I 

114TH CONGRESS 

2D SESSION H. R. 5241 

To amend title XVIII of the Social Security Act to distribute additional 

information to Medicare beneficiaries to prevent health care fraud, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 13, 2016 

Mr. RUIZ 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 XVIII of the Social Security Act to distribute 

additional information to Medicare beneficiaries to prevent health care fraud, and for other purposes. 

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; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Protecting Seniors from Health Care Fraud Act of 

6 2016’’. 

7 (b) FINDINGS.—Congress finds the following: 

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1 (1) Seniors are more vulnerable to fraud than 

2 the general population. 

3 (2) Because seniors require more health care 

4 services than the general population, they need more 

5 information on health care schemes so they can pro6 tect themselves. 

7 (3) The Department of Health and Human 

8 Services should provide more up-to-date information 

9 in order to educate seniors on health care scams. 

10 SEC. 2. DISTRIBUTION OF ADDITIONAL INFORMATION TO 

11 SENIORS TO PREVENT HEALTH CARE FRAUD. 

12 Section 1804 of the Social Security Act (42 U.S.C. 

13 1395b–2) is amended by adding at the end the following 

14 new subsection: 

15 ‘‘(d) DISTRIBUTION OF ADDITIONAL INFORMATION

16 ON HEALTH CARE FRAUD.— 

17 ‘‘(1) ANNUAL REPORTS ON HEALTH CARE

18 FRAUD SCHEMES.— 

19 ‘‘(A) IN GENERAL.—In connection with the 

20 Health Care Fraud and Abuse Control Program 

21 established under section 1128C, the Secretary, 

22 acting through the Office of the Inspector Gen23 eral of the Department of Health and Human 

24 Services, and the Attorney General, shall trans25 mit to Congress, and make available to the pubmstockstill on DSK3G9T082PROD with BILLS

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1 lic, an annual report on health care fraud 

2 schemes that are targeted to seniors and steps 

3 that are being taken to combat such schemes 

4 and to educate seniors concerning such 

5 schemes. The first such report shall be trans6 mitted and made available not later than 2 

7 years after the date of the enactment of this 

8 subsection. 

9 ‘‘(B) CONTENTS OF REPORTS.— 

10 ‘‘(i) IN GENERAL.—Subject to clause 

11 (ii), each annual report under subpara12 graph (A) shall include the following infor13 mation: 

14 ‘‘(I) IDENTIFICATION OF MOST

15 PREVALENT FRAUD SCHEMES.—The 

16 identification of the 10 most prevalent 

17 health care fraud schemes that are 

18 targeted to seniors and the prevalence 

19 and trends in such schemes. 

20 ‘‘(II) PROTECTION OF SEN21 IORS.—Actions that seniors and law 

22 enforcement and government agencies 

23 are taking and can take to combat 

24 such schemes and to protect seniors 

25 against health care fraud schemes. 

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1 ‘‘(III) ADDITIONAL SUGGES2 TIONS.—Policy suggestions to improve 

3 protections for seniors, including 

4 whether the additional information 

5 provided under this subsection is help6 ing seniors in protecting them against 

7 fraud. 

8 ‘‘(ii) LIMITATIONS.—The Secretary 

9 may— 

10 ‘‘(I) omit information from an 

11 annual report on fraud schemes tar12 geting seniors if public disclosure of 

13 the information would compromise an 

14 ongoing investigation; and 

15 ‘‘(II) report information on fraud 

16 schemes by categories in an annual 

17 report if a more detailed disclosure of 

18 such a scheme would educate crimi19 nals rather than seniors. 

20 ‘‘(iii) PRIVATE-PUBLIC PARTNER21 SHIP.—The Secretary, acting through the 

22 Office of the Inspector General of the De23 partment of Health and Human Services 

24 and the Attorney General, may enter into 

25 an arrangement between public and private 

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1 partners to develop the report that identi2 fies the top 10 most prevalent health care 

3 fraud schemes and the associated report 

4 information. 

