S.454 - Strengthening Program Integrity and Accountability in Health Care Act of 2011

A bill to amend titles XVIII and XIX of the Social Security Act to prevent fraud, waste, and abuse under Medicare, Medicaid, and CHIP, and for other purposes. view all titles (2)

All Bill Titles

  • Official: A bill to amend titles XVIII and XIX of the Social Security Act to prevent fraud, waste, and abuse under Medicare, Medicaid, and CHIP, and for other purposes. as introduced.
  • Short: Strengthening Program Integrity and Accountability in Health Care Act of 2011 as introduced.

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03/02/11
 
 
 
 
 
 
 

Official Summary

Strengthening Program Integrity and Accountability in Health Care Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) change from discretionary to mandatory the authority of the Secretary of Health and Human Services (HHS) to suspend Medicare and Medicaid pa

Official Summary

Strengthening Program Integrity and Accountability in Health Care Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to:
(1) change from discretionary to mandatory the authority of the Secretary of Health and Human Services (HHS) to suspend Medicare and Medicaid payments pending investigation of credible allegations of fraud; and
(2) require the Secretary to extend to up to 365 calendar days for particular categories of service providers or suppliers in which fraud, waste, or abuse is likely the number of days in which Medicare claims are required to be paid in order to ensure that they are clean claims. Requires the Inspector General of HHS to notify the relevant congressional committees within 30 days after transmitting to another HHS agency a management implication report (which details investigative findings about the possible implication of agency management in prohibited or otherwise inappropriate transactions). Directs the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, to establish an information sharing program regarding beneficiary medical ID theft under the programs under SSA titles XVIII (Medicare), XIX (Medicaid), and XXI (State Children's Health Insurance) (CHIP). Amends SSA title XI to authorize the Secretary to exclude from federal health care programs entities affiliated with a sanctioned entity, as well as any officer or managing employee of an affiliated entity (currently, only individuals with an ownership or control interest in a sanctioned entity), if the affiliated entity was so affiliated at the time of any of the conduct forming the basis for the conviction or exclusion of the sanctioned entity. Directs the Secretary to make available to the public Medicare claims and payment data. Amends SSA title XIX to require a state Medicaid agency to exclude from program participation with respect to a particular period any individual or entity which owns, controls, or manages an entity that:
(1) has delinquent unpaid overpayments during such period;
(2) is suspended or excluded from Medicaid participation or whose participation is terminated; or
(3) is affiliated with an individual or entity that has been suspended or excluded from Medicaid participation or whose participation is terminated. Amends the Federal Food, Drug, and Cosmetic Act to require the Secretary to list on the Food and Drug Administration (FDA) Internet website certain new drugs (for human consumption) or new animal drugs that have not been approved by the FDA, together with the name of the person who listed such drug and the authority under such Act that does not require such drug to be subject to FDA approval. Amends SSA title XIX to prohibit a state from making a Medicaid payment for a covered outpatient drug which has not been FDA-approved. Amends SSA title XI to require individuals or entities that participate in or conduct activities under federal health care programs to comply with certain congressional requests for documents, information, or interviews.

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