3.0.0 4222 2023-01-11T13:16:59Z 2023-01-11T13:16:59Z House H HR 2009-12-08 111 hsif00 Energy and Commerce Committee House Standing hsif14 Health Subcommittee Referred to 2009-12-09T20:19:29Z Referred to 2009-12-08T14:03:46Z Prevent Health Care Fraud Act of 2009 111 2128 S 2009-10-30 Sponsor introductory remarks on measure. (CR S10949-10951) Related bill CRS 2009-12-09 hsif14 Health Subcommittee 1 House committee actions Referred to the Subcommittee on Health. Committee 2009-12-08 Referred to the House Committee on Energy and Commerce. IntroReferral H11100 2 House floor actions hsif00 Energy and Commerce Committee 2009-12-08 Introduced in House IntroReferral Intro-H 9 Library of Congress 2009-12-08 Introduced in House IntroReferral 1000 9 Library of Congress B001247 Rep. Brown-Waite, Ginny [R-FL-5] Ginny Brown-Waite R FL 5 N E000172 Rep. Emerson, Jo Ann [R-MO-8] JO EMERSON R MO ANN 8 2009-12-08 True S001143 Rep. Souder, Mark E. [R-IN-3] MARK SOUDER R IN EDWARD 3 2009-12-08 True R000583 Rep. Rooney, Thomas J. [R-FL-16] Thomas Rooney R FL J. 16 2009-12-08 True B001260 Rep. Buchanan, Vern [R-FL-13] Vern Buchanan R FL 13 2009-12-08 True R000580 Rep. Roskam, Peter J. [R-IL-6] Peter Roskam R IL J. 6 2009-12-08 True D000299 Rep. Diaz-Balart, Lincoln [R-FL-21] LINCOLN DIAZ-BALART R FL 21 2009-12-08 True P000586 Rep. Putnam, Adam H. [R-FL-12] ADAM PUTNAM R FL H. 12 2009-12-08 True D000600 Rep. Diaz-Balart, Mario [R-FL-25] Mario Diaz-Balart R FL 25 2009-12-08 True M001155 Rep. Mack, Connie [R-FL-14] Connie Mack R FL 14 2009-12-08 True W000804 Rep. Wittman, Robert J. [R-VA-1] Robert Wittman R VA J. 1 2010-03-11 False K000365 Rep. Kagen, Steve [D-WI-8] Steve Kagen D WI 8 2010-03-11 False Health Administrative law and regulatory procedures Child health Crime prevention Criminal justice information and records Department of Health and Human Services Executive agency funding and structure Federal officials Fraud offenses and financial crimes Health care costs and insurance Health information and medical records Medicaid Medicare Public contracts and procurement Health 00 2009-12-08 Introduced in House 2010-05-17T17:55:01Z Prevent Health Care Fraud Act of 2009 - Establishes in the Department of Health and Human Services (HHS) the Office of the Deputy Secretary for Health Care Fraud Prevention. Requires the Office to: (1) direct the implementation within HHS of health care fraud prevention and detection recommendations made by federal and private sector antifraud and oversight entities; (2) routinely consult with HHS's Office of the Inspector General, the Attorney General, and private sector health care antifraud entities to identify emerging fraud issues requiring immediate action; (3) provide for the design, development, and operation of a predictive model antifraud system to analyze health care claims data in real-time to identify high risk claims activity and develop a comprehensive antifraud database for federal health agency activities; (4) promulgate and enforce regulations relating to the reporting of data claims to such system by federal health agencies; (5) establish thresholds for fraudulent, wasteful, or abusive claims for excluding providers or suppliers from participation in federal health programs and for the referral of claims to law enforcement entities; and (6) share antifraud information and best practices.

Sets forth requirements for the fraud prevention system, including that it shall: (1) allow viewing of all provider and patient activities across all federal health program payers; (2) provide for a centralized file for data from all government health insurance claims data sources; (3) provide real-time ability to identify high-risk behavior patterns across markets, geographies, and specialty group providers; (4) involve the implementation of a predictive modeling technology that is designed to prevent waste, fraud, and abuse; (5) systematically present scores, reason codes, and treatment actions for high-risk scored transactions; (6) monitor consumer transactions in real-time and monitor provider behavior at different stages within the transaction flow based upon provider, transaction, and consumer trends; and (7) not be designed to deny health care services or to negatively impact prompt-pay laws because assessments are late.

Directs the Deputy Secretary to: (1) prohibit the payment of any health care claim identified as potentially fraudulent, wasteful, or abusive until the claim has been verified as valid; and (2) provide maximum protection of personal privacy consistent with carrying out the Office's responsibilities.

Directs the Secretary to establish procedures for the implementation of fraud and abuse detection methods under all federal health programs.

]]> Prevent Health Care Fraud Act of 2009 Display Title Prevent Health Care Fraud Act of 2009 Official Title as Introduced To provide for the establishment of the Office of Deputy Secretary for Health Care Fraud Prevention. Introduced in House IH Short Titles as Introduced Prevent Health Care Fraud Act of 2009 Introduced in House 2009-12-08T05:00:00Z https://www.govinfo.gov/content/pkg/BILLS-111hr4222ih/xml/BILLS-111hr4222ih.xml 2009-12-09 Referred to the Subcommittee on Health. text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.