Summary:
Fairness in Health Care Claims, Guidance, and Investigations Act - Amends the False Claims Act to set forth special rules for the investigation and prosecution of false claims submitted with respect to a federal health care program (i.e., a health care program funded by the federal government, a state health care program defined by the Social Security Act, or a health plan offered under the Patient Protection and Affordable Care Act).

Requires the Attorney General to certify in writing, prior to requesting any information from a physician, hospital, or other provider or supplier of health care services in connection with an investigation reasonably expected to concern 10 or more claims submitted to a federal health care program by or on behalf of a single entity, that: (1) each agency responsible for promulgating relevant regulations, guidelines, and billing instructions relevant to any allegations of fraud has examined such regulations, guidelines, and instructions, all communications between the alleged perpetrator of the fraud and the agency, and each of the allegedly false claims; (2) the allegations under investigation are viewed as viable based on unambiguous regulations, guidelines, and billing instructions issued during the relevant time period; and (3) if proven to be true, the allegations will be pursued under the False Claims Act.

Prohibits an action against a health care provider or supplier under the False Claims Act: (1) unless the amount of damages alleged to have been sustained by the government is a material amount, (2) if a claim is submitted in good faith reliance on erroneous information or written statements of federal policy provided by a federal agency or in good faith reliance on an audit or review by an agency of the entity submitting the claim or retaining an overpayment, or (3) if a claim is submitted in substantial compliance with a model compliance plan issued by the Secretary of Health and Human Services (HHS).

Establishes the standard of proof necessary for a civil prosecution of a claim submitted with respect to a federal health care program as clear and convincing evidence (currently, a preponderance of the evidence is required for all other claims).

fairness health care claims guidance investigations act amends false claims act set forth special rules investigation prosecution false claims submitted respect federal health care program health care program funded federal government state health care program defined social_security_act health plan offered patient_protection affordable care act requires attorney general certify writing prior requesting information physician hospital provider supplier health care services connection investigation reasonably expected concern claims submitted federal health care program behalf single entity agency responsible promulgating relevant regulations guidelines billing instructions relevant allegations fraud examined regulations guidelines instructions communications alleged perpetrator fraud agency allegedly false claims allegations investigation viewed viable based unambiguous regulations guidelines billing instructions issued relevant time period proven true allegations pursued false claims act prohibits action health care provider supplier false claims act damages alleged sustained government material claim submitted good faith reliance erroneous information written statements federal policy provided federal agency good faith reliance audit review agency entity submitting claim retaining overpayment claim submitted substantial compliance model compliance plan issued secretary health_and_human_services hhs establishes standard proof necessary civil prosecution claim submitted respect federal health care program clear convincing evidence currently preponderance evidence required claims


Summary:
Medicare Prescription Drug Integrity Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to require a prescription drug plan (PDP) sponsor to have in place procedures designed to prevent fraud and abuse in PDPs.

Authorizes the Secretary of Health and Human Services (HHS), with respect to establishing special enrollment periods for full-benefit dual eligible individuals, to set coverage limits for individuals who have obtained coverage for a covered Medicare part D drug at a frequency or amount not medically necessary.

Amends SSA title IX to allow the Secretary to exclude from participation in any federal health care program any individual or entity that has engaged in the inappropriate prescribing or dispensing of a covered Medicare part D drug.

Amends SSA title XVIII part D to allow a PDP or a MedicareAdvantage-PD (MA-PD) plan to exclude from qualified prescription drug coverage, and deny payment for, any covered part D drug: (1) prescribed or dispensed inappropriately to an individual under a PDP or a MA-PD plan that could not have been prescribed or dispensed to the individual on the date of such prescribing or dispensing; or (2) any drug at a frequency or amount that represents a practice or pattern of abusive prescribing or dispensing, or presents a risk to enrollee health or safety.

Amends the Controlled Substances Act to direct the Attorney General to: (1) compile a list of the unique health identifiers of prescribers and dispensers that are members of a group practice registered and authorized to prescribe or dispense controlled substances in schedules II and III, and (2) make the list available to all PDP sponsors.

Amends SSA title XVIII with respect to the use of recovery audit contractors under the Medicare Integrity Program to identify underpayments and overpayments and recoup the latter. Authorizes the Secretary to retain an additional portion of up to 25% of the amounts recovered for purposes of carrying out this Act.

amends voluntary prescription drug benefit program title xviii medicare social security act ssa require prescription drug plan pdp sponsor place procedures designed prevent fraud abuse pdps authorizes secretary health_and_human_services hhs respect establishing special enrollment periods benefit dual eligible individuals set coverage limits individuals obtained coverage covered medicare drug frequency medically necessary amends ssa title allow secretary exclude participation federal health care program individual entity engaged inappropriate prescribing dispensing covered medicare drug amends ssa title xviii allow pdp medicareadvantage ma-pd plan exclude qualified prescription drug coverage deny payment covered drug prescribed dispensed inappropriately individual pdp plan prescribed dispensed individual date prescribing dispensing drug frequency represents practice pattern abusive prescribing dispensing presents risk enrollee health safety amends controlled substances act direct attorney general compile list unique health identifiers prescribers dispensers members group practice registered authorized prescribe dispense controlled substances schedules iii list available pdp sponsors amends ssa title xviii respect use recovery audit contractors medicare_integrity_program identify underpayments overpayments recoup authorizes secretary retain additional portion amounts recovered purposes carrying act


Summary: Medicare Established Provider Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to develop a system to designate service providers and suppliers who meet specified criteria representing a low risk for submitting fraudulent Medicare claims as established providers afforded certain special treatment in the claim review process.

medicare established provider act amends title xviii medicare social security act direct secretary health_and_human_services hhs develop system designate service providers suppliers meet specified criteria representing low risk submitting fraudulent medicare claims established providers afforded certain special treatment claim review process


Summary:
Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to establish a safe pharmacy access program under which a prescription drug plan (PDP) sponsor (or a Medicare Advantage (MA) organization offering an MA-PD plan) shall have in place procedures designed to prevent fraud and abuse in the dispensing of certain controlled substances under Medicare part D.

Allows a PDP sponsor to suspend payments and clean claim notifications to a pharmacy pending an investigation of a credible allegation of fraud against the pharmacy, unless the Secretary determines there is a good cause not to suspend payments.

Directs the Secretary of Health and Human Services (HHS), under contracts entered into under the Medicare integrity program with Medicare drug integrity contractors (MEDICs), to authorize such MEDICs to obtain prescription and medical records directly from entities such as pharmacies, PDPs, and physicians. Requires a MEDIC to acknowledge receipt of a PDP sponsor referral of information for investigation, report back to the sponsor the investigation results within 45 days, and share them with appropriate agencies.

Requires electronic transmission (e-prescribing) of prescriptions for certain covered Medicare part D controlled substances.

medicare patient safety drug abuse prevention act amends voluntary prescription drug benefit program title xviii medicare social security act ssa establish safe pharmacy access program prescription drug plan pdp sponsor medicare advantage organization offering ma-pd plan shall place procedures designed prevent fraud abuse dispensing certain controlled substances medicare allows pdp sponsor suspend payments clean claim notifications pharmacy pending investigation credible allegation fraud pharmacy secretary determines good cause suspend payments directs secretary health_and_human_services hhs contracts entered medicare integrity program medicare drug integrity contractors medics authorize medics obtain prescription medical records directly entities pharmacies pdps physicians requires medic acknowledge receipt pdp sponsor referral information investigation report sponsor investigation results days share appropriate agencies requires electronic transmission prescribing prescriptions certain covered medicare controlled substances


Summary:
Protecting Seniors from Health Care Fraud Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), acting through the HHS Office of Inspector General, and the Attorney General to report annually to Congress and the public on health care fraud schemes targeted to seniors and steps being taken to combat such schemes and to educate seniors about them.

