F:\P11\NHI\TRICOMM\AAHCA09_001.

XML

689
1 pose, or in cases under paragraph (8), an assess-
2 ment of not more than 3 times the amount claimed
3 as the result of the false statement, omission, or
4 misrepresentation of material fact claimed by a pro-
5 vider of services or supplier whose application to
6 participate contained such false statement, omission,
7 or misrepresentation)’’.
8 (b) EFFECTIVE DATE.—The amendments made by
9 subsection (a) shall apply to acts committed on or after
10 January 1, 2010.
11 SEC. 1612. ENHANCED PENALTIES FOR SUBMISSION OF

12 FALSE STATEMENTS MATERIAL TO A FALSE

13 CLAIM.

14 (a) IN GENERAL.—Section 1128A(a) of the Social

15 Security Act (42 U.S.C. 1320a–7a(a)), as amended by sec-
16 tion 1611, is further amended—
17 (1) in paragraph (7), by striking ‘‘or’’ at the
18 end;
19 (2) in paragraph (8), by inserting ‘‘or’’ at the
20 end; and
21 (3) by inserting after paragraph (8), the fol-
22 lowing new paragraph:
23 ‘‘(9) knowingly makes, uses, or causes to be
24 made or used, a false record or statement material
25 to a false or fraudulent claim for payment for items

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

690
1 and services furnished under a Federal health care
2 program;’’; and
3 (4) in the matter following paragraph (9), as
4 inserted by paragraph (3)—
5 (A) by striking ‘‘or in cases under para-
6 graph (8)’’ and inserting ‘‘in cases under para-
7 graph (8)’’; and
8 (B) by striking ‘‘a material fact)’’ and in-
9 serting ‘‘a material fact, in cases under para-
10 graph (9), $50,000 for each false record or
11 statement)’’.
12 (b) EFFECTIVE DATE.—The amendments made by
13 subsection (a) shall apply to acts committed on or after
14 January 1, 2010.
15 SEC. 1613. ENHANCED PENALTIES FOR DELAYING INSPEC-

16 TIONS.

17 (a) IN GENERAL.—Section 1128A(a) of the Social

18 Security Act (42 U.S.C. 1320a–7a(a)), as amended by sec-
19 tions 1611 and 1612, is further amended—
20 (1) in paragraph (8), by striking ‘‘or’’ at the
21 end;
22 (2) in paragraph (9), by inserting ‘‘or’’ at the
23 end;
24 (3) by inserting after paragraph (9) the fol-
25 lowing new paragraph:

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

691
1 ‘‘(10) fails to grant timely access, upon reason-
2 able request (as defined by the Secretary in regula-
3 tions), to the Inspector General of the Department
4 of Health and Human Services, for the purpose of
5 audits, investigations, evaluations, or other statutory
6 functions of the Inspector General of the Depart-
7 ment of Health and Human Services;’’; and
8 (4) in the matter following paragraph (10), as
9 inserted by paragraph (3)—
10 (A) by striking ‘‘or’’ after ‘‘$50,000 for
11 each such act,’’; and
12 (B) by inserting ‘‘, or in cases under para-
13 graph (10), $15,000 for each day of the failure
14 described in such paragraph’’ after ‘‘false
15 record or statement’’.
16 (b) ENSURING TIMELY INSPECTIONS RELATING TO

17 CONTRACTS WITH MA ORGANIZATIONS.—Section

18 1857(d)(2) of such Act (42 U.S.C. 1395w–27(d)(2)) is
19 amended—
20 (1) in subparagraph (A), by inserting ‘‘timely’’
21 before ‘‘inspect’’; and
22 (2) in subparagraph (B), by inserting ‘‘timely’’
23 before ‘‘audit and inspect’’.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

692
1 (c) EFFECTIVE DATE.—The amendments made by
2 subsection (a) shall apply to violations committed on or
3 after January 1, 2010.
4 SEC. 1614. ENHANCED HOSPICE PROGRAM SAFEGUARDS.

5 (a) MEDICARE.—Part A of title XVIII of the Social

6 Security Act is amended by inserting after section 1819
7 the following new section:
8 ‘‘SEC. 1819A. ASSURING QUALITY OF CARE IN HOSPICE

9 CARE.

10 ‘‘(a) IN GENERAL.—If the Secretary determines on

11 the basis of a survey or otherwise, that a hospice program
12 that is certified for participation under this title has dem-
13 onstrated a substandard quality of care and failed to meet
14 such other requirements as the Secretary may find nec-
15 essary in the interest of the health and safety of the indi-
16 viduals who are provided care and services by the agency
17 or organization involved and determines—
18 ‘‘(1) that the deficiencies involved immediately
19 jeopardize the health and safety of the individuals to
20 whom the program furnishes items and services, the
21 Secretary shall take immediate action to remove the
22 jeopardy and correct the deficiencies through the
23 remedy specified in subsection (b)(2)(A)(iii) or ter-
24 minate the certification of the program, and may

