[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 525 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 525

To amend title XI of the Social Security Act to direct the Secretary of 
Health and Human Services to establish a public-private partnership for 
      purposes of identifying health care waste, fraud, and abuse.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 11, 2019

    Mr. Walden (for himself, Mr. Pallone, Mr. Brady, and Mr. Neal) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XI of the Social Security Act to direct the Secretary of 
Health and Human Services to establish a public-private partnership for 
      purposes of identifying health care waste, fraud, and abuse.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Strengthening the Health Care Fraud 
Prevention Task Force Act of 2019''.

SEC. 2. PUBLIC-PRIVATE PARTNERSHIP FOR HEALTH CARE WASTE, FRAUD, AND 
              ABUSE DETECTION.

    (a) In General.--Section 1128C(a) of the Social Security Act (42 
U.S.C. 1320a-7c(a)) is amended by adding at the end the following new 
paragraph:
            ``(6) Public-private partnership for waste, fraud, and 
        abuse detection.--
                    ``(A) In general.--Under the program described in 
                paragraph (1), there is established a public-private 
                partnership (in this paragraph referred to as the 
                `partnership') of health plans, Federal and State 
                agencies, law enforcement agencies, health care anti-
                fraud organizations, and any other entity determined 
                appropriate by the Secretary (in this paragraph 
                referred to as `partners') for purposes of detecting 
                and preventing health care waste, fraud, and abuse.
                    ``(B) Contract with trusted third party.--In 
                carrying out the partnership, the Secretary shall enter 
                into a contract with a trusted third party for purposes 
                of carrying out the duties of the partnership described 
                in subparagraph (C).
                    ``(C) Duties of partnership.--The partnership 
                shall--
                            ``(i) provide technical and operational 
                        support to facilitate data sharing between 
                        partners in the partnership;
                            ``(ii) analyze data so shared to identify 
                        fraudulent and aberrant billing patterns;
                            ``(iii) conduct aggregate analyses of 
                        health care data so shared across Federal, 
                        State, and private health plans for purposes of 
                        detecting fraud, waste, and abuse schemes;
                            ``(iv) identify outlier trends and 
                        potential vulnerabilities of partners in the 
                        partnership with respect to such schemes;
                            ``(v) refer specific cases of potential 
                        unlawful conduct to appropriate governmental 
                        entities;
                            ``(vi) convene, not less than annually, 
                        meetings with partners in the partnership for 
                        purposes of providing updates on the 
                        partnership's work and facilitating information 
                        sharing between the partners;
                            ``(vii) enter into data sharing and data 
                        use agreements with partners in the partnership 
                        in such a manner so as to ensure the 
                        partnership has access to data necessary to 
                        identify waste, fraud, and abuse while 
                        maintaining the confidentiality and integrity 
                        of such data;
                            ``(viii) provide partners in the 
                        partnership with plan-specific, confidential 
                        feedback on any aberrant billing patterns or 
                        potential fraud identified by the partnership 
                        with respect to such partner;
                            ``(ix) establish a process by which 
                        entities described in subparagraph (A) may 
                        enter the partnership and requirements such 
                        entities must meet to enter the partnership;
                            ``(x) provide appropriate training, 
                        outreach, and education to partners based on 
                        the results of data analyses described in 
                        clauses (ii) and (iii); and
                            ``(xi) perform such other duties as the 
                        Secretary determines appropriate.
                    ``(D) Substance use disorder treatment analysis.--
                Not later than 2 years after the date of the enactment 
                of the Strengthening the Health Care Fraud Prevention 
                Task Force Act of 2019, the trusted third party with a 
                contract in effect under subparagraph (B) shall perform 
                an analysis of aberrant or fraudulent billing patterns 
                and trends with respect to providers and suppliers of 
                substance use disorder treatments from data shared with 
                the partnership.
                    ``(E) Executive board.--
                            ``(i) Executive board composition.--
                                    ``(I) In general.--There shall be 
                                an executive board of the partnership 
                                comprised of representatives of the 
                                Federal Government and representatives 
                                of the private sector selected by the 
                                Secretary.
                                    ``(II) Chairs.--The executive board 
                                shall be co-chaired by one Federal 
                                Government official and one 
                                representative from the private sector.
                            ``(ii) Meetings.--The executive board of 
                        the partnership shall meet at least once per 
                        year.
                            ``(iii) Executive board duties.--The duties 
                        of the executive board shall include the 
                        following:
                                    ``(I) Providing strategic direction 
                                for the partnership, including 
                                membership criteria and a mission 
                                statement.
                                    ``(II) Communicating with the 
                                leadership of the Department of Health 
                                and Human Services and the Department 
                                of Justice and the various private 
                                health sector associations.
                    ``(F) Reports.--Not later than September 30, 2021, 
                and every 2 years thereafter, the Secretary shall 
                submit to Congress and make available on the public 
                website of the Centers for Medicare & Medicaid Services 
                a report containing--
                            ``(i) a review of activities conducted by 
                        the partnership over the 2-year period ending 
                        on the date of the submission of such report, 
                        including any progress to any objectives 
                        established by the partnership;
                            ``(ii) any savings voluntarily reported by 
                        health plans participating in the partnership 
                        attributable to the partnership during such 
                        period;
                            ``(iii) any savings to the Federal 
                        Government attributable to the partnership 
                        during such period;
                            ``(iv) any other outcomes attributable to 
                        the partnership, as determined by the 
                        Secretary, during such period; and
                            ``(v) a strategic plan for the 2-year 
                        period beginning on the day after the date of 
                        the submission of such report, including a 
                        description of any emerging fraud and abuse 
                        schemes, trends, or practices that the 
                        partnership intends to study during such 
                        period.
                    ``(G) Funding.--The partnership shall be funded by 
                amounts otherwise made available to the Secretary for 
                carrying out the program described in paragraph (1).
                    ``(H) Transitional provisions.--To the extent 
                consistent with this subsection, all functions, 
                personnel, assets, liabilities, and administrative 
                actions applicable on the date before the date of the 
                enactment of this paragraph to the National Fraud 
                Prevention Partnership established on September 17, 
                2012, by charter of the Secretary shall be transferred 
                to the partnership established under subparagraph (A) 
                as of the date of the enactment of this paragraph.
                    ``(I) Nonapplicability of faca.--The provisions of 
                the Federal Advisory Committee Act shall not apply to 
                the partnership established by subparagraph (A).
                    ``(J) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement the 
                partnership established by subparagraph (A) by program 
                instruction or otherwise.
                    ``(K) Definition.--For purposes of this paragraph, 
                the term `trusted third party' means an entity that--
                            ``(i) demonstrates the capability to carry 
                        out the duties of the partnership described in 
                        subparagraph (C);
                            ``(ii) complies with such conflict of 
                        interest standards determined appropriate by 
                        the Secretary; and
                            ``(iii) meets such other requirements as 
                        the Secretary may prescribe.''.
    (b) Potential Expansion of Public-Private Partnership Analyses.--
Not later than 2 years after the date of the enactment of this Act, the 
Secretary of Health and Human Services shall conduct a study and submit 
to Congress a report on the feasibility of the partnership (as 
described in section 1128C(a)(6) of the Social Security Act, as added 
by subsection (a)) establishing a system to conduct real-time data 
analysis to proactively identify ongoing as well as emergent fraud 
trends for the entities participating in the partnership and provide 
such entities with real-time feedback on potentially fraudulent claims. 
Such report shall include the estimated cost of and any potential 
barriers to the partnership establishing such a system.
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