Directs the Secretary to: (1) disseminate such reports through mechanisms that reach the most Medicare beneficiaries, and (2) mail to each Medicare beneficiary a list of the top 10 most prevalent health care fraud schemes.

health care fraud act amends title xviii medicare social security act ssa direct secretary health_and_human_services hhs acting attorney general report annually congress public health care fraud schemes targeted seniors steps taken combat schemes educate seniors directs secretary disseminate reports mechanisms reach medicare beneficiaries mail medicare beneficiary list prevalent health care fraud schemes


Summary:
Saving Lives, Saving Costs Act - Establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.

Requires the Secretary of Health and Human Services (HHS) to publish clinical practice guidelines that have been provided and maintained by national or state medical societies or medical specialty societies designated by the Secretary. Sets forth standards for the development of guidelines, including related to transparency, the composition of the panel, and the review of existing evidence.

Declares that this Act does not preempt or supersede any state or federal law that imposes greater procedural or substantive protections for health care providers and health care organizations from liability, loss, or damages than those provided under this Act nor does it create a cause of action or preempt any defenses otherwise available.

Allows a defendant to remove any health care liability action brought in a state court to a district court.

Requires an independent medical review in health care liability actions if the eligible professionals allege that they adhered to applicable clinical practice guideline. Sets forth procedures for the use of the panel's findings at trial. Enables defendants to recover costs and attorneys' fees from plaintiffs if the defendants prevail subsequent to preliminary findings in their favor.

saving lives saving costs act establishes framework health care liability lawsuits undergo review independent medical review panels health care professionals practicing physicians agents employees allege adherence applicable clinical practice guidelines provision health care goods services requires secretary health_and_human_services hhs publish clinical practice guidelines provided maintained national state medical societies medical specialty societies designated secretary sets forth standards development guidelines including related transparency composition panel review existing evidence declares act preempt supersede state federal law imposes greater procedural substantive protections health care providers health care organizations liability loss damages provided act create cause action preempt defenses available allows defendant remove health care liability action brought state court district court requires independent medical review health care liability actions eligible professionals allege applicable clinical practice guideline sets forth procedures use panel findings trial enables defendants recover costs attorneys fees plaintiffs defendants prevail subsequent preliminary findings favor


Summary:
Generic Drug Pricing Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.

Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.

fairness act amends voluntary prescription drug benefit program title xviii medicare social security act require contract entered prescription drug plan pdp sponsor respect pdp sponsor offers prohibit pdp entering contract pharmacy benefits manager pbm manage prescription drug coverage provided plan control costs prescription drug coverage pbm adheres specified criteria handling personally identifiable utilization claims data sensitive patient data revises requirements contracts pdp sponsors require pdp sponsor disclose applicable pharmacies sources making update prescription drug pricing standard source standard publicly available disclose pharmacies individual drug prices updated advance use reimbursement claims requires pdp sponsor establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price drug


Summary:
Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare Administrative Contractor Payment Outreach and Education Program for DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) suppliers.

Requires each Medicare administrative contractor responsible for DMEPOS payments, in order to reduce improper payments to DMEPOS suppliers under Medicare part B (Supplementary Medical Insurance), to provide suppliers, physicians and practitioners who prescribe DMEPOS, and discharge planners and case managers who coordinate DMEPOS for individuals in the contractor's area with error rate reduction training as well as:

 a list of suppliers' most frequent payment errors and the most expensive payment errors over the last quarter, specific instructions regarding how to correct or avoid such errors in the future as well as to prevent future issues related to new audits, and a notice of all new topics that have been approved by the Secretary of Health and Human Services (HHS) for audits. Sets forth the structure for audits of DMEPOS suppliers, requiring a contractor to give priority to activities under the DMEPOS payment outreach and education program that will reduce improper Medicare payments based on technical errors, medical necessity, and fraud.

Requires annual reports to Congress on the use of recovery audit contractors under the Medicare Integrity Program to include certain information on the results of audit appeals related to DMEPOS.

Requires the Secretary to: (1) increase the maximum record requests made by Medicare DMEPOS contractors in auditing claims of suppliers with a relatively high audited claims error rate for DMEPOS payments, and (2) decrease the maximum record requests for suppliers with a relatively low error rate.

Directs the Secretary to limit the audit documentation review period for Medicare administrative contractors to three years.

act amends title xviii medicare social security act ssa establish education program dmepos durable medical equipment prosthetics orthotics supplies suppliers requires medicare administrative contractor responsible dmepos payments order reduce improper payments dmepos suppliers medicare supplementary_medical_insurance provide suppliers physicians practitioners prescribe dmepos discharge planners case managers coordinate dmepos individuals contractor area error rate reduction training list suppliers frequent payment errors expensive payment errors quarter specific instructions correct avoid errors future prevent future issues related new audits notice new topics approved secretary health_and_human_services hhs audits sets forth structure audits dmepos suppliers requiring contractor priority activities dmepos payment outreach education program reduce improper medicare payments based technical errors medical necessity fraud requires annual reports congress use recovery audit contractors medicare_integrity_program include certain information results audit appeals related dmepos requires secretary increase maximum record requests contractors auditing claims suppliers relatively high audited claims error rate dmepos payments decrease maximum record requests suppliers relatively low error rate directs secretary limit audit documentation review period medicare administrative contractors years


Summary:
Fighting Medicare Fraud Act of 2014 - Amends title XI of the Social Security Act (SSA) with respect to the authority of the Secretary of Health and Human Services (HHS) to exclude from federal health programs certain individuals, including officers or managing employees, with an ownership or control interest in entities sanctioned for a criminal conviction relating to fraud, obstruction of an investigation or audit, or a misdemeanor related to a controlled substance.

Extends the permissive exclusion from federal health programs to persons, including officers or managing employees, with an ownership or control interest in entities affiliated with a sanctioned entity. Includes individuals with such connections at the time of the conduct that formed a basis for the conviction or exclusion of the sanctioned entity or the affiliated entity.

Establishes criminal penalties for anyone who knowingly and with intent to defraud purchases, sells, or distributes, or arranges for the purchase, sale, or distribution of two or more beneficiary identification or provider numbers under SSA titles XVIII (Medicare), XIX (Medicaid), or XXI (Children's Health Insurance Program [CHIP]).

Amends SSA title XVIII part C (Medicare+Choice) to require a contract with a Medicare Advantage (MA) organization offering an MA plan to require that the MA organization report to the Secretary any instances of probable fraud or abuse related to the payment or delivery of health benefits within 60 days after the organization identifies that instance.

fighting medicare amends title social security act ssa respect authority secretary health_and_human_services hhs exclude federal health programs certain individuals including officers managing employees ownership control interest entities sanctioned criminal conviction relating fraud obstruction investigation audit misdemeanor related controlled substance extends exclusion federal health programs persons including officers managing employees ownership control interest entities affiliated sanctioned entity includes individuals connections time conduct formed basis conviction exclusion sanctioned entity affiliated entity establishes criminal penalties knowingly intent defraud purchases sells distributes arranges purchase sale distribution beneficiary identification provider numbers ssa titles xviii medicare xix medicaid amends ssa title xviii require contract organization offering plan require organization report secretary instances probable fraud abuse related payment delivery health benefits days organization identifies instance


Summary:
Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act - Amends title XI of the Social Security Act with respect to standards for financial and administrative transactions and their data elements to enable the electronic exchange of health information.

