PUBLIC LAW 109–432—DEC. 20, 2006
120 STAT. 2991
‘‘$10,000,000,000’’ and inserting ‘‘2012,’’ and ‘‘$3,500,000,000’’, respectively. SEC. 302. EXTENSION AND EXPANSION OF RECOVERY AUDIT CONTRACTOR PROGRAM UNDER THE MEDICARE INTEGRITY PROGRAM.
(a) IN GENERAL.—Section 1893 of the Social Security Act (42 U.S.C. 1395ddd) is amended by adding at the end the following new subsection: ‘‘(h) USE OF RECOVERY AUDIT CONTRACTORS.— ‘‘(1) IN GENERAL.—Under the Program, the Secretary shall enter into contracts with recovery audit contractors in accordance with this subsection for the purpose of identifying underpayments and overpayments and recouping overpayments under this title with respect to all services for which payment is made under part A or B. Under the contracts— ‘‘(A) payment shall be made to such a contractor only from amounts recovered; ‘‘(B) from such amounts recovered, payment— ‘‘(i) shall be made on a contingent basis for collecting overpayments; and ‘‘(ii) may be made in such amounts as the Secretary may specify for identifying underpayments; and ‘‘(C) the Secretary shall retain a portion of the amounts recovered which shall be available to the program management account of the Centers for Medicare & Medicaid Services for purposes of activities conducted under the recovery audit program under this subsection. ‘‘(2) DISPOSITION OF REMAINING RECOVERIES.—The amounts recovered under such contracts that are not paid to the contractor under paragraph (1) or retained by the Secretary under paragraph (1)(C) shall be applied to reduce expenditures under parts A and B. ‘‘(3) NATIONWIDE COVERAGE.—The Secretary shall enter into contracts under paragraph (1) in a manner so as to provide for activities in all States under such a contract by not later than January 1, 2010. ‘‘(4) AUDIT AND RECOVERY PERIODS.—Each such contract shall provide that audit and recovery activities may be conducted during a fiscal year with respect to payments made under part A or B— ‘‘(A) during such fiscal year; and ‘‘(B) retrospectively (for a period of not more than 4 fiscal years prior to such fiscal year). ‘‘(5) WAIVER.—The Secretary shall waive such provisions of this title as may be necessary to provide for payment of recovery audit contractors under this subsection in accordance with paragraph (1). ‘‘(6) QUALIFICATIONS OF CONTRACTORS.— ‘‘(A) IN GENERAL.—The Secretary may not enter into a contract under paragraph (1) with a recovery audit contractor unless the contractor has staff that has the appropriate clinical knowledge of, and experience with, the payment rules and regulations under this title or the contractor has, or will contract with, another entity that has such knowledgeable and experienced staff.
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