F:\P11\NHI\TRICOMM\AAHCA09_001.

XML

729
1 renal dialysis facility, upon the request of the Secretary,
2 shall provide to the Secretary access to information relat-
3 ing to any ownership or compensation arrangement be-
4 tween such facility and the medical director of such facility
5 or between such facility and any physician.’’.
6 SEC. 1644. BILLING AGENTS, CLEARINGHOUSES, OR OTHER

7 ALTERNATE PAYEES REQUIRED TO REG-

8 ISTER UNDER MEDICARE.

9 (a) MEDICARE.—Section 1866(j)(1) of the Social Se-

10 curity Act (42 U.S.C. 1395cc(j)(1)) is amended by adding
11 at the end the following new subparagraph:
12 ‘‘(D) BILLING AGENTS AND CLEARING-

13 HOUSES REQUIRED TO BE REGISTER UNDER

14 MEDICARE.—Any agent, clearinghouse, or other

15 alternate payee that submits claims on behalf of
16 a health care provider must be registered with
17 the Secretary in a form and manner specified
18 by the Secretary.’’.
19 (b) MEDICAID.—For a similar provision with respect
20 to the Medicaid program under title XIX of the Social Se-
21 curity Act, see section 1759.
22 (c) EFFECTIVE DATE.—The amendment made by
23 subsection (a) shall apply to claims submitted on or after
24 January 1, 2012.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

730
1 SEC. 1645. CONFORMING CIVIL MONETARY PENALTIES TO

2 FALSE CLAIMS ACT AMENDMENTS.

3 Section 1128A of the Social Security Act, as amended

4 by sections 1611, 1612, 1613, and 1615, is further
5 amended—
6 (1) in subsection (a)—
7 (A) in paragraph (1), by striking ‘‘to an
8 officer, employee, or agent of the United States,
9 or of any department or agency thereof, or of
10 any State agency (as defined in subsection
11 (i)(1))’’;
12 (B) in paragraph (4)—
13 (i) by striking ‘‘participating in a pro-
14 gram under title XVIII or a State health
15 care program’’ and inserting ‘‘participating
16 in a Federal health care program (as de-
17 fined in section 1128B(f))’’; and
18 (ii) in subparagraph (A), by striking
19 ‘‘title XVIII or a State health care pro-
20 gram’’ and inserting ‘‘a Federal health
21 care program (as defined in section
22 1128B(f))’’;
23 (C) by striking ‘‘or’’ at the end of para-
24 graph (10);
25 (D) by inserting after paragraph (11) the
26 following new paragraphs:
f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

731
1 ‘‘(12) conspires to commit a violation of this
2 section; or
3 ‘‘(13) knowingly makes, uses, or causes to be
4 made or used, a false record or statement material
5 to an obligation to pay or transmit money or prop-
6 erty to a Federal health care program, or knowingly
7 conceals or knowingly and improperly avoids or de-
8 creases an obligation to pay or transmit money or
9 property to a Federal health care program;’’; and
10 (E) in the matter following paragraph
11 (13), as inserted by subparagraph (D), by strik-
12 ing ‘‘or in cases under paragraph (11), $50,000
13 for each such violation’’ and inserting ‘‘in cases
14 under paragraph (11), $50,000 for each such
15 violation, in cases under paragraph (12),
16 $50,000 for any violation described in this sec-
17 tion committed in furtherance of the conspiracy
18 involved; or in cases under paragraph (13),
19 $50,000 for each false record or statement, or
20 concealment, avoidance, or decrease’’; and
21 (F) in the second sentence, by striking
22 ‘‘such false statement or misrepresentation)’’
23 and inserting ‘‘such false statement or mis-
24 representation, in cases under paragraph (12),
25 an assessment of not more than 3 times the

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

732
1 total amount that would otherwise apply for
2 any violation described in this section com-
3 mitted in furtherance of the conspiracy in-
4 volved, or in cases under paragraph (13), an as-
5 sessment of not more than 3 times the total
6 amount of the obligation to which the false
7 record or statment was material or that was
8 avoided or decreased)’’.
9 (2) in subsection (c)(1), by striking ‘‘six years’’
10 and inserting ‘‘10 years’’; and
11 (3) in subsection (i)—
12 (A) by amending paragraph (2) to read as
13 follows:
14 ‘‘(2) The term ‘‘claim’’ means any application,
15 request, or demand, whether under contract, or oth-
16 erwise, for money or property for items and services
17 under a Federal health care program (as defined in
18 section 1128B(f)), whether or not the United States
19 or a State agency has title to the money or property,
20 that—
21 ‘‘(A) is presented or caused to be pre-
22 sented to an officer, employee, or agent of the
23 United States, or of any department or agency
24 thereof, or of any State agency (as defined in
25 subsection (i)(1)); or