Requires the Secretary of Health and Human Services (HHS) to adopt standards that: (1) ensure that any entity producing and transmitting valid transactions that include code sets for appropriate data elements is subject to a consistent, industry-wide framework that supports a seamless transition to new and modified code sets; and (2) establish an end-to-end testing procedure for new and modified code sets that shall require the participation of any entity producing and transmitting valid transactions that use the new or modified code set.

Prohibits the Secretary from adopting a new or modified code set unless the Secretary: (1) assesses its impact on fraud prevention and pre-payment review, determines that anti-fraud edits work as intended, and confirms that a plan is in place to ensure continuing effective detection of fraud following the adoption of the code set; (2) ensures that the end-to-end testing procedure established has been completed; and (3) completes end-to-end testing with any federal government entity that produces and transmits valid transactions that include the code set with private sector tracking partners. Exempts routine, regularly scheduled updates to existing code sets from such prohibition.

Directs the Secretary, with respect to information supplied to it by a disclosing entity about those with an ownership or control interest in the entity, to verify such information in a specified manner and confirm the accuracy of any Social Security account number or employer identification number.

Holds immune from civil liability (in a safe harbor) any non-governmental entity participating in a Healthcare Fraud Prevention Partnership, including private insurers, for sharing information about potentially fraudulent providers with each other, HHS, the Department of Justice (DOJ), any other federal or state law enforcement agency, any federal or state agency contractor, and another Partnership participant.

Directs the Medicare Payment Advisory Commission (MEDPAC) to study administrative efforts to strengthen program integrity in the Medicare program.

Amends the Small Business Jobs Act of 2010, with respect to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program, to require predictive analytics technologies to capture outcome information on civil recoveries, administrative actions, and criminal convictions for fraud.

act_-_amends title social security act respect standards financial administrative transactions data elements enable electronic exchange health information requires secretary health_and_human_services hhs adopt standards ensure entity producing transmitting valid transactions include code sets appropriate data elements subject consistent industry wide framework supports seamless transition new modified code sets establish end end testing procedure new modified code sets shall require participation entity producing transmitting valid transactions use new modified code set prohibits secretary adopting new modified code set secretary assesses impact fraud prevention pre payment review determines anti fraud work intended confirms plan place ensure continuing effective detection fraud following adoption code set ensures end end testing procedure established completed completes end end testing federal government entity produces transmits valid transactions include code set private sector tracking partners exempts routine regularly scheduled updates existing code sets prohibition directs secretary respect information supplied disclosing entity ownership control interest entity verify information specified manner confirm accuracy social_security account number employer identification number holds immune civil liability safe harbor non governmental entity participating including private insurers sharing information potentially fraudulent providers hhs department_of_justice doj federal state law enforcement agency federal state agency contractor partnership participant directs medicare_payment_advisory_commission medpac study administrative efforts strengthen program integrity medicare program amends small_business_jobs_act respect use predictive modeling analytics technologies identify prevent waste fraud abuse medicare fee service program require predictive analytics technologies capture outcome information civil recoveries administrative actions criminal convictions fraud


Summary:
Protecting the Integrity of Medicare Act of 2014 - Amends title II (Old Age, Survivors and Disability Insurance) (OASDI) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to establish cost-effective procedures to ensure that: (1) a Social Security account number (or any derivative) is not displayed, coded, or embedded on the Medicare card issued to an individual entitled to benefits under part A (Hospital Insurance) of SSA title XVIII (Medicare) or enrolled under Medicare part B (Supplementary Medical Insurance); and (2) any other identifier displayed on such card is not identifiable as a Social Security account number (or any derivative).

Directs the Secretary to establish procedures to ensure that Medicare payment is not made for items and services furnished to an individual incarcerated, deceased, or otherwise ineligible and not lawfully present in the United States.

Directs the Secretary, if cost-effective and technologically viable, to consider appropriate measures to implement use of electronic Medicare beneficiary and provider cards.

Extends the Medicare durable medical equipment (DME) face-to-face encounter documentation requirement to include physician assistants, practitioners, or specialists as well as physicians (as under current law).

Requires each Medicare administrative contractor to establish an improper payment outreach and education program for service providers and suppliers in order to reduce improper Medicare payments.

Requires the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 to encourage greater participation by individuals to report fraud and abuse in the Medicare program.

Directs the Secretary to require a claim for a covered Medicare part D (Voluntary Prescription Drug Benefit Program) drug for an individual enrolled in a prescription drug plan (PDP) or in a Medicare Advantage Prescription Drug (MA-PD) plan to include a valid prescriber National Provider Identifier.

Gives Medicare beneficiaries the option to receive the Medicare Summary Notice (explanation of benefits) electronically.

Directs the Secretary to: (1) apply competitive procedures to selection of a Medicare administrative contractor at least once every 10 years (currently once every 5 years); and (3) study and, as appropriate, specify incentives for states to work with the Secretary under the Medicare-Medicaid Data Match Program to protect the federal and state share of expenditures.

Authorizes a PDP sponsor to establish a drug management program for at-risk beneficiaries.

Directs the Secretary to authorize Medicare drug integrity contractors (MEDICs) to accept directly an individual's prescription and necessary medical records from pharmacies, prescription drug plans, and physicians in order for MEDICs to provide information relevant to determining whether the individual is an at-risk beneficiary.

Directs the Secretary to issue a clarification or modification with respect to the application of the Common Rule (governing the protection of human subjects in research) to activities involving clinical data registries.

Amends SSA title XI to eliminate civil monetary penalties for inducements to physicians to limit services that are not medically necessary.

Directs the Secretary to report to Congress on options for amending existing Medicare fraud and abuse laws and regulations to permit gainsharing or similar arrangements between physicians and hospitals that would otherwise be subject to penalties.

Modifies the Medicare home health surety bond condition of participation requirement.

Directs the Secretary to: (1) implement a process for medical review of spinal subluxation services by a chiropractor, and (2) develop educational and training programs to improve the ability of chiropractors to document services in a manner that demonstrates they are reasonable and necessary.

Applies Medicare competitive bidding to vacuum erection systems, and requires the Secretary to phase-in a national mail order program for such devices.

Requires the Secretary to: (1) revise the testing in New Jersey, Pennsylvania, and South Carolina of a model of prior authorization for repetitive scheduled non-emergent ambulance transport to cover specified additional states; and (2) apply the prior authorization program to all states.

