Section 1 Short title
This Act may be cited as the “Health Care Fraud Prevention and Enforcement Act”.
Health Care Fraud Prevention and Enforcement Act
A BILL
To amend title XVIII of the Social Security Act to strengthen program integrity oversight for the Health Care Fraud and Abuse Control Program, and for other purposes.
Sec. 2 Strengthening program integrity oversight for the Health Care Fraud and Abuse Control Program
Additional funding—
Departments of Health and Human Services and Justice— Section 1817(k)(3)(A)(i) of the Social Security Act (42 U.S.C. 1395i(k)(3)(A)(i)) is amended—
in subclause (III), by striking “and” at the end;
in subclause (IV)—
by inserting “and before fiscal year 2027” after “after fiscal year 2006”; and
by striking the period at the end and inserting a semicolon; and
by adding at the end the following new subclauses:
“(V) for fiscal year 2027, $490,000,000;
“(VI) for fiscal year 2028, $520,000,000;
“(VII) for fiscal year 2029, $570,000,000; and
“(VIII) for each fiscal year after fiscal year 2029, the limit under this clause for the preceding fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over the previous year.”
Office of the Inspector General of the Department of Health and Human Services— Section 1817(k)(3)(A)(ii) of the Social Security Act (42 U.S.C. 1395i(k)(3)(A)(ii)) is amended—
in subclause (VIII), by striking “and” at the end;
in subclause (IX)—
by inserting “and before fiscal year 2027” after “after fiscal year 2007”; and
by striking the period at the end and inserting a semicolon; and
by adding at the end the following new subclauses:
“(X) for fiscal year 2027, $320,000,000;
“(XI) for fiscal year 2028, $340,000,000;
“(XII) for fiscal year 2029, $370,000,000; and
“(XIII) for each fiscal year after fiscal year 2029, not less than the amount required under this clause for the preceding fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over the previous year.”
Federal Bureau of Investigation— Section 1817(k)(3)(B) of the Social Security Act (42 U.S.C. 1395i(k)(3)(B)) is amended—
in clause (vii), by striking “and” at the end;
in clause (viii)—
by inserting “and before fiscal year 2027” after “after fiscal year 2006”; and
by striking the period at the end and inserting a semicolon; and
by adding at the end the following new clauses:
“(ix) for fiscal year 2027, $230,000,000;
“(x) for fiscal year 2028, $250,000,000;
“(xi) for fiscal year 2029, $270,000,000; and
“(xii) for each fiscal year after fiscal year 2029, the amount to be appropriated under this subparagraph for the preceding fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over the previous year.”
Medicare Integrity Program— Section 1817(k)(4) of the Social Security Act (42 U.S.C. 1395i(k)(4)) is amended—
in subparagraph (B)—
in clause (vii), by inserting “and before fiscal year 2027” after “after fiscal year 2002”; and
by adding at the end the following new clauses:
“(viii) For fiscal year 2027, $1,280,000,000.
“(ix) For fiscal year 2028, $1,380,000,000.
“(x) For fiscal year 2029, $1,480,000,000.
“(xi) For each fiscal year after fiscal year 2029, the amount appropriated under this subparagraph for the preceding fiscal year, as increased pursuant to subparagraph (C)(ii).”
in subparagraph (C)(ii), by striking “For each fiscal year after 2010” and inserting “For each of fiscal years 2011 through 2026, and for each fiscal year after fiscal year 2029”.
Medicare-Medicaid data match program— Section 1817(k)(4)(D) of the Social Security Act (42 U.S.C. 1395i(k)(4)(D)) is amended—
in clause (v), by inserting “through fiscal year 2026” after “and each fiscal year thereafter”; and
by adding at the end the following new clauses:
“(vi) $110,000,000 for fiscal year 2027.
“(vii) $120,000,000 for fiscal year 2028.
“(viii) $130,000,000 for fiscal year 2029.
“(ix) For each fiscal year after fiscal year 2028, the amount appropriated under this subparagraph for the preceding fiscal year, as increased pursuant to subparagraph (C)(ii).”
Expansion of investigative authority of the office of the inspector general of the department of health and human services— Section 1817(k)(3)(A)(ii) of the Social Security Act (42 U.S.C. 1395i(k)(3)(A)(ii)) is amended—
in the heading, by striking “Medicare and medicaid activities” and inserting “Office of the inspector general of the department of health and human services”; and
in the matter preceding subclause (I), by striking “title XIX” and inserting “title XIX and any program established under title I (or under the amendments made by such title) of the Patient Protection and Affordable Care Act (Public Law 111–148) that is administered by the Secretary”.
Clarification concerning the definition of health plan— Section 1128C of the Social Security Act (42 U.S.C. 1320a–7c) is amended—
in subsection (a)(1)(B), by inserting “public and private” before “delivery”; and
in subsection (c), in the matter preceding paragraph (1), by inserting “public or private” before “plan or program”.
Clarification of authority for the activities of the departments of justice and health and human services— Section 1817(k)(3) of the Social Security Act (42 U.S.C. 1395i(k)(3)) is amended by adding at the end the following new subparagraph:
“(D) Rule of construction.—Nothing in this paragraph shall be construed to limit the authority of the Secretary, the Attorney General, or the Inspector General of the Department of Health and Human Services to use funds made available under this paragraph to—
“(i) detect or prosecute health care fraud and abuse; and
“(ii) communicate with the public about health care fraud.”
Annual report to congress— Section 1817(k)(5) of the Social Security Act (42 U.S.C. 1395i(k)(5)) is amended—
by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and indenting appropriately;
by striking “report.—Not later than January 1” and inserting “report.—
“(A) In general—Not later than April 1”
by adding at the end the following new subparagraph:
“(B) Required notice of delay
“(i) In general—If the annual report required under subparagraph (A) is not submitted to Congress by April 1 of the year, the Secretary and Attorney General shall jointly provide notice to the appropriate committees of Congress beginning not later than such April 1, and annually thereafter until such report is submitted to Congress, stating the reason for the delay.
“(ii) Applicable committees of Congress defined—For purposes of this subparagraph, the term appropriate committees of Congress means the Committees on Finance and the Budget of the Senate and the Committees on Ways and Means, the Budget, and Energy and Commerce of the House of Representatives.”
Process for determining funding allocation for departments of justice and health and human services— Section 1817(k)(3)(A)(i) of the Social Security Act (42 U.S.C. 1395i(k)(3)(A)(i)) is amended, in the matter preceding subclause (I), by striking “certify” and inserting “agree”.
Inclusion of children’s health insurance program in medicare-Medicaid data match program— Section 1893(g) of the Social Security Act (42 U.S.C. 1395ddd(g)) is amended—
in paragraph (1)(A)—
in the matter preceding clause (i), by striking “under title XIX for the purpose of” and inserting “under title XIX, and beginning with 2027, with respect to the State Children's Health Insurance Program under title XXI, for the purpose of”;
in clause (i), by striking “under this title and the Medicaid program established under title XIX” and inserting “under this title, the Medicaid program established under title XIX, and the State Children's Health Insurance Program established under title XXI”;
in clause (ii), by inserting “and the State Children's Health Insurance Program under title XXI” after “under title XIX”; and
in clause (iii), by striking “both”; and
in paragraph (2), by striking “titles XI and XIX” and inserting “titles XI, XIX, and XXI”.
Sec. 3 GAO study and report on performance and effectiveness of Health Care Fraud and Abuse Control Program
Study— The Comptroller General of the United States (in this section referred to as the “Comptroller General”) shall conduct a study regarding the performance and effectiveness of the Health Care Fraud and Abuse Control Program. To the extent feasible and data are available, the study shall include the following:
An analysis of how the Department of Health and Human Services and the Department of Justice have used their appropriations to achieve the goals of the Health Care Fraud and Abuse Control Program under section 1128C of the Social Security Act (42 U.S.C. 1320a–7c).
An analysis of performance assessments and other metrics the Department of Health and Human Services and the Department of Justice use to determine the performance and effectiveness of the Health Care Fraud and Abuse Control Program.
A description of how the Department of Health and Human Services and the Department of Justice obligated funds for the Health Care Fraud and Abuse Control Program.
An analysis of how the Department of Health and Human Services and the Department of Justice assess Health Care Fraud and Abuse Control activities and whether key program outputs have changed over time since the most recent Government Accountability Office report under section 1817(k)(6) of the Social Security Act (42 U.S.C. 1395i(k)(6)).
An analysis of evidence available regarding the effectiveness of the Health Care Fraud and Abuse Control Program in reducing health care fraud and abuse.
An analysis of the timeliness of the annual Health Care Fraud and Abuse Control report under section 1817(k)(5) of the Social Security Act (42 U.S.C. 1395i(k)(5)) and how the Department of Health and Human Services and the Department of Justice could improve the timeliness of such report.
Report— Not later than 16 months after the date of enactment of this Act, the Comptroller General shall report to Congress the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.