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

733
1 ‘‘(B) is made to a contractor, grantee, or
2 other recipient if the money or property is to be
3 spent or used on the Federal health care pro-
4 gram’s behalf or to advance a Federal health
5 care program interest, and if the Federal health
6 care program—
7 ‘‘(i) provides or has provided any por-
8 tion of the money or property requested or
9 demanded; or
10 ‘‘(ii) will reimburse such contractor,
11 grantee, or other recipient for any portion
12 of the money or property which is re-
13 quested or demanded.’’;
14 (B) by amending paragraph (3) to read as
15 follows:
16 ‘‘(3) The term ‘item or service’ means, without
17 limitation, any medical, social, management, admin-
18 istrative, or other item or service used in connection
19 with or directly or indirectly related to a Federal
20 health care program.’’;
21 (C) in paragraph (6)—
22 (i) in subparagraph (C), by striking at
23 the end ‘‘or’’;

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

734
1 (ii) in the first subparagraph (D), by
2 striking at the end the period and inserting
3 ‘‘; or’’; and
4 (iii) by redesignating the second sub-
5 paragraph (D) as a subparagraph (E);
6 (D) by amending paragraph (7) to read as
7 follows:
8 ‘‘(7) The terms ‘knowing’, ‘knowingly’, and
9 ‘should know’ mean that a person, with respect to
10 information—
11 ‘‘(A) has actual knowledge of the informa-
12 tion;
13 ‘‘(B) acts in deliberate ignorance of the
14 truth or falsity of the information; or
15 ‘‘(C) acts in reckless disregard of the truth
16 or falsity of the information;
17 and require no proof of specific intent to defraud.’’;
18 and
19 (E) by adding at the end the following new
20 paragraphs:
21 ‘‘(8) The term ‘obligation’ means an established
22 duty, whether or not fixed, arising from an express
23 or implied contractual, grantor-grantee, or licensor-
24 licensee relationship, from a fee-based or similar re-

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

735
1 lationship, from statute or regulation, or from the
2 retention of any overpayment.
3 ‘‘(9) The term ‘material’ means having a nat-
4 ural tendency to influence, or be capable of influ-
5 encing, the payment or receipt of money or prop-
6 erty.’’.
7 Subtitle D—Access to Information
8 Needed to Prevent Fraud,
9 Waste, and Abuse
10 SEC. 1651. ACCESS TO INFORMATION NECESSARY TO IDEN-

11 TIFY FRAUD, WASTE, AND ABUSE.

12 Section 1128G of the Social Security Act, as added

13 by section 1631 and amended by sections 1632 and 1641,
14 is further amended by adding at the end the following new
15 subsection;
16 ‘‘(d) ACCESS TO INFORMATION NECESSARY TO IDEN-
17 TIFY FRAUD, WASTE, AND ABUSE.—For purposes of law
18 enforcement activity, and to the extent consistent with ap-
19 plicable disclosure, privacy, and security laws, including
20 the Health Insurance Portability and Accountability Act
21 of 1996 and the Privacy Act of 1974, and subject to any
22 information systems security requirements enacted by law
23 or otherwise required by the Secretary, the Attorney Gen-
24 eral shall have access, facilitation by the Inspector General
25 of the Department of Health and Human Services, to

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

736
1 claims and payment data relating to titles XVIII and XIX,
2 in consultation with the Centers for Medicare & Medicaid
3 Services or the owner of such data.’’.
4 SEC. 1652. ELIMINATION OF DUPLICATION BETWEEN THE

5 HEALTHCARE INTEGRITY AND PROTECTION

6 DATA BANK AND THE NATIONAL PRACTI-

7 TIONER DATA BANK.

8 (a) IN GENERAL.—To eliminate duplication between

9 the Healthcare Integrity and Protection Data Bank
10 (HIPDB) established under section 1128E of the Social
11 Security Act and the National Practitioner Data Bank
12 (NPBD) established under the Health Care Quality Im-
13 provement Act of 1986, section 1128E of the Social Secu-
14 rity Act (42 U.S.C. 1320a-7e) is amended—
15 (1) in subsection (a), by striking ‘‘Not later
16 than’’ and inserting ‘‘Subject to subsection (h), not
17 later than’’;
18 (2) in the first sentence of subsection (d)(2), by
19 striking ‘‘(other than with respect to requests by
20 Federal agencies)’’; and
21 (3) by adding at the end the following new sub-
22 section:
23 ‘‘(h) SUNSET OF THE HEALTHCARE INTEGRITY AND

24 PROTECTION DATA BANK; TRANSITION PROCESS.—Ef-

25 fective upon the enactment of this subsection, the Sec-

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC