Bill > S1123

This bill, known as the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013 (PRIME Act), aims to combat waste, fraud, and abuse within the Medicare and Medicaid programs by implementing several key provisions. It mandates that pharmacy claims for prescription drugs must include a valid prescriber's National Provider Identifier (NPI), which is a unique identification number for healthcare providers, and establishes procedures for verifying these identifiers and reporting invalid ones. The bill also reforms how the Centers for Medicare & Medicaid Services (CMS) tracks and addresses vulnerabilities identified by Recovery Audit Contractors (RACs), which are entities hired to detect improper payments, by requiring more detailed reporting on these vulnerabilities and ensuring they are addressed promptly. Furthermore, it seeks to improve the Senior Medicare Patrol program, which empowers seniors to detect and report fraud, by revising its incentive program to encourage more reporting and extending it to Medicaid, and it strengthens penalties for illegally distributing Medicare, Medicaid, or Children's Health Insurance Program (CHIP) beneficiary identification or billing privileges, making such offenses punishable by significant prison time and fines. The bill also enhances data sharing between federal and state agencies, allowing access to the National Directory of New Hires for eligibility determination and program integrity in Medicare and state health subsidy programs, and improves the Medicare-Medicaid Data Match Program to facilitate better data sharing between federal and state Medicaid programs, including providing states with data on improper Medicare payments for dual-eligible individuals. Finally, it introduces incentives for Medicare Administrative Contractors (MACs), which are private companies that process Medicare claims, to reduce improper payment error rates and requires valid beneficiary identification numbers on Medicaid and CHIP claims to ensure individuals receiving services are eligible.