Directs the Secretary to submit a plan to Congress for including in the annual report of the Comprehensive Error Rate Testing (CERT) programs data on services (other than medical visits) paid under the physician fee schedule where the fee schedule amount exceeds $250 and where the error rate exceeds 20%.

protecting integrity medicare act amends title old age survivors disability insurance oasdi social security act ssa direct secretary health_and_human_services hhs establish cost effective procedures ensure social_security account number derivative displayed coded embedded medicare card issued individual entitled benefits ssa title xviii medicare enrolled medicare supplementary_medical_insurance identifier displayed card identifiable social_security account number derivative directs secretary establish procedures ensure medicare payment items services furnished individual incarcerated deceased ineligible lawfully present united_states directs secretary cost effective technologically viable consider appropriate measures implement use electronic medicare beneficiary provider cards extends medicare durable medical equipment dme face face encounter documentation requirement include physician assistants practitioners specialists physicians current law requires medicare administrative contractor establish improper payment outreach education program service providers suppliers order reduce improper medicare payments requires secretary develop plan revise incentive program health_insurance_portability_and_accountability_act encourage greater participation individuals report fraud abuse medicare program directs secretary require claim covered medicare voluntary prescription drug benefit program drug individual enrolled prescription drug plan pdp medicare advantage prescription drug ma-pd plan include valid prescriber national provider identifier gives medicare beneficiaries option receive medicare summary notice explanation benefits electronically directs secretary apply competitive procedures selection medicare administrative contractor years currently years study appropriate specify incentives states work secretary medicare-medicaid data_match_program protect federal state share expenditures authorizes pdp sponsor establish drug management program risk beneficiaries directs secretary authorize medicare drug integrity contractors medics accept directly individual prescription necessary medical records pharmacies prescription drug plans physicians order medics provide information relevant determining individual risk beneficiary directs secretary issue clarification modification respect application common rule governing protection human subjects research activities involving clinical data registries amends ssa title eliminate civil monetary penalties inducements physicians limit services medically necessary directs secretary report congress options amending existing medicare fraud abuse laws regulations permit gainsharing similar arrangements physicians hospitals subject penalties modifies medicare home health surety bond condition participation requirement directs secretary implement process medical review spinal services chiropractor develop educational training programs improve ability chiropractors document services manner demonstrates reasonable necessary applies medicare competitive bidding vacuum systems requires secretary phase national mail order program devices requires secretary revise testing new_jersey pennsylvania south_carolina model prior authorization repetitive scheduled non emergent ambulance transport cover specified additional states apply prior authorization program states directs secretary submit plan congress including annual report programs data services medical visits paid physician fee schedule fee schedule exceeds error rate exceeds


Summary:
Generic Drug Pricing Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.

Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.

Directs the Secretary of Defense (DOD), with respect to the TRICARE retail pharmacy program, to ensure that a contract entered into with a TRICARE managed care support contractor includes requirements to ensure the provision of information regarding the pricing standard for prescription drugs.

Establishes criteria to which a carrier and a PBM must adhere under a contract or an approved plan under which the carrier has an agreement with the PBM to manage prescription drug coverage or to control the costs of such coverage.

Prohibits a PBM under such criteria from: (1) transmitting to a pharmacy owned by the PBM any personally identifiable utilization or claims data relating to an enrolled individual who has not voluntarily elected in writing or via secure electronic means to fill that particular prescription at such a pharmacy; or (2) requiring any enrolled individual to use a retail pharmacy, mail order pharmacy, specialty pharmacy, or other pharmacy entity in which the PBM has an ownership interest, or that has an ownership interest in the PBM, or give an incentive to encourage an enrollee to use the pharmacy if the incentive applies only to those pharmacies.

Requires any contract or approved plan providing for a reimbursement standard with respect to a PDP to require the carrier to: (1) update the standard at least once every seven days to reflect the market price of a drug accurately; (2) disclose to pharmacies the sources used for making any such update; (3) make advance disclosure to those pharmacies of all individual drug prices to be updated if the source for a standard is not publicly available; and (4) establish a process to appeal, investigate, and resolve disputes regarding individual drug prices less than the pharmacy acquisition price.

fairness act amends voluntary prescription drug benefit program title xviii medicare social security act require contract entered prescription drug plan pdp sponsor respect pdp sponsor offers prohibit pdp entering contract pharmacy benefits manager pbm manage prescription drug coverage provided plan control costs prescription drug coverage pbm adheres specified criteria handling personally identifiable utilization claims data sensitive patient data revises requirements contracts pdp sponsors require pdp sponsor disclose applicable pharmacies sources making update prescription drug pricing standard source standard publicly available disclose pharmacies individual drug prices updated advance use reimbursement claims requires pdp sponsor establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price drug directs secretary defense dod respect tricare retail pharmacy program ensure contract entered tricare managed care support contractor includes requirements ensure provision information pricing standard prescription drugs establishes criteria carrier pbm adhere contract approved plan carrier agreement pbm manage prescription drug coverage control costs coverage prohibits pbm criteria transmitting pharmacy owned pbm personally identifiable utilization claims data relating enrolled individual voluntarily elected writing secure electronic means fill particular prescription pharmacy requiring enrolled individual use retail pharmacy mail order pharmacy specialty pharmacy pharmacy entity pbm ownership interest ownership interest pbm incentive encourage enrollee use pharmacy incentive applies pharmacies requires contract approved plan providing reimbursement standard respect pdp require carrier update standard seven days reflect market price drug accurately disclose pharmacies sources making update advance disclosure pharmacies individual drug prices updated source standard publicly available establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price


Summary: Local Medicaid Enforcement Incentives Act of 2014 - Directs the Secretary of Health and Human Services (HHS) to establish a grant program to provide states with funds to: (1) detect and prevent Medicaid fraud, waste, and abuse; (2) recover overpayments to individuals or entities receiving Medicaid funds that result from such fraud, waste, or abuse; and (3) share with localities within the state that assist in such detection and prevention, or the recovery of such overpayments, at least 50% of the state's share of the total overpayments recovered during a period, minus administrative costs.

local directs secretary health_and_human_services hhs establish grant program provide states funds detect prevent medicaid fraud waste abuse recover overpayments individuals entities receiving medicaid funds result fraud waste abuse share localities state assist detection prevention recovery overpayments state share total overpayments recovered period minus administrative costs


Summary:
Medical Care Access Protection Act of 2013 or MCAP Act - Prescribes requirements for lawsuits for health care liability claims related to the provision of health care services.

Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions.

Requires a court to impose sanctions for the filing of frivolous lawsuits.

Limits noneconomic damages to $250,000 from the provider or health care institution, but no more than $500,000 from multiple health care institutions. Makes each party liable only for the amount of damages directly proportional to its percentage of responsibility.

Allows the court to restrict the payment of attorney contingency fees. Limits the fees to a decreasing percentage based on the increasing value of the amount awarded.

Prescribes qualifications for expert witnesses.

Requires the court to reduce damages received by the amount of collateral source benefits to which a claimant is entitled, unless the payor of such benefits has the right to reimbursement or subrogation under federal or state law.

Authorizes the award of punitive damages only where: (1) it is proven by clear and convincing evidence that a person acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury the claimant was substantially certain to suffer, and (2) compensatory damages are awarded. Limits punitive damages to the greater of two times the amount of economic damages or $250,000.

Prohibits a health care provider from being named as a party in a product liability or class action lawsuit for prescribing or dispensing a Food and Drug Administration (FDA)-approved prescription drug, biological product, or medical device for an approved indication.

Provides for periodic payments of future damage awards.

requirements lawsuits health care liability claims related provision health care services sets statute limitations years date manifestation injury year claimant discovers injury certain exceptions requires court impose sanctions filing frivolous lawsuits limits noneconomic damages provider health care institution multiple health care institutions makes party liable damages directly proportional percentage responsibility allows court restrict payment attorney contingency fees limits fees decreasing percentage based increasing value awarded prescribes qualifications expert witnesses requires court reduce damages received collateral source benefits claimant entitled payor benefits right reimbursement subrogation federal state law authorizes award punitive damages proven clear convincing evidence person acted malicious intent injure claimant deliberately failed avoid unnecessary injury claimant substantially certain suffer compensatory damages awarded limits punitive damages greater times economic damages prohibits health care provider named party product liability class action lawsuit prescribing dispensing food_and_drug_administration prescription drug biological product medical device approved indication provides periodic payments future damage awards


Summary:
State Leadership in Health Care Act - Amends the Patient Protection and Affordable Care Act (PPACA) to allow states to apply for a waiver of specified requirements under PPACA with respect to health insurance coverage within that state due to implementation of a state plan that provides comparable coverage for plan years beginning in 2015 (currently, 2017). Permits the Secretary of Health and Human Services (HHS) or the Secretary of the Treasury to deny waivers only if: (1) the state plan does not meet requirements for granting a waiver, (2) the Secretary of HHS or the Treasury notifies the state in writing of the requirements that the state plan did not meet and provides the state with information used in making such a determination, and (3) the state is given an opportunity to appeal.

