text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Medicare Fraud Enforcement and 
  Prevention Act of 2010''.
  
  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 such Act (42 
  U.S.C. 1320a-7b) is amended by adding at the end the following new 
  subsection:
      ``(g) Whoever knowingly, intentionally, and with the intent to 
  defraud purchases, sells, or distributes, or arranges for the purchase, 
  sale, or 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 three 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. 42 U.S.C. 1395y), as added by section 
  6402(h) of the Patient Protection and Affordable Care Act (Public Law 
  111-148), 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)), as added by section 6408(a) of the Patient 
  Protection and Affordable Care Act (Public Law 111-148), 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 PILOT PROGRAM.
  
      (a) Enhanced Screening.--Section 1866(j)(2)(B)(ii) of the Social 
  Security Act (42 U.S.C. 1395cc(j)), as inserted by section 6401(a)(3) 
  of the Patient Protection and Affordable Care Act (Public Law 111-148), 
  is amended by striking ``may'' and inserting ``shall''.
      (b) Access to Real Time Claims and Payment Data.--
  Section1128J(a)(2) of the Social Security Act, as added by section 
  6402(a) of the Patient Protection and Affordable Care Act (Public Law 
  111-148), 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) Biometric Technology Pilot Program.--
              (1) In general.--By not later than one year after the date 
          of the enactment of this Act, the Secretary of Health and Human 
          Services shall carry out a 5-year pilot 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. Under such pilot program the Secretary 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) Reports.--The Secretary of Health and Human Services 
          shall, for each of the third, fourth, and fifth years of the 
          pilot program under paragraph (1), submit to Congress a report 
          on the effectiveness of the pilot program in reducing the 
          occurrence of waste, fraud, and abuse in the Medicare program 
          under title XVIII of the Social Security Act.
              (3) Authorization of appropriations.--For purpose of 
          carrying out paragraph (1), there is authorized to be 
          appropriated such sums as may be necessary.
  
  SEC. 5. GAO STUDY AND REPORT.
  
      (a) Study.--The Comptroller General of the United States shall 
  conduct a study on Medicare administrative contractors under section 
  1874A of the Social Security Act, including Recovery Audit Contractors, 
  regarding the following areas:
              (1) Training and expertise in identifying fraud, including 
          the education levels of the key individuals tasked to identify 
          or refer potential cases of fraud, and whether the Centers for 
          Medicare & Medicaid Services should be providing more training 
          to contractors, or require contractors to hire experts with 
          greater medical training.
              (2) Acquisition and implementation of data mining software 
          among Medicare administrative contractors, if applicable, and 
          the ability or availability of such software to provide real-
          time data mining capabilities.
      (b) Report.--Not later than one year after the date of the 
  enactment of this Act, the Comptroller General of the United States 
  shall complete the study under this section and submit a report to 
  Congress regarding the findings of the study and recommendations for 
  legislation and administrative action.
target: Medicare Fraud Enforcement and Prevention Act of 2010 - Amends title XI of the Social Security Act (SSA) to increase criminal penalties for both felony and misdemeanor fraud under SSA titles XVIII (Medicare) and XIX (Medicaid).
  
  Adds a new offense of distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges with the intent to defraud.
  
  Applies civil monetary penalties to: (1) conspiracy to make false statements or commit other specified offenses with respect to Medicare or Medicaid claims; and (2) knowing creation or use of false records or statements with respect to the transmission of money or property to a federal health care program. Extends the statute of limitations from six to 10 years after presentation of a claim.
  
  Amends SSA title XVIII (Medicare), as amended by the Patient Protection and Affordable Care Act (PPACA), to revise screening requirements.
  
  Amends SSA title XI, as amended by PPACA, to require the access to claims and payment data granted to Inspector General of the Department of Health and Human Services (HHS) and the Attorney General to include access to real time claims and payment data.
  
  Requires the HHS Inspector General to implement mechanisms for the sharing of information about suspected fraud relating to the federal health care programs under Medicare, Medicaid, and SSA title XXI (Children's Health Insurance Program) (CHIP) with other appropriate law enforcement officials.
  
  Directs the HHS Secretary to carry out a five-year pilot program that implements biometric technology to ensure that individuals entitled to benefits under Medicare part A or enrolled under Medicare part B are physically present at the time and place of receipt of certain items and services for which payment may be made.
  
  Requires the Comptroller General to study and report to Congress on Medicare administrative contractors, including Recovery Audit Contractors.
feat_title: To provide for enhanced penalties to combat Medicare and Medicaid fraud, a Medicare data-mining system and biometric technology pilot program, and a GAO study on Medicare administrative contractors.