Page:United States Statutes at Large Volume 117.djvu/2425

 117 STAT. 2406

PUBLIC LAW 108–173—DEC. 8, 2003 ‘‘(A) The Secretary, the medicare administrative contractor involved, or any fiduciary, officer, director, or employee of the Department of Health and Human Services, or of such contractor. ‘‘(B) The individual (or authorized representative). ‘‘(C) The health care professional that provides the items or services involved in the case. ‘‘(D) The institution at which the items or services (or treatment) involved in the case are provided. ‘‘(E) The manufacturer of any drug or other item that is included in the items or services involved in the case. ‘‘(F) Any other party determined under any regulations to have a substantial interest in the case involved.’’. (3) REDUCING MINIMUM NUMBER OF QUALIFIED INDEPENDENT CONTRACTORS.—Section 1869(c)(4) (42 U.S.C. 1395ff(c)(4)) is amended by striking ‘‘not fewer than 12 qualified independent contractors under this subsection’’ and inserting ‘‘a sufficient number of qualified independent contractors (but not fewer than 4 such contractors) to conduct reconsiderations consistent with the timeframes applicable under this subsection’’. (4) EFFECTIVE DATE.—The amendments made by paragraphs (1) and (2) shall be effective as if included in the enactment of the respective provisions of subtitle C of title V of BIPA (114 Stat. 2763A–534). (5) TRANSITION.—In applying section 1869(g) of the Social Security Act (as added by paragraph (2)), any reference to a medicare administrative contractor shall be deemed to include a reference to a fiscal intermediary under section 1816 of the Social Security Act (42 U.S.C. 1395h) and a carrier under section 1842 of such Act (42 U.S.C. 1395u).

42 USC 1395ff note.

42 USC 1395ff note.

SEC. 934. PREPAYMENT REVIEW.

(a) IN GENERAL.—Section 1874A, as added by section 911(a)(1) and as amended by sections 912(b), 921(b)(1), and 921(c)(1), is further amended by adding at the end the following new subsection: ‘‘(h) CONDUCT OF PREPAYMENT REVIEW.— ‘‘(1) CONDUCT OF RANDOM PREPAYMENT REVIEW.— ‘‘(A) IN GENERAL.—A medicare administrative contractor may conduct random prepayment review only to develop a contractor-wide or program-wide claims payment error rates or under such additional circumstances as may be provided under regulations, developed in consultation with providers of services and suppliers. ‘‘(B) USE OF STANDARD PROTOCOLS WHEN CONDUCTING PREPAYMENT REVIEWS.—When a medicare administrative contractor conducts a random prepayment review, the contractor may conduct such review only in accordance with a standard protocol for random prepayment audits developed by the Secretary. ‘‘(C) CONSTRUCTION.—Nothing in this paragraph shall be construed as preventing the denial of payments for claims actually reviewed under a random prepayment review. ‘‘(D) RANDOM PREPAYMENT REVIEW.—For purposes of this subsection, the term ‘random prepayment review’

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