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

693
1 provide, in addition, for 1 or more of the other rem-
2 edies described in subsection (b)(2)(A); or
3 ‘‘(2) that the deficiencies involved do not imme-
4 diately jeopardize the health and safety of the indi-
5 viduals to whom the program furnishes items and
6 services, the Secretary may—
7 ‘‘(A) impose intermediate sanctions devel-
8 oped pursuant to subsection (b), in lieu of ter-
9 minating the certification of the program; and
10 ‘‘(B) if, after such a period of intermediate
11 sanctions, the program is still not in compliance
12 with such requirements, the Secretary shall ter-
13 minate the certification of the program.
14 If the Secretary determines that a hospice program
15 that is certified for participation under this title is
16 in compliance with such requirements but, as of a
17 previous period, was not in compliance with such re-
18 quirements, the Secretary may provide for a civil
19 money penalty under subsection (b)(2)(A)(i) for the
20 days in which it finds that the program was not in
21 compliance with such requirements.
22 ‘‘(b) INTERMEDIATE SANCTIONS.—
23 ‘‘(1) DEVELOPMENT AND IMPLEMENTATION.—

24 The Secretary shall develop and implement, by not

25 later than July 1, 2012—

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

694
1 ‘‘(A) a range of intermediate sanctions to
2 apply to hospice programs under the conditions
3 described in subsection (a), and
4 ‘‘(B) appropriate procedures for appealing
5 determinations relating to the imposition of
6 such sanctions.
7 ‘‘(2) SPECIFIED SANCTIONS.—

8 ‘‘(A) IN GENERAL.—The intermediate

9 sanctions developed under paragraph (1) may
10 include—
11 ‘‘(i) civil money penalties in an
12 amount not to exceed $10,000 for each day
13 of noncompliance or, in the case of a per
14 instance penalty applied by the Secretary,
15 not to exceed $25,000,
16 ‘‘(ii) denial of all or part of the pay-
17 ments to which a hospice program would
18 otherwise be entitled under this title with
19 respect to items and services furnished by
20 a hospice program on or after the date on
21 which the Secretary determines that inter-
22 mediate sanctions should be imposed pur-
23 suant to subsection (a)(2),
24 ‘‘(iii) the appointment of temporary
25 management to oversee the operation of

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

695
1 the hospice program and to protect and as-
2 sure the health and safety of the individ-
3 uals under the care of the program while
4 improvements are made,
5 ‘‘(iv) corrective action plans, and
6 ‘‘(v) in-service training for staff.
7 The provisions of section 1128A (other than
8 subsections (a) and (b)) shall apply to a civil
9 money penalty under clause (i) in the same
10 manner as such provisions apply to a penalty or
11 proceeding under section 1128A(a). The tem-
12 porary management under clause (iii) shall not
13 be terminated until the Secretary has deter-
14 mined that the program has the management
15 capability to ensure continued compliance with
16 all requirements referred to in that clause.
17 ‘‘(B) CLARIFICATION.—The sanctions
18 specified in subparagraph (A) are in addition to
19 sanctions otherwise available under State or
20 Federal law and shall not be construed as lim-
21 iting other remedies, including any remedy
22 available to an individual at common law.
23 ‘‘(C) COMMENCEMENT OF PAYMENT.—A

24 denial of payment under subparagraph (A)(ii)

25 shall terminate when the Secretary determines

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

696
1 that the hospice program no longer dem-
2 onstrates a substandard quality of care and
3 meets such other requirements as the Secretary
4 may find necessary in the interest of the health
5 and safety of the individuals who are provided
6 care and services by the agency or organization
7 involved.
8 ‘‘(3) SECRETARIAL AUTHORITY.—The Secretary
9 shall develop and implement, by not later than July
10 1, 2011, specific procedures with respect to the con-
11 ditions under which each of the intermediate sanc-
12 tions developed under paragraph (1) is to be applied,
13 including the amount of any fines and the severity
14 of each of these sanctions. Such procedures shall be
15 designed so as to minimize the time between identi-
16 fication of deficiencies and imposition of these sanc-
17 tions and shall provide for the imposition of incre-
18 mentally more severe fines for repeated or uncor-
19 rected deficiencies.’’.
20 (b) APPLICATION TO MEDICAID.—Section 1905(o) of
21 the Social Security Act (42 U.S.C. 1396d(o)) is amended
22 by adding at the end the following new paragraph:
23 ‘‘(4) The provisions of section 1819A shall apply to
24 a hospice program providing hospice care under this title

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC