Foreign Medical Program Integrity and Improvement Act

This Act may be cited as the “Foreign Medical Program Integrity and Improvement Act”.

(a) Rates of payment.— Section 1724 of title 38, United States Code, is amended by adding at the end the following new subsection:

“(g)

(1) Subject to paragraph (2), the rate paid for hospital care or medical services under this section shall be the lesser of—

(A) the amount billed for such hospital care or medical services; or

(B) the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined in section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C. 1395m), for the same care or services.

(2) The Secretary may make a payment in excess of the rate determined under paragraph (1) to ensure that a veteran has access to hospital care or medical services, including in an emergency.”.

(b) In the case of a deceased veteran or provider.— Section 1724 of title 38, United States Code, is amended by adding at the end the following new subsection:

“(h)

(1) The Secretary may not use any Federal funds to pay for care or services furnished under this section—

(A)

(i) to an individual who appears in the Death Master File; or

(ii) by an individual who appears in the Death Master File; and

(B) after the date of death of such individual.

(2) In this subsection, the term “Death Master File” has the meaning given such term in section 203 of the Bipartisan Budget Act of 2013 (Public Law 113–167; 42 U.S.C. 1306c).”.

(c) In cases of fraud.— Section 1724 of title 38, United States Code, is further amended by adding at the end the following new subsections:

“(i) In the case of a claim for payment for care or services furnished under this section that the Secretary suspects constitutes fraud, waste or abuse, the Secretary—

(1) shall refer such claim to the Inspector General of the Department;

(2) may withhold such payment during the investigation of such claim;

(3) shall approve the claim and release such payment as soon as practicable if the Inspector General determines that the claim is proper; and

(4) shall, if the Inspector General determines that such claim constitutes fraud, waste or abuse—

(A) deny the claim; and

(B) take action the Secretary determines appropriate to recover any Federal funds already paid in relation to such claim, claimant, or provider.

(j)

(1) The Secretary shall maintain a list of providers of care or services furnished under this section who have submitted fraudulent claims for such care or services.

(2) The Secretary may not use any Federal funds to pay for care or services furnished under this section by a provider whose name appears on the list.

(3) Each time the Secretary adds the name of a provider to the list, the Secretary shall distribute the list electronically to veterans registered in a program under this section.

(j) The Secretary shall designate a Fraud Detection and Prevention Coordinator to carry out subsections (h), (i), and (j) of this section.”.

(d) Authority To contract.—

(1) In general.— Section 1724 of title 38, United States Code, is further amended by adding at the end the following new subsection:

“(k) The Secretary may enter into an agreement with an entity pursuant to which such entity shall serve as a third-party administrator of claims for care or services furnished under this section.”.

(2) Temporary expansion.— The Secretary of Veterans Affairs may enter into an agreement with an entity pursuant to which such entity shall provide to the Secretary access to an information technology system for the administration of claims for care or services furnished under such section. If the Secretary exercises such authority, the Secretary shall ensure that implementation of such system is complete not later than one year after the date of the enactment of this Act.