Amended by section 1303 of HCERA. Directs CMS to include in the Integrated Data Repository (IDR) claims and payment data for sharing and data-matching purposes from Medicare, Medicaid, and CHIP, as well as health-related programs administered by the VA and DoD, SSA, and the IHS. Authorizes the DOJ and OIG to access HHS claims and payment data within the IDR provided applicable privacy, security, and disclosure laws remain intact.
Directs the Secretary of HHS to impose an appropriate administrative penalty on any individual who has knowingly participated in a federal health care fraud scheme.
Specifies requirements with respect to returning any overpayment received, indicating that any such overpayment must be reported and returned within 60 days after the point at which it was identified.
Directs the Secretary to promulgate regulations that requires all Medicare and Medicaid providers and suppliers to, by January 1, 2011, include their national provider identifier (NPI) on all applications and claims. Also directs the Secretary to withhold federal Medicaid matching payments for states that fail to report enrollee encounter data in the Medicaid Statistical Information System (MSIS).
Sets forth further requirements pertaining to permissive exclusions and civil monetary penalties (CMPs) such that any individual who knows of an overpayment and does not return the overpayment would be subject to up to $50,000 for each false statement and misrepresentation of a material fact.
With respect to requirements of DMEPOS and HHAs to obtain a surety bond (of not less than $50,000), directs the Secretary in determining such amount to take into consideration the volume of the provider or supplier’s billing.
Authorizes the Secretary, in consultation with the OIG, to suspend Medicare and Medicaid payments pending an investigation of credible allegations of fraud, and to promulgate regulations in accordance with this authority.
Appropriates $10 million for each of FYs 2010-2020 to the Health Care Fraud and Abuse Control (HFAC) fund and includes additional appropriations – namely: $95 million in FY 2011; $55 million in FY 2012; $30 million in FYs 2013-2014; and $20 million in each of FYs 2015-2016.
Requires Medicare and Medicaid Integrity Program contractors to provide performance statistics reports (e.g., amount of overpayments recovered, the number of fraud referrals, and the return on investment of such activities by the entity).
Further specifies certain evaluations and annual reports of HHS.