[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 525 Referred in Senate (RFS)]
<DOC>
116th CONGRESS
1st Session
H. R. 525
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 26, 2019
Received; read twice and referred to the Committee on Finance
_______________________________________________________________________
AN ACT
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.
Passed the House of Representatives February 25, 2019.
Attest:
CHERYL L. JOHNSON,
Clerk.