Requires the Secretary of HHS or the Treasury to reconsider the determination in the event of an appeal and issue a written decision within 60 days.

state leadership health care act amends patient protection affordable care act ppaca allow states apply waiver specified requirements ppaca respect health insurance coverage state implementation state plan provides comparable coverage plan years beginning currently permits secretary health_and_human_services hhs secretary treasury deny waivers state plan meet requirements granting waiver secretary hhs treasury notifies state writing requirements state plan meet provides state information making determination state given opportunity appeal requires secretary hhs treasury reconsider determination event appeal issue written decision days


Summary:
Family Health Care Accessibility Act of 2013 - Amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients. Sets forth conditions for such liability protection, including: (1) the service is provided to the individual at a community health center or through offsite programs or events carried out by such center; and (2) the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses.

Considers an entity as sponsoring the health care practitioner if the entity submits an application to the Secretary of Health and Human Services (HHS), and the Secretary determines that the health care practitioner is deemed to be an employee of the Public Health Service.

Requires the Attorney General to submit to Congress an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the actions or omissions of health professional volunteers, will be paid pursuant to this Act annually. Requires the Secretary to transfer such estimated amount from the claims fund to the appropriate accounts in the Treasury, subject to the extent of amounts in the fund.

Makes this Act effective on October 1, 2013.

family health care accessibility act amends public_health_service_act deem health professional volunteer providing primary health care individual community health center employee public_health_service purposes civil action arise providing services patients sets forth conditions liability protection including service provided individual community health center offsite programs events carried center health care practitioner receive compensation providing service repayment reasonable expenses considers entity sponsoring health care practitioner entity submits application secretary health_and_human_services hhs secretary determines health care practitioner deemed employee public_health_service requires attorney general submit congress estimate claims related fees expenses witnesses reason actions omissions health professional volunteers paid pursuant act annually requires secretary transfer estimated claims fund appropriate accounts treasury subject extent amounts fund makes act effective october


Summary:
Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.

Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.

Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.

Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.

Directs the Secretary to publish on the Internet website of the Centers for Medicare & Medicaid Services information on recovery audit contractor performance regarding: (1) audit rates, denials, and appeals outcomes; and (2) independent performance evaluations.

Deems to be an original claim for Medicare part B (Supplementary Medical Insurance) payment a resubmitted hospital claim for Medicare part A payment for inpatient hospital services which a recovery audit contractor determines: (1) were not medically necessary and reasonable based on the site of service, but (2) would be medically necessary and reasonable in an outpatient setting of the hospital. Requires payment to be made for such a resubmitted claim for all furnished items and services for which payment may be made under Medicare part B.

Deems to be a reopened claim, for purposes of a hospital's ability to resubmit a claim for Medicare payment in timely fashion, any claim that is the subject of an audit by a recovery audit contractor or a Medicare administrative contractor.

Requires contracts for a recovery audit contractor to require that a physician review each denial of a claim for medical necessity made by an employee of the contractor who is not a physician.

Subjects to administrative and judicial review the Secretary's compliance with guidelines for reopening and revising benefit determinations.

medicare audit improvement act directs secretary health_and_human_services hhs establish process subjects single combined maximum annual limit applied incrementally number additional documentation requests hospital medicare administrative contractors recovery audit contractors comprehensive error rate testing program contractors pursuant prepayment audits requiring hospital submit medical record audit purposes directs secretary establish distinct additional documentation request limit computed according specified formula hospital claim type hospital day period year amends title xviii medicare social security act respect medicare_integrity_program use recovery audit contractors requires secretary ensure recovery audit contracts include certain mandatory terms conditions pertaining penalties certain compliance failures penalties overturned appeals prepayment audits guidelines prepayment review directs secretary publish internet website centers information recovery audit contractor performance audit rates denials appeals outcomes independent performance evaluations deems original claim medicare supplementary_medical_insurance payment resubmitted hospital claim medicare payment inpatient hospital services recovery audit contractor determines medically necessary reasonable based site service medically necessary reasonable outpatient setting hospital requires payment resubmitted claim furnished items services payment medicare deems reopened claim purposes hospital ability resubmit claim medicare payment timely fashion claim subject audit recovery audit contractor medicare administrative contractor requires contracts recovery audit contractor require physician review denial claim medical necessity employee contractor physician subjects administrative judicial review secretary compliance guidelines reopening revising benefit determinations


Summary:
Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013 or PRIME Act of 2013 - Amends part D (Prescription Drug Benefits) of title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to prohibit sponsors of prescription drug plans (PDPs) from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug's prescriber.

Requires the Secretary's annual report to Congress on the use of recovery audit contractors under the Medicare Integrity Program to: (1) describe the types and financial cost of improper payment vulnerabilities identified by recovery audit contractors and how the Secretary is addressing them, and (2) assess the effectiveness of changes made to Medicare payment policies and procedures in order to address those vulnerabilities.

Requires the Secretary to address improper payment vulnerabilities in a timely manner, prioritized based on the risk to the Medicare program.

Authorizes the Secretary, under recovery audit contracts under both Medicare and Medicaid (SSA title XIX), to retain a certain portion of the recovered amounts for a program management account for activities addressing problems that contribute to improper payments and fraud.

Requires the Secretary, under such contracts, to retain an additional 5% of the recovered amounts to be made available to the HHS Inspector General to investigate improper payments or audit internal controls associated with Medicare or Medicaid payments.

Directs the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse. Requires the plan to include certain recommendations for: (1) ways to enhance rewards for individuals reporting, and (2) extention of the incentive program to the Medicaid program.

Amends SSA title XIX to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Secretary to increase Centers for Medicare and Medicaid Services (CMS) staff whose duties consist solely of protecting the integrity of the Medicare program by a number determined necessary to carry out the Program (currently, by 100).

Directs the Secretary to provide incentives for Medicare administrative contractors to reduce the improper payment error rates in their jurisdictions.

Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for knowingly, intentionally, and with the intent to defraud purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges under SSA titles XVIII, title XIX, or title XXI (Children's Health Insurance Program).

Amends SSA title IV part D (Child Support and Establishment of Paternity) with respect to the Federal Parent Locator Service to give the CMS Administrator access to information in the National Directory of New Hires to determine the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program under the Patient Protection and Affordable Care Act (PPACA).

Requires the Secretary to disclose to the HHS Inspector General information on individuals and their employers in the National Directory of New Hires if the HHS Inspector General gives the Secretary their names and Social Security account numbers. Restricts the use of such information to: (1) determining the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program; or (2) evaluating the integrity of such programs. Sets forth rules for the use and disclosure of such information by state agencies.

Directs the Secretary to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program). Revises Medi-Medi Data Match Program purposes.

