Sec. 5. Requiring valid National Provider Identifiers for prescribers on pharmacy claims and limiting access to the National Provider Identifier registry

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Section 1860D–2(e)(2) of the Social Security Act (42 U.S.C. 1395w–102(e)(2)) is amended by adding at the end the following new subparagraph: For plan years that begin on or after January 1, 2015, such term does not include a drug prescribed by an individual who does not have a valid National Provider Identifier, as determined through procedures established by the Secretary. . In the case that the procedures established by the Secretary of Health and Human Services under section 1860D–2(e)(2) of the Social Security Act ( 42 U.S.C. 1395w–102(e)(2) ) result in a PDP sponsor identifying a claim for reimbursement under a prescription drug plan under part D of title XVIII of such Act as being for a drug that was prescribed by an individual who did not have a valid National Provider Identifier, the PDP sponsor shall submit to the Inspector General of the Department of Health and Human Services any information on such invalid prescribers on pharmacy claims, including any invalid national provider identifiers being used to submit such claims and any records related to such claims.

The Inspector General of the Department of Health and Human Services shall provide to the appropriate law enforcement agencies information submitted under subparagraph

(A). Not later than January 1, 2016, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on the effectiveness of the procedures established under section 1860D–2(e)(2)(C) of the Social Security Act ( 42 U.S.C. 1395w–102(e)(2)(C) ). The Secretary of Health and Human Services, in consultation with the Attorney General, the Inspector General of the Department of Health and Human Services, the Chairman of the Federal Trade Commission, and affected parties (including prescription drug plans under part D of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–101 et seq. ), MA–PD plans under part C of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–21 et seq. ), pharmacies, physicians, and pharmacy computer vendors), shall establish procedures and rules to restrict access to the National Provider Identifier Registry in order to deter the fraudulent use of National Provider Identifiers for purposes of making claims under titles XVIII and XIX of the Social Security Act. The procedures established under paragraph

(1)shall provide governmental and nongovernmental entities with appropriate (as determined by the Secretary) access to the National Provider Identifier Registry. In order to receive such access, each such governmental and nongovernmental entity shall enter into a data use agreement with the Secretary and agree to use the data in such registry in accordance with rules established by the Secretary pursuant such paragraph.

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42 USC 1395w–102(e)(2)
42 USC 1395w–102(e)(2)(C)
42 USC 1395w–101
42 USC 1395w–21

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Sec. 5

Requiring valid National Provider Identifiers for prescribers on pharmacy claims and limiting access to the National Provider Identifier registry

Cite42 USC 1395w–102(e)(2)

Cite42 USC 1395w–102(e)(2)(C)

Cite42 USC 1395w–101

Cite42 USC 1395w–21

Cites 4Cited by 0 across 0 sources