5 ‘‘(C) QUARTERLY UPDATING.—The infor6 mation described in clauses (i) and (ii) of sub7 paragraph (B) shall be updated quarterly to re8 flect changes in fraud schemes and methods to 

9 combat and educate seniors concerning such 

10 schemes. 

11 ‘‘(D) LANGUAGES.—Such reports, as up12 dated, shall be available in English and Span13 ish. 

14 ‘‘(2) DISSEMINATION OF REPORTS AND TOP 10

15 LIST.— 

16 ‘‘(A) IN GENERAL.—The Secretary shall— 

17 ‘‘(i) disseminate the reports under 

18 paragraph (1) to Medicare beneficiaries 

19 through mechanisms that reach the most 

20 Medicare beneficiaries; and 

21 ‘‘(ii) provide for the mailing to each 

22 Medicare beneficiary of a list of the top 10 

23 most prevalent health care fraud schemes. 

24 ‘‘(B) QUARTERLY UPDATES OF TOP 10

25 LIST INCLUDED WITH MEDICARE SUMMARY NOmstockstill on DSK3G9T082PROD with BILLS

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1 TICES.—The Secretary shall include an updated 

2 list of the top 10 most prevalent health care 

3 fraud schemes under paragraph (1)(C) with the 

4 quarterly Medicare summary notices mailed to 

5 Medicare beneficiaries. 

6 ‘‘(C) POSTING OF REPORTS AND QUAR7 TERLY UPDATES ON WEBSITES.—The annual 

8 reports, and quarterly updates, under this sub9 section shall be posted on the website of the 

10 Health Care Fraud and Abuse Control Program 

11 and on other websites maintained or supported 

12 by the Secretary relating to the Medicare pro13 gram, the State Health Insurance Assistance 

14 Program, and Senior Medicare Patrol of the 

15 Administration on Aging. 

16 ‘‘(3) SOURCES OF INFORMATION FOR RE17 PORTS.—Information for the reports and updates 

18 under paragraph (1) shall be gathered from at least 

19 the following sources: 

20 ‘‘(A) DEPARTMENT OF HEALTH AND

21 HUMAN SERVICES.—The following sources with22 in the Department of Health and Human Serv23 ices: 

24 ‘‘(i) Medicare hotlines, including 1– 

25 800–MEDICARE, 1–800–HHSTIPS, and 

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1 Medicare fraud toll-free hotlines and 

2 websites (such as 

3 www.stopmedicarefraud.gov) established by 

4 the Office of the Inspector General of the 

5 Department of Health and Human Serv6 ices and the Centers for Medicare & Med7 icaid Services. 

8 ‘‘(ii) State Health Insurance Assist9 ance Programs (SHIPs). 

10 ‘‘(iii) The Administration on Commu11 nity Living, including— 

12 ‘‘(I) the Senior Medicare Patrol 

13 (SMP) of the Administration on 

14 Aging; and 

15 ‘‘(II) Aging and Disability Re16 source Centers. 

17 ‘‘(iv) Medicare administrative contrac18 tors, fiscal intermediaries, and other con19 tractors with the Centers for Medicare & 

20 Medicaid Services performing functions 

21 which may relate to fraud and abuse under 

22 the Medicare program. 

23 ‘‘(v) The Indian Health Service. 

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1 ‘‘(B) DEPARTMENT OF JUSTICE.—The De2 partment of Justice, including the Federal Bu3 reau of Investigation. 

4 ‘‘(C) SSA.—The Social Security Adminis5 tration. 

6 ‘‘(D) FTC.—The Federal Trade Commis7 sion. 

8 ‘‘(E) OPTIONAL ADDITIONAL SOURCES.— 

9 At the option of the Secretary— 

10 ‘‘(i) State agencies that deal with 

11 elder abuse; and 

12 ‘‘(ii) other governmental and non13 governmental entities with expertise in the 

14 protection of seniors from health care 

15 fraud as deemed appropriate.’’. 

Æ 

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