Amends SSA title XIX, as amended by PPACA, and XXI with respect to claims processing and detection of fraud within the Medicaid and CHIP programs.

preventing reducing improper medicare medicaid expenditures act prime act amends prescription drug benefits title xviii medicare social security act ssa direct secretary health_and_human_services hhs prohibit sponsors prescription drug plans pdps paying claims prescription drugs include valid national provider identifier drug prescriber requires secretary annual report congress use recovery audit contractors medicare_integrity_program describe types financial cost improper payment vulnerabilities identified recovery audit contractors secretary addressing assess effectiveness changes medicare payment policies procedures order address vulnerabilities requires secretary address improper payment vulnerabilities timely manner prioritized based risk medicare program authorizes secretary recovery audit contracts medicare medicaid ssa title xix retain certain portion recovered amounts program management account activities addressing problems contribute improper payments fraud requires secretary contracts retain additional recovered amounts available investigate improper payments audit internal controls associated medicare medicaid payments directs secretary develop plan revise incentive program health_insurance_portability_and_accountability_act reporting fraud abuse encourage greater participation individuals reporting medicare fraud abuse requires plan include certain recommendations ways enhance rewards individuals reporting incentive program medicaid program amends ssa title xix cover costs equipment salaries benefits travel training appropriations medicaid_integrity_program allows secretary increase centers medicare medicaid_services cms staff duties consist solely protecting integrity medicare program number determined necessary carry program currently directs secretary provide incentives medicare administrative contractors reduce improper payment error rates jurisdictions requires imprisonment years fine million case corporation knowingly intentionally intent defraud purchasing selling distributing arranging purchase sale distribution medicare medicaid chip beneficiary identification number billing privileges ssa titles xviii title xix title amends ssa title child support establishment paternity respect federal_parent_locator_service access information national_directory_of_new_hires determine eligibility applicant enrollee medicare program applicable state health subsidy program patient_protection affordable care act ppaca requires secretary disclose hhs_inspector general information individuals employers national_directory_of_new_hires hhs_inspector general gives secretary names social_security account numbers restricts use information determining eligibility applicant enrollee medicare program applicable state health subsidy program evaluating integrity programs sets forth rules use disclosure information state agencies directs secretary establish plan encourage facilitate participation states medicare-medicaid data_match_program medi-medi_program data match program purposes amends ssa title xix amended ppaca xxi respect claims processing detection fraud medicaid chip programs


Summary: Medicare Data Access for Transparency and Accountability Act - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to make available to the public HHS claims and payment data related to SSA title XVIII (Medicare), including data on payments made to any service provider or supplier.

title social security act ssa direct secretary health_and_human_services hhs available public hhs claims payment data related ssa title xviii medicare including data payments service provider supplier


Summary:
No Obamacare Kickbacks Act of 2013 - Amends title XI of the Social Security Act, with respect to criminal penalties for acts involving federal health care programs, to include any plan or program established or funded under subtitles D (Available Coverage Choices for All Americans) or E (Affordable Coverage Choices for All Americans) of title I of the Patient Protection and Affordable Care Act.

Directs the Inspector General of the Department of Health and Human Services (HHS) and the Comptroller General (GAO) to jointly study, and report to Congress on, the effect of applying the anti-kickback laws and other prohibitions involving federal health care programs to qualified health plans, federally-facilitated marketplaces, state health care exchanges, and any other plan or program established or funded under the provisions described above.

obamacare kickbacks act amends title social security act respect criminal penalties acts involving federal health care programs include plan program established funded subtitles available coverage choices americans affordable coverage choices americans title patient_protection affordable care act directs inspector general department_of_health_and_human_services hhs comptroller_general gao jointly study report congress effect applying anti laws prohibitions involving federal health care programs qualified health plans federally facilitated state health care exchanges plan program established funded provisions described


Summary:
Quality Data, Quality Healthcare Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the use of certain data by qualified public or private entities to evaluate the performance of service providers and suppliers under Medicare insurance programs.

 Authorizes a qualified entity to: (1) use Medicare data, and information derived from service provider and supplier performance evaluations, for additional non-public analyses; or (2) provide or sell such data and analyses to specified health care-related entities for non-public use (including for purposes of assisting service providers and suppliers to develop and participate in quality and patient care improvement activities, particularly development of new models of care).

Conditions such authorization upon a data use agreement between a qualified entity and a specified health care-related entity under which the latter: (1) may not re-sell such data or analyses; and (2) shall comply with the qualified entity's privacy and security policies in using such data or analyses.

Prescribes a civil money penalty for unauthorized use of data and analyses.

Requires the Secretary of Health and Human Services (HHS) to provide Medicare claims data to qualified clinical data registries for purposes of linking it with clinical outcomes data and performing and disseminating risk-adjusted, scientifically valid research to support quality improvement.

Prohibits a qualified clinical data registry from reporting publicly any claims data thus made available that individually identifies a service provider or supplier without prior consent.

quality healthcare act amends title xviii medicare social security act ssa respect use certain data qualified public private entities evaluate performance service providers suppliers medicare insurance programs authorizes qualified entity use medicare data information derived service provider supplier performance evaluations additional non public analyses provide sell data analyses specified health care related entities non public use including purposes assisting service providers suppliers develop participate quality patient care improvement activities particularly development new models care conditions authorization data use agreement qualified entity specified health care related entity sell data analyses shall comply qualified entity privacy security policies data analyses prescribes civil money penalty unauthorized use data analyses requires secretary health_and_human_services hhs provide medicare claims data qualified clinical data registries purposes linking clinical outcomes data performing disseminating risk adjusted scientifically valid research support quality improvement prohibits qualified clinical data registry reporting publicly claims data available individually identifies service provider supplier prior consent


Summary:
Standard of Care Protection Act - Provides that the development, recognition, or implementation of any guideline or other standard under any provision of the Patient Protection and Affordable Care Act, the health care-related parts of the Health Care and Education Reconciliation Act of 2010, or titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act shall not be construed to establish the standard or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim.

Prohibits such health care provisions from being construed to preempt any state or common law governing medical malpractice or medical product liability actions or claims.

development recognition implementation guideline standard provision patient_protection affordable care act health care related parts health_care_and_education reconciliation act titles xviii medicare xix medicaid social security act shall construed establish standard duty care owed health care provider patient medical malpractice medical product liability action claim prohibits health care provisions construed preempt state common law governing medical malpractice medical product liability actions claims


Summary:
Steps Toward Access and Reform Act of 2013 or STAR Act of 2013 - Limits the commencement of a health care lawsuit, except in certain cases including fraud or intentional concealment, to three years after the date of manifestation of injury or one year after the claimant discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs first.

Limits to $250,000 the amount of noneconomic damages in such a lawsuit, but allows a claim for the full amount of any economic damages.

Requires the court, in any health care lawsuit, to supervise the arrangements for payment of damages to protect against conflicts of interest that may have the effect of reducing the amount of damages awarded that are actually paid to claimants.

Allows any party in any health care lawsuit involving injury or wrongful death to introduce evidence of collateral source benefits.

Specifies criteria for the award of punitive damages, limited to the greater of $250,000 or double the amount of economic damages.

Preempts state law with respect to health care lawsuits, but subjects to otherwise applicable state or federal law any issue not governed by this Act or any law (including state standards of negligence) established by or under it.

Declares the sense of Congress that a health insurer should be liable for damages for harm caused when it makes a decision as to what care is medically necessary and appropriate.

