I 

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. 

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

3 SECTION 1. SHORT TITLE. 

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

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


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

2 WASTE, FRAUD, AND ABUSE DETECTION. 

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

4 Security Act (42 U.S.C. 1320a–7c(a)) is amended by add5 ing at the end the following new paragraph: 

6 ‘‘(6) PUBLIC-PRIVATE PARTNERSHIP FOR

7 WASTE, FRAUD, AND ABUSE DETECTION.— 

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

9 described in paragraph (1), there is established 

10 a public-private partnership (in this paragraph 

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

12 Federal and State agencies, law enforcement 

13 agencies, health care anti-fraud organizations, 

14 and any other entity determined appropriate by 

15 the Secretary (in this paragraph referred to as 

16 ‘partners’) for purposes of detecting and pre17 venting health care waste, fraud, and abuse. 

18 ‘‘(B) CONTRACT WITH TRUSTED THIRD

19 PARTY.—In carrying out the partnership, the 

20 Secretary shall enter into a contract with a 

21 trusted third party for purposes of carrying out 

22 the duties of the partnership described in sub23 paragraph (C). 

24 ‘‘(C) DUTIES OF PARTNERSHIP.—The 

25 partnership shall— 


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1 ‘‘(i) provide technical and operational 

2 support to facilitate data sharing between 

3 partners in the partnership; 

4 ‘‘(ii) analyze data so shared to iden5 tify fraudulent and aberrant billing pat6 terns; 

7 ‘‘(iii) conduct aggregate analyses of 

8 health care data so shared across Federal, 

9 State, and private health plans for pur10 poses of detecting fraud, waste, and abuse 

11 schemes; 

12 ‘‘(iv) identify outlier trends and poten13 tial vulnerabilities of partners in the part14 nership with respect to such schemes; 

15 ‘‘(v) refer specific cases of potential 

16 unlawful conduct to appropriate govern17 mental entities; 

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

19 meetings with partners in the partnership 

20 for purposes of providing updates on the 

21 partnership’s work and facilitating infor22 mation sharing between the partners; 

23 ‘‘(vii) enter into data sharing and 

24 data use agreements with partners in the 

25 partnership in such a manner so as to enVerDate Sep 11 2014 01:21 Jan 26, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H525.IH H525

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1 sure the partnership has access to data 

2 necessary to identify waste, fraud, and 

3 abuse while maintaining the confidentiality 

4 and integrity of such data; 

5 ‘‘(viii) provide partners in the partner6 ship with plan-specific, confidential feed7 back on any aberrant billing patterns or 

8 potential fraud identified by the partner9 ship with respect to such partner; 

10 ‘‘(ix) establish a process by which en11 tities described in subparagraph (A) may 

12 enter the partnership and requirements 

13 such entities must meet to enter the part14 nership; 

15 ‘‘(x) provide appropriate training, out16 reach, and education to partners based on 

17 the results of data analyses described in 

18 clauses (ii) and (iii); and 

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

20 Secretary determines appropriate. 

21 ‘‘(D) SUBSTANCE USE DISORDER TREAT22 MENT ANALYSIS.—Not later than 2 years after 

23 the date of the enactment of the Strengthening 

24 the Health Care Fraud Prevention Task Force 

25 Act of 2019, the trusted third party with a conVerDate Sep 11 2014 01:21 Jan 26, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H525.IH H525

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1 tract in effect under subparagraph (B) shall 

2 perform an analysis of aberrant or fraudulent 

3 billing patterns and trends with respect to pro4 viders and suppliers of substance use disorder 

5 treatments from data shared with the partner6 ship. 

7 ‘‘(E) EXECUTIVE BOARD.— 

8 ‘‘(i) EXECUTIVE BOARD COMPOSI9 TION.— 

10 ‘‘(I) IN GENERAL.—There shall 

11 be an executive board of the partner12 ship comprised of representatives of 

13 the Federal Government and rep14 resentatives of the private sector se15 lected by the Secretary. 

16 ‘‘(II) CHAIRS.—The executive 

17 board shall be co-chaired by one Fed18 eral Government official and one rep19 resentative from the private sector. 

20 ‘‘(ii) MEETINGS.—The executive 

21 board of the partnership shall meet at 

22 least once per year. 

23 ‘‘(iii) EXECUTIVE BOARD DUTIES.— 

24 The duties of the executive board shall in25 clude the following: 


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1 ‘‘(I) Providing strategic direction 

2 for the partnership, including mem3 bership criteria and a mission state4 ment. 

5 ‘‘(II) Communicating with the 

6 leadership of the Department of 

7 Health and Human Services and the 

8 Department of Justice and the var9 ious private health sector associations. 

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

11 30, 2021, and every 2 years thereafter, the Sec12 retary shall submit to Congress and make avail13 able on the public website of the Centers for 

14 Medicare & Medicaid Services a report con15 taining— 

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

17 the partnership over the 2-year period end18 ing on the date of the submission of such 

19 report, including any progress to any ob20 jectives established by the partnership; 

21 ‘‘(ii) any savings voluntarily reported 

22 by health plans participating in the part23 nership attributable to the partnership 

24 during such period; 


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1 ‘‘(iii) any savings to the Federal Gov2 ernment attributable to the partnership 

3 during such period; 

4 ‘‘(iv) any other outcomes attributable 

5 to the partnership, as determined by the 

6 Secretary, during such period; and 

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

8 period beginning on the day after the date 

9 of the submission of such report, including 

10 a description of any emerging fraud and 

11 abuse schemes, trends, or practices that 

12 the partnership intends to study during 

13 such period. 

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

15 funded by amounts otherwise made available to 

16 the Secretary for carrying out the program de17 scribed in paragraph (1). 

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

19 extent consistent with this subsection, all func20 tions, personnel, assets, liabilities, and adminis21 trative actions applicable on the date before the 

22 date of the enactment of this paragraph to the 

23 National Fraud Prevention Partnership estab24 lished on September 17, 2012, by charter of the 

25 Secretary shall be transferred to the partnerVerDate Sep 11 2014 01:21 Jan 26, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H525.IH H525

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1 ship established under subparagraph (A) as of 

2 the date of the enactment of this paragraph. 

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

4 provisions of the Federal Advisory Committee 

5 Act shall not apply to the partnership estab6 lished by subparagraph (A). 

7 ‘‘(J) IMPLEMENTATION.—Notwithstanding 

8 any other provision of law, the Secretary may 

9 implement the partnership established by sub10 paragraph (A) by program instruction or other11 wise. 

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

13 paragraph, the term ‘trusted third party’ means 

14 an entity that— 

15 ‘‘(i) demonstrates the capability to 

16 carry out the duties of the partnership de17 scribed in subparagraph (C); 

18 ‘‘(ii) complies with such conflict of in19 terest standards determined appropriate by 

20 the Secretary; and 

21 ‘‘(iii) meets such other requirements 

22 as the Secretary may prescribe.’’. 

23 (b) POTENTIAL EXPANSION OF PUBLIC-PRIVATE

24 PARTNERSHIP ANALYSES.—Not later than 2 years after 

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


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1 Health and Human Services shall conduct a study and 

2 submit to Congress a report on the feasibility of the part3 nership (as described in section 1128C(a)(6) of the Social 

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

5 system to conduct real-time data analysis to proactively 

6 identify ongoing as well as emergent fraud trends for the 

7 entities participating in the partnership and provide such 

8 entities with real-time feedback on potentially fraudulent 

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

10 any potential barriers to the partnership establishing such 

11 a system. 

Æ 


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