Skip to main content
HR 6575 112th Congress House

Medicare Audit Improvement Act of 2012

Official title: To amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and a… Show full official titleShow less

Official title: To amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors, and for other purposes.

Introduced: October 23, 2012 Introduced by: Graves, Sam Republican · Missouri See on congress.gov
Health Accounting and auditingAdministrative law and regulatory proceduresAdministrative remediesDepartment of Health and Human Services
More subjectsShow fewer subjects
Government information and archivesHealth facilities and institutionsHealth personnelHome and outpatient careHospital careJudicial review and appealsLegal fees and court costsMedicarePerformance measurementPublic contracts and procurement
This bill died when the 112th Congress ended
It never became law before the 112th Congress (2011–2012) adjourned, and bills don't carry over to the next Congress. It would have to be reintroduced. You can still save it for reference, but it won't receive updates.
 Everywhere this bill has been 3 steps
Introduced
In committee
Reported out
Passed House
Passed Senate
To President
Became law
Oct 26, 2012
Referred to the Subcommittee on Health.
Oct 16, 2012
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Oct 16, 2012
Introduced in House
 Ask about this bill AI · grounded in the bill text

Have a question about what this bill does? Ask in plain English; the answer is drawn from the bill's actual text and official record, and it'll tell you when something isn't in the text rather than guess.

AI answers can be imperfect; always confirm against the full bill text.

 Latest action October 26, 2012

Referred to the Subcommittee on Health.

 Plain-English summary Congressional Research Service

Medicare Audit Improvement Act of 2012 - Directs the Secretary of Health and Human Services (HHS) to establish a process under which the number of additional documentation requests made by a Medicare contractor pursuant to a complex prepayment or postpayment audit with respect to a hospital's Medicare part A (Hospital Insurance) claims in a year may not exceed, across all such contractors with respect to the hospital's claims, the lesser of: (1) 2% of all such claims for such year, or (2) 500 additional documentation requests during any 45-day period.

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.

Prohibits the Secretary, in conducting the Medicare Part A and Part B Rebilling Demonstration, from prohibiting any appeal by a hospital of any finding by a recovery audit contractor that an inpatient admission was not reasonably and medically necessary.

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.


 Bill text 1 version

Source documents hosted by congress.gov.

 Committees of jurisdiction 3
Cite this page click to expand
APA
U.S. Congress. (2026). H.R. 6575: Medicare Audit Improvement Act of 2012. 112th Congress. Open America. https://openamerica.io/bill/112-HR-6575/
MLA
"H.R. 6575: Medicare Audit Improvement Act of 2012." 112th Congress, 2026, Open America, https://openamerica.io/bill/112-HR-6575/.
Bluebook (legal)
H.R. 6575, 112th Cong. (2026), https://openamerica.io/bill/112-HR-6575/.
Markdown link
[H.R. 6575: Medicare Audit Improvement Act of 2012](https://openamerica.io/bill/112-HR-6575/)
Report a problem