Directs the Secretary of Health and Human Services (HHS) to contract with eligible health professionals to serve for a period of at least four years as a primary care provider in a medically underserved community, in consideration for which the Secretary shall pay up to $100,000 on the principal and interest on the individual's graduate medical, osteopathic, or other health professional educational loans.

Amends the Internal Revenue Code to allow a bad debt deduction from gross income for worthless qualified medical care debt of at least 75% of a tax-paying medical care provider's charge for such care.

Prohibits the Food and Drug Administration (FDA) from taking action to prevent an individual not in the business of importing a prescription drug from importing one from Canada that complies with the Federal Food, Drug, and Cosmetic Act. Amends the Public Health Service Act to declare that the laws of the state designated by a health insurance issuer (primary state) shall apply to individual health insurance coverage offered by that issuer in the primary state and in any other state (secondary state), but only if the coverage and issuer comply with conditions of this Act.

Prohibits a health insurance issuer from offering, selling, or issuing individual health insurance coverage in a secondary state if its insurance commissioner does not use a risk-based capital formula for determining capital and surplus requirements for all health insurance issuers.

steps access reform_act star act limits commencement health care lawsuit certain cases including fraud intentional concealment years date manifestation injury year claimant discovers use reasonable diligence discovered injury whichever occurs limits noneconomic damages lawsuit allows claim economic damages requires court health care lawsuit supervise arrangements payment damages protect conflicts interest effect reducing damages awarded actually paid claimants allows party health care lawsuit involving injury wrongful death introduce evidence collateral source benefits specifies criteria award punitive damages limited greater double economic damages preempts state law respect health care lawsuits subjects applicable state federal law issue governed act law including state standards negligence established declares sense congress health insurer liable damages harm caused makes decision care medically necessary appropriate directs secretary health_and_human_services hhs contract eligible health professionals serve period years primary care provider medically underserved community consideration secretary shall pay principal interest individual graduate medical osteopathic health professional educational loans amends internal revenue code allow bad debt deduction gross income worthless qualified medical care debt tax paying medical care provider charge care fda taking action prevent individual business importing prescription drug importing canada complies cosmetic act amends public_health_service_act declare laws state designated health insurance issuer primary state shall apply individual health insurance coverage offered issuer primary state state secondary state coverage issuer comply conditions act prohibits health insurance issuer offering selling issuing individual health insurance coverage secondary state insurance commissioner use risk based capital formula determining capital surplus requirements health insurance issuers


Summary:
Protecting Seniors from Health Care Fraud Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), acting through the HHS Office of Inspector General, and the Attorney General to report annually to Congress and the public on health care fraud schemes targeted to seniors and steps being taken to combat such schemes and to educate seniors about them.

Directs the Secretary to: (1) disseminate such reports through mechanisms that reach the most Medicare beneficiaries, and (2) mail to each Medicare beneficiary a list of the top 10 most prevalent health care fraud schemes.

health care fraud act amends title xviii medicare social security act ssa direct secretary health_and_human_services hhs acting attorney general report annually congress public health care fraud schemes targeted seniors steps taken combat schemes educate seniors directs secretary disseminate reports mechanisms reach medicare beneficiaries mail medicare beneficiary list prevalent health care fraud schemes


Summary: Preventing Unnecessary Medicare Payments (PUMP) Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to: (1) apply Medicare competitive bidding to vacuum erection systems, and (2) require the Secretary of Health and Human Services (HHS) to phase-in a national mail order program for such devices.

preventing unnecessary medicare payments pump act amends title xviii medicare social security act apply medicare competitive bidding vacuum systems require secretary health_and_human_services hhs phase national mail order program devices


Summary:
VA Accountability Act of 2014 - Prohibits any officer, employee, or agent of the Department of Veterans Affairs (VA) from:

 knowingly falsifying an individual's VA health records; knowingly destroying or excluding information from such records with the intent to defraud the individual, a federal officer or employee, or a Member of Congress; directing another individual to engage in such prohibited conduct; or knowing of such prohibited conduct by an individual under his or her supervision and failing to stop, if possible, or report to a superior the commission of such conduct. Allows an individual aggrieved by such conduct to bring a civil action against the officer, employee, or agent in an appropriate U.S. district court for damages or other legal or equitable relief.

Authorizes the VA Secretary to terminate, without prior notice or cause, the employment and benefits of a VA officer, employee, or agent found by such court to have violated this Act.

Provides that this Act shall apply to conduct committed before, on, or after its enactment.

accountability act prohibits officer employee agent department_of_veterans_affairs knowingly falsifying individual health records knowingly destroying excluding information records intent defraud individual federal officer employee member congress directing individual engage prohibited conduct knowing prohibited conduct individual supervision failing stop possible report superior commission conduct allows individual aggrieved conduct bring civil action officer employee agent appropriate district court damages legal equitable relief authorizes secretary terminate prior notice cause employment benefits officer employee agent found court violated act provides act shall apply conduct committed enactment


Summary:
Health Insurance Industry Antitrust Enforcement Act of 2015

Prohibits the McCarran-Ferguson Act from being construed to permit health insurance or medical malpractice insurance issuers to engage in price fixing, bid rigging, or market allocations in connection with providing health insurance or medical malpractice coverage.

Amends the McCarran-Ferguson Act to provide that nothing in it modifies, impairs, or supersedes the operation of antitrust laws with respect to the business of health insurance.

Applies prohibitions of unfair methods of competition to the business of health insurance without regard to whether the business is for profit.

prohibits mccarran ferguson act construed permit health insurance medical malpractice insurance issuers engage price fixing bid rigging market allocations connection providing health insurance medical malpractice coverage amends mccarran ferguson act provide modifies supersedes operation antitrust laws respect business health insurance applies prohibitions unfair methods competition business health insurance regard business profit


Summary:
MAC Transparency Act

Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.

Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.

Directs the Secretary of Defense (DOD), with respect to the TRICARE retail pharmacy program, to ensure that a contract entered into with a TRICARE managed care support contractor includes requirements to ensure the provision of information regarding the pricing standard for prescription drugs.

Establishes criteria to which a carrier and a PBM must adhere under a contract or an approved plan under which the carrier has an agreement with the PBM to manage prescription drug coverage or to control the costs of such coverage.

Prohibits a PBM under such criteria from: (1) transmitting to a pharmacy owned by the PBM any personally identifiable utilization or claims data relating to an enrolled individual who has not voluntarily elected in writing or via secure electronic means to fill that particular prescription at such a pharmacy; or (2) requiring any enrolled individual to use a retail pharmacy, mail order pharmacy, specialty pharmacy, or other pharmacy entity in which the PBM has an ownership interest, or that has an ownership interest in the PBM, or give an incentive to encourage an enrollee to use the pharmacy if the incentive applies only to those pharmacies.

