwise be
allowed under this title.''.

SEC. 7. STRATEGIC PLAN FOR THE DEVELOPMENT OF A SERIAL NUMBER
TRACKING SYSTEM FOR DURABLE MEDICAL EQUIPMENT.

Section 1834(a) of the Social Security Act (42 U.S.C.
1395m(a)), as amended by section 6(a), is amended by adding
at the end the following new paragraph:
``(23) Strategic plan for the development of a serial
number tracking system for durable medical equipment.--
``(A) In general.--Not later than 1 year after the date of
enactment of this paragraph, the Secretary shall develop a
strategic plan for the development and implementation of a
serial number tracking system for durable medical equipment.
``(B) Serial number tracking system for durable medical
equipment.--The plan developed under subparagraph (A) shall
include mechanisms to ensure that an item of durable medical
equipment which has not been issued a unique identifier under
the unique device identification system established under
section 519(f) of the Federal Food, Drug, and Cosmetic Act
bears a unique identifier, unless the Secretary already
requires an alternative placement or provides an exception
for a particular item or type of durable medical equipment
under such section 519(f).
``(C) Provision of unique identifier to the secretary.--The
plan developed under subparagraph (A) shall include
appropriate mechanisms for manufacturers of items of durable
medical equipment to submit to the Secretary unique
identifiers issued under subparagraph (B) or such section
519(f) with

[[Page S13061]]

respect to such items. The plan shall include mechanisms for
the Secretary to provide for the storage of such unique
identifier in accordance with subparagraph (F)(i).
``(D) Requirements for manufacturers and wholesalers.--The
plan developed under subparagraph (A) shall include
mechanisms for manufacturers of items of durable medical
equipment, or, in the case where a wholesaler provides an
item of durable medical equipment to suppliers, wholesalers,
to--
``(i) upon issuing an item to a supplier, develop a product
description for the item which includes--

``(I) the unique identifier of the item;
``(II) the specific Healthcare Common Procedure Coding
System (HCPCS) code for the item;
``(III) the name of the supplier the item was shipped to;
and
``(IV) the supplier's Medicare identification number; and

``(ii) submit the product description developed under
clause (i) to the Secretary for storage in the unique
identifier database in accordance with subparagraph (F)(i).
``(E) Requirements for suppliers.--The plan developed under
subparagraph (A) shall include mechanisms to ensure that
suppliers of items of durable medical equipment--
``(i) upon issuing the item to a beneficiary, note the
unique identifier of such item on--

``(I) the claim form submitted for such item; and
``(II) when appropriate or otherwise required, the detailed
product description of the item;

``(ii) in the case where the item is issued to a
beneficiary on a rental basis, designate the unique
identifier with an `R' after the number to indicate that the
item was rented, and not purchased, by the beneficiary; and
``(iii) upon return of the item to the supplier, notify the
Secretary--

``(I) before reissuing that item and resubmitting that
number on such a claim form; or
``(II) upon resubmitting that number on such a claim form.

``(F) Responsibilities for the secretary.--
``(i) Maintenance of database of serial numbers.--The plan
developed under subparagraph (A) shall include the
responsibility of the Secretary to establish and maintain a
database containing the unique identifiers submitted by
manufacturers of items of durable medical equipment under
subparagraph (C).
``(ii) Payment.--

``(I) Limitation.--Subject to subclause (II), the plan
developed under subparagraph (A) shall include mechanisms to
ensure that payment may only be made for an item of durable
medical equipment if the unique identifier on the claim form
submitted for such item matches the unique identifier
submitted by the manufacturer of such item under subparagraph
(C).
``(II) Exception to limitation after verification of
receipt.--The plan developed under subparagraph (A) shall
include mechanisms to ensure that in the case where the
unique identifier is not on the claim form submitted for such
item or does not match the unique identifier submitted by the
manufacturer of such item under subparagraph (C), no payment
shall be made under this part for the item of durable medical
equipment until the Secretary has verified that the
beneficiary has received such item in accordance with
subclause (IV).
``(III) Duplicative unique identifiers.--The plan developed
under subparagraph (A) shall include mechanisms to ensure
that in the case where a unique identifier is submitted on
more than 1 claim form submitted for such an item and there
is no indication from the supplier that the item of durable
medical equipment has been returned by 1 beneficiary and is
now being used by another beneficiary, no payment shall be
made under this part for such item of durable medical
equipment unless the Secretary has verified that the
beneficiary has received such item in accordance with
subclause (IV).
``(IV) Verification.--The plan developed under subparagraph
(A) shall include provisions for the Secretary to conduct any
verification required under subclause (II) or (III) within 30
days after receipt by the Secretary of the relevant claim
form. In the case where such verification is not completed
within such time period, the Secretary shall pay such claim,
complete the verification, and, in the case where the
Secretary has entered into a contract with an entity for the
conduct of such verification, recover any payments that would
not have been made if the verification had been completed
within such time period from such entity.

``(iii) Quality control audits.--The plan developed under
subparagraph (A) shall include a requirement that the
Secretary conduct quality control audits to identify unusual
billing patterns with respect to items of durable medical
equipment for which payment is made under this part and may
provide that the Secretary conduct unannounced site visits or
commission other agencies to conduct such site visits as part
of such quality control audits.
``(iv) No use as a precertification mechanism.--The plan
developed under subparagraph (A) shall include mechanisms to
ensure that in no case shall a unique identifier issued under
subparagraph (B) or section 519(f) of the Federal Food, Drug,
and Cosmetic Act be used as a precertification mechanism for
the supply of an item of durable medical equipment or the
payment of a claim for such an item under this part.''.

SEC. 8. GAO STUDY AND REPORT ON EFFECTIVENESS OF SURETY BOND
REQUIREMENTS FOR SUPPLIERS OF DURABLE MEDICAL
EQUIPMENT IN COMBATING FRAUD.

(a) Study.--The Comptroller General of the United States
shall conduct a study on the effectiveness of the surety bond
requirement under section 1834(a)(16) of the Social Security
Act (42 U.S.C. 1395m(a)(16)) in combating fraud.
(b) Report.--Not later than 18 months after the date of
enactment of this Act, the Comptroller General shall submit
to Congress a report containing the results of the study
conducted under subsection (a), together with recommendations
for such legislation and administrative action as the
Comptroller General determines appropriate.

____________________