IIB 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Strengthening the 

3 Health Care Fraud Prevention Task Force Act of 2019’’. 

4 SEC. 2. PUBLIC-PRIVATE PARTNERSHIP FOR HEALTH CARE 

5 WASTE, FRAUD, AND ABUSE DETECTION. 

6 (a) IN GENERAL.—Section 1128C(a) of the Social 

7 Security Act (42 U.S.C. 1320a–7c(a)) is amended by add8 ing at the end the following new paragraph: 

9 ‘‘(6) PUBLIC-PRIVATE PARTNERSHIP FOR

10 WASTE, FRAUD, AND ABUSE DETECTION.— 

11 ‘‘(A) IN GENERAL.—Under the program 

12 described in paragraph (1), there is established 

13 a public-private partnership (in this paragraph 

14 referred to as the ‘partnership’) of health plans, 

15 Federal and State agencies, law enforcement 

16 agencies, health care anti-fraud organizations, 

17 and any other entity determined appropriate by 

18 the Secretary (in this paragraph referred to as 

19 ‘partners’) for purposes of detecting and pre20 venting health care waste, fraud, and abuse. 

21 ‘‘(B) CONTRACT WITH TRUSTED THIRD

22 PARTY.—In carrying out the partnership, the 

23 Secretary shall enter into a contract with a 

24 trusted third party for purposes of carrying out 

25 the duties of the partnership described in sub26 paragraph (C). 


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1 ‘‘(C) DUTIES OF PARTNERSHIP.—The 

2 partnership shall— 

3 ‘‘(i) provide technical and operational 

4 support to facilitate data sharing between 

5 partners in the partnership; 

6 ‘‘(ii) analyze data so shared to iden7 tify fraudulent and aberrant billing pat8 terns; 

9 ‘‘(iii) conduct aggregate analyses of 

10 health care data so shared across Federal, 

11 State, and private health plans for pur12 poses of detecting fraud, waste, and abuse 

13 schemes; 

14 ‘‘(iv) identify outlier trends and poten15 tial vulnerabilities of partners in the part16 nership with respect to such schemes; 

17 ‘‘(v) refer specific cases of potential 

18 unlawful conduct to appropriate govern19 mental entities; 

20 ‘‘(vi) convene, not less than annually, 

21 meetings with partners in the partnership 

22 for purposes of providing updates on the 

23 partnership’s work and facilitating infor24 mation sharing between the partners; 


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HR 525 RFS

1 ‘‘(vii) enter into data sharing and 

2 data use agreements with partners in the 

3 partnership in such a manner so as to en4 sure the partnership has access to data 

5 necessary to identify waste, fraud, and 

6 abuse while maintaining the confidentiality 

7 and integrity of such data; 

8 ‘‘(viii) provide partners in the partner9 ship with plan-specific, confidential feed10 back on any aberrant billing patterns or 

11 potential fraud identified by the partner12 ship with respect to such partner; 

13 ‘‘(ix) establish a process by which en14 tities described in subparagraph (A) may 

15 enter the partnership and requirements 

16 such entities must meet to enter the part17 nership; 

18 ‘‘(x) provide appropriate training, out19 reach, and education to partners based on 

20 the results of data analyses described in 

21 clauses (ii) and (iii); and 

22 ‘‘(xi) perform such other duties as the 

23 Secretary determines appropriate. 

24 ‘‘(D) SUBSTANCE USE DISORDER TREAT25 MENT ANALYSIS.—Not later than 2 years after 


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1 the date of the enactment of the Strengthening 

2 the Health Care Fraud Prevention Task Force 

3 Act of 2019, the trusted third party with a con4 tract in effect under subparagraph (B) shall 

5 perform an analysis of aberrant or fraudulent 

6 billing patterns and trends with respect to pro7 viders and suppliers of substance use disorder 

8 treatments from data shared with the partner9 ship. 

10 ‘‘(E) EXECUTIVE BOARD.— 

11 ‘‘(i) EXECUTIVE BOARD COMPOSI12 TION.— 

13 ‘‘(I) IN GENERAL.—There shall 

14 be an executive board of the partner15 ship comprised of representatives of 

16 the Federal Government and rep17 resentatives of the private sector se18 lected by the Secretary. 