Requires any contract or approved plan providing for a reimbursement standard with respect to a PDP to require the carrier to: (1) update the standard at least once every seven days to reflect the market price of a drug accurately; (2) disclose to pharmacies the sources used for making any such update; (3) make advance disclosure to those pharmacies of all individual drug prices to be updated if the source for a standard is not publicly available; and (4) establish a process to appeal, investigate, and resolve disputes regarding individual drug prices less than the pharmacy acquisition price.

mac transparency act amends voluntary prescription drug benefit program title xviii medicare social security act require contract entered prescription drug plan pdp sponsor respect pdp sponsor offers prohibit pdp entering contract pharmacy benefits manager pbm manage prescription drug coverage provided plan control costs prescription drug coverage pbm adheres specified criteria handling personally identifiable utilization claims data sensitive patient data revises requirements contracts pdp sponsors require pdp sponsor disclose applicable pharmacies sources making update prescription drug pricing standard source standard publicly available disclose pharmacies individual drug prices updated advance use reimbursement claims requires pdp sponsor establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price drug directs secretary defense dod respect tricare retail pharmacy program ensure contract entered tricare managed care support contractor includes requirements ensure provision information pricing standard prescription drugs establishes criteria carrier pbm adhere contract approved plan carrier agreement pbm manage prescription drug coverage control costs coverage prohibits pbm criteria transmitting pharmacy owned pbm personally identifiable utilization claims data relating enrolled individual voluntarily elected writing secure electronic means fill particular prescription pharmacy requiring enrolled individual use retail pharmacy mail order pharmacy specialty pharmacy pharmacy entity pbm ownership interest ownership interest pbm incentive encourage enrollee use pharmacy incentive applies pharmacies requires contract approved plan providing reimbursement standard respect pdp require carrier update standard seven days reflect market price drug accurately disclose pharmacies sources making update advance disclosure pharmacies individual drug prices updated source standard publicly available establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price


Summary:
Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015

Amends part D (Prescription Drug Benefits) of title XVIII (Medicare) of the Social Security Act (SSAct) to direct the Secretary of Health and Human Services (HHS) to prohibit sponsors of prescription drug plans from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug's prescriber.

Requires the Secretary's annual report to Congress on the use of recovery audit contractors under the Medicare Integrity Program to: (1) describe the types and financial cost of improper payment vulnerabilities identified by recovery audit contractors and how the Secretary is addressing them, and (2) assess the effectiveness of changes made to Medicare payment policies and procedures in order to address those vulnerabilities.

Requires the Secretary to address improper payment vulnerabilities in a timely manner, prioritized based on the risk to the Medicare program.

Authorizes the Secretary, under recovery audit contracts under both Medicare and Medicaid (SSAct title XIX), to retain a certain portion of the recovered amounts for a program management account for activities addressing problems that contribute to improper payments and fraud.

Requires the Secretary, under such contracts, to retain an additional 5% of the recovered amounts to be made available to the HHS Inspector General to investigate improper payments or audit internal controls associated with Medicare or Medicaid payments.

Directs the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse. Requires the plan to include certain recommendations for: (1) ways to enhance rewards for individuals reporting, and (2) extension of the incentive program to the Medicaid program.

Amends SSAct title XIX to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Secretary to increase Centers for Medicare and Medicaid Services (CMS) staff whose duties consist solely of protecting the integrity of the Medicare program by a number determined necessary to carry out the Program (currently, by 100).

Directs the Secretary to provide incentives for Medicare administrative contractors to reduce the improper payment error rates in their jurisdictions.

Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for knowingly, intentionally, and with the intent to defraud purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges under SSAct titles XVIII, title XIX, or title XXI (Children's Health Insurance Program) (CHIP).

Amends SSAct title IV part D (Child Support and Establishment of Paternity) with respect to the Federal Parent Locator Service to give the CMS Administrator access to information in the National Directory of New Hires to determine the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program under the Patient Protection and Affordable Care Act (PPACA).

Requires the Secretary to disclose to the HHS Inspector General information on individuals and their employers in the National Directory of New Hires if the HHS Inspector General gives the Secretary their names and Social Security account numbers. Restricts the use of such information to: (1) determining the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program; or (2) evaluating the integrity of such programs. Sets forth rules for the use and disclosure of such information by state agencies.

Directs the Secretary to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program). Revises Medi-Medi Data Match Program purposes.

Amends SSAct title XIX, as amended by PPACA, and SSAct XXI with respect to claims processing and detection of fraud within the Medicaid and CHIP programs.

preventing reducing improper medicare medicaid expenditures act prime act amends prescription drug benefits title xviii medicare social security act ssact direct secretary health_and_human_services hhs prohibit sponsors prescription drug plans paying claims prescription drugs include valid national provider identifier drug prescriber requires secretary annual report congress use recovery audit contractors medicare_integrity_program describe types financial cost improper payment vulnerabilities identified recovery audit contractors secretary addressing assess effectiveness changes medicare payment policies procedures order address vulnerabilities requires secretary address improper payment vulnerabilities timely manner prioritized based risk medicare program authorizes secretary recovery audit contracts medicare medicaid ssact title xix retain certain portion recovered amounts program management account activities addressing problems contribute improper payments fraud requires secretary contracts retain additional recovered amounts available investigate improper payments audit internal controls associated medicare medicaid payments directs secretary develop plan revise incentive program health_insurance_portability_and_accountability_act reporting fraud abuse encourage greater participation individuals reporting medicare fraud abuse requires plan include certain recommendations ways enhance rewards individuals reporting extension incentive program medicaid program amends ssact title xix cover costs equipment salaries benefits travel training appropriations medicaid_integrity_program allows secretary increase centers medicare medicaid_services cms staff duties consist solely protecting integrity medicare program number determined necessary carry program currently directs secretary provide incentives medicare administrative contractors reduce improper payment error rates jurisdictions requires imprisonment years fine million case corporation knowingly intentionally intent defraud purchasing selling distributing arranging purchase sale distribution medicare medicaid chip beneficiary identification number billing privileges ssact titles xviii title xix title chip amends ssact title child support establishment paternity respect federal_parent_locator_service access information national_directory_of_new_hires determine eligibility applicant enrollee medicare program applicable state health subsidy program patient_protection affordable care act ppaca requires secretary disclose hhs_inspector general information individuals employers national_directory_of_new_hires hhs_inspector general gives secretary names social_security account numbers restricts use information determining eligibility applicant enrollee medicare program applicable state health subsidy program evaluating integrity programs sets forth rules use disclosure information state agencies directs secretary establish plan encourage facilitate participation states medicare-medicaid data_match_program medi-medi_program data match program purposes amends ssact title xix amended ppaca ssact xxi respect claims processing detection fraud medicaid chip programs


Summary:
Good Samaritan Health Professionals Act of 2015

Amends the Public Health Service Act to shield a health care professional from liability under federal or state law for harm caused by any act or omission if: (1) the professional is serving as a volunteer in response to a disaster; and (2) the act or omission occurs during the period of the disaster, in the professional's capacity as a volunteer, and in a good faith belief that the individual being treated is in need of health care services.

Makes exceptions where: (1) the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed; or (2) the professional rendered the health care services under the influence of alcohol or an intoxicating drug.

good samaritan health professionals act amends public_health_service_act shield health care professional liability federal state law harm caused act omission professional serving volunteer response disaster act omission occurs period disaster professional capacity volunteer good faith belief individual treated need health care services makes exceptions harm caused act omission constituting willful criminal misconduct gross negligence reckless misconduct conscious flagrant indifference rights safety individual harmed professional rendered health care services influence alcohol intoxicating drug


Summary:
Sports Medicine Licensure Clarity Act of 2016

(Sec. 2) This bill extends the liability insurance coverage of a state-licensed medical professional to another state when the professional provides medical services to an athlete, athletic team, or team staff member pursuant to a written agreement. Prior to providing such services, the medical professional must disclose the nature and extent of the services to the insurer. This extension of coverage does not apply at a health care facility or while a medical professional licensed in the state is transporting the injured individual to a health care facility.

sec bill extends liability insurance coverage state licensed medical professional state professional provides medical services athlete athletic team team staff member pursuant written agreement prior providing services medical professional disclose nature extent services insurer extension coverage apply health care facility medical professional licensed state transporting injured individual health care facility