S 861 114th Congress Senate

PRIME Act of 2015

Official title: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs.

Introduced: March 25, 2015 See on congress.gov

Health Accounting and auditingChild healthEmployee hiringFraud offenses and financial crimes

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Government information and archivesGovernment studies and investigationsHealth care costs and insuranceHealth programs administration and fundingMedicaidMedicarePrescription drugsPublic contracts and procurement

Everywhere this bill has been 5 steps

Introduced

In committee

Reported out

Passed House

Passed Senate

To President

Became law

Jul 30, 2015

Placed on Senate Legislative Calendar under General Orders. Calendar No. 183.

Jul 30, 2015

Committee on Finance. Reported by Senator Hatch with an amendment in the nature of a substitute. With written report No. 114-104.

Jun 24, 2015

Committee on Finance. Ordered to be reported without amendment favorably.

Mar 25, 2015

Read twice and referred to the Committee on Finance.

Mar 25, 2015

Introduced in Senate

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Latest action July 30, 2015

Placed on Senate Legislative Calendar under General Orders. Calendar No. 183.

Plain-English summary Congressional Research Service

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

(Sec. 2) Amends title XIX (Medicaid) of the Social Security Act (SSAct) to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Department of Health and Human Services (HHS) to increase Centers for Medicare and Medicaid Services staff whose duties consist solely of protecting the integrity of the Medicare program under SSAct title XVIII by a number determined necessary to carry out the Program (currently, by 100).

(Sec. 3) Directs HHS to provide incentives for Medicare administrative contractors (MACs) to reduce the improper payment error rates in their jurisdictions.

Authorizes among such incentives:

a sliding scale of award fee payments and additional incentives to MACs that either reduce the improper payment rates in their jurisdictions to certain HHS-determined thresholds or accomplish tasks that further improve payment accuracy; and
substantial reductions in award fee payments under cost-plus-award-fee contracts for MACs that reach an upper end improper payment rate threshold or fail to accomplish tasks that further improve payment accuracy.

(Sec. 4) 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 without lawful authority knowingly and willfully purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a beneficiary identification number or unique health identifier for a health care provider under SSAct titles XVIII, XIX, or XXI (Children's Health Insurance Program) (CHIP).

(Sec. 5) Directs HHS 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.

Directs HHS to develop and implement a plan that allows state agencies responsible for administering a state Medicaid plan access to relevant data on improper or fraudulent payments made under the Medicare program for health care items or services provided to dual eligible individuals (eligible for both Medicare and Medicaid).

Related & companion bills 2