19 ‘‘(II) CHAIRS.—The executive 

20 board shall be co-chaired by one Fed21 eral Government official and one rep22 resentative from the private sector. 

23 ‘‘(ii) MEETINGS.—The executive 

24 board of the partnership shall meet at 

25 least once per year. 


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1 ‘‘(iii) EXECUTIVE BOARD DUTIES.— 

2 The duties of the executive board shall in3 clude the following: 

4 ‘‘(I) Providing strategic direction 

5 for the partnership, including mem6 bership criteria and a mission state7 ment. 

8 ‘‘(II) Communicating with the 

9 leadership of the Department of 

10 Health and Human Services and the 

11 Department of Justice and the var12 ious private health sector associations. 

13 ‘‘(F) REPORTS.—Not later than September 

14 30, 2021, and every 2 years thereafter, the Sec15 retary shall submit to Congress and make avail16 able on the public website of the Centers for 

17 Medicare & Medicaid Services a report con18 taining— 

19 ‘‘(i) a review of activities conducted by 

20 the partnership over the 2-year period end21 ing on the date of the submission of such 

22 report, including any progress to any ob23 jectives established by the partnership; 

24 ‘‘(ii) any savings voluntarily reported 

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1 nership attributable to the partnership 

2 during such period; 

3 ‘‘(iii) any savings to the Federal Gov4 ernment attributable to the partnership 

5 during such period; 

6 ‘‘(iv) any other outcomes attributable 

7 to the partnership, as determined by the 

8 Secretary, during such period; and 

9 ‘‘(v) a strategic plan for the 2-year 

10 period beginning on the day after the date 

11 of the submission of such report, including 

12 a description of any emerging fraud and 

13 abuse schemes, trends, or practices that 

14 the partnership intends to study during 

15 such period. 

16 ‘‘(G) FUNDING.—The partnership shall be 

17 funded by amounts otherwise made available to 

18 the Secretary for carrying out the program de19 scribed in paragraph (1). 

20 ‘‘(H) TRANSITIONAL PROVISIONS.—To the 

21 extent consistent with this subsection, all func22 tions, personnel, assets, liabilities, and adminis23 trative actions applicable on the date before the 

24 date of the enactment of this paragraph to the 

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1 lished on September 17, 2012, by charter of the 

2 Secretary shall be transferred to the partner3 ship established under subparagraph (A) as of 

4 the date of the enactment of this paragraph. 

5 ‘‘(I) NONAPPLICABILITY OF FACA.—The 

6 provisions of the Federal Advisory Committee 

7 Act shall not apply to the partnership estab8 lished by subparagraph (A). 

9 ‘‘(J) IMPLEMENTATION.—Notwithstanding 

10 any other provision of law, the Secretary may 

11 implement the partnership established by sub12 paragraph (A) by program instruction or other13 wise. 

14 ‘‘(K) DEFINITION.—For purposes of this 

15 paragraph, the term ‘trusted third party’ means 

16 an entity that— 

17 ‘‘(i) demonstrates the capability to 

18 carry out the duties of the partnership de19 scribed in subparagraph (C); 

20 ‘‘(ii) complies with such conflict of in21 terest standards determined appropriate by 

22 the Secretary; and 

23 ‘‘(iii) meets such other requirements 

24 as the Secretary may prescribe.’’. 


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1 (b) POTENTIAL EXPANSION OF PUBLIC-PRIVATE

2 PARTNERSHIP ANALYSES.—Not later than 2 years after 

3 the date of the enactment of this Act, the Secretary of 

4 Health and Human Services shall conduct a study and 

5 submit to Congress a report on the feasibility of the part6 nership (as described in section 1128C(a)(6) of the Social 

7 Security Act, as added by subsection (a)) establishing a 

8 system to conduct real-time data analysis to proactively 

9 identify ongoing as well as emergent fraud trends for the 

10 entities participating in the partnership and provide such 

11 entities with real-time feedback on potentially fraudulent 

12 claims. Such report shall include the estimated cost of and 

13 any potential barriers to the partnership establishing such 

14 a system. 

Passed the House of Representatives February 25, 

2019. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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