[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 5326 Introduced in Senate (IS)]
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119th CONGRESS
2d Session
S. 5326
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.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
August 6, 2026
Ms. Cortez Masto (for herself, Mr. Grassley, Mr. Wyden, and Mr. Crapo)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
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.
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 ``Health Care Fraud Prevention and
Enforcement Act''.
SEC. 2. STRENGTHENING PROGRAM INTEGRITY OVERSIGHT FOR THE HEALTH CARE
FRAUD AND ABUSE CONTROL PROGRAM.
(a) Additional Funding.--
(1) 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--
(A) in subclause (III), by striking ``and'' at the
end;
(B) in subclause (IV)--
(i) by inserting ``and before fiscal year
2027'' after ``after fiscal year 2006''; and
(ii) by striking the period at the end and
inserting a semicolon; and
(C) 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.''.
(2) 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--
(A) in subclause (VIII), by striking ``and'' at the
end;
(B) in subclause (IX)--
(i) by inserting ``and before fiscal year
2027'' after ``after fiscal year 2007''; and
(ii) by striking the period at the end and
inserting a semicolon; and
(C) 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.''.
(3) Federal bureau of investigation.--Section 1817(k)(3)(B)
of the Social Security Act (42 U.S.C. 1395i(k)(3)(B)) is
amended--
(A) in clause (vii), by striking ``and'' at the
end;
(B) in clause (viii)--
(i) by inserting ``and before fiscal year
2027'' after ``after fiscal year 2006''; and
(ii) by striking the period at the end and
inserting a semicolon; and
(C) 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.''.
(4) Medicare integrity program.--Section 1817(k)(4) of the
Social Security Act (42 U.S.C. 1395i(k)(4)) is amended--
(A) in subparagraph (B)--
(i) in clause (vii), by inserting ``and
before fiscal year 2027'' after ``after fiscal
year 2002''; and
(ii) 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).'';
and
(B) 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''.
(5) 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--
(A) in clause (v), by inserting ``through fiscal
year 2026'' after ``and each fiscal year thereafter'';
and
(B) 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).''.
(b) 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--
(1) 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
(2) 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''.
(c) Clarification Concerning the Definition of Health Plan.--
Section 1128C of the Social Security Act (42 U.S.C. 1320a-7c) is
amended--
(1) in subsection (a)(1)(B), by inserting ``public and
private'' before ``delivery''; and
(2) in subsection (c), in the matter preceding paragraph
(1), by inserting ``public or private'' before ``plan or
program''.
(d) 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.''.
(e) Annual Report to Congress.--Section 1817(k)(5) of the Social
Security Act (42 U.S.C. 1395i(k)(5)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively, and indenting appropriately;
(2) by striking ``report.--Not later than January 1'' and
inserting ``report.--
``(A) In general.--Not later than April 1''; and
(3) 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.''.
(f) 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''.
(g) 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--
(1) in paragraph (1)(A)--
(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'';
(B) 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'';
(C) in clause (ii), by inserting ``and the State
Children's Health Insurance Program under title XXI''
after ``under title XIX''; and
(D) in clause (iii), by striking ``both''; and
(2) 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.
(a) 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:
(1) 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).
(2) 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.
(3) 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.
(4) 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)).
(5) An analysis of evidence available regarding the
effectiveness of the Health Care Fraud and Abuse Control
Program in reducing health care fraud and abuse.
(6) 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.
(b) 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.
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