provement and maximum effectiveness in keep-
ing up with ever changing fraud and abuse pat-
terns. Such system shall provide the capability 
to test different treatments or actions randomly 
(typically through use of random digit assign-
ments). 
(K) DECISION
TECHNOLOGY.—The fraud 
prevention system shall have the capability to 
monitor consumer transactions in real-time and 
monitor provider behavior at different stages 
within the transaction flow based upon pro-
vider, transaction and consumer trends. The 
fraud prevention system shall provide for the 
identification of provider and claims excessive 
usage patterns and trends that differ from simi-
lar peer groups, have the capability to trigger 
on multiple criteria, such as predictive model 
scores or custom attributes, and be able to seg-
ment transaction waste, fraud, and abuse into 
multiple types for health care categories and 
business types. 
(L) FEEDBACK LOOP.—The fraud preven-
tion system shall have a feedback loop where all 
Federal health payers provide pre-payment and 
post-payment information about the eventual 
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status of a claim designated as ‘‘Normal’’, 
‘‘Waste’’, ‘‘Fraud’’, ‘‘Abuse’’, or ‘‘Education 
Required’’. Such feedback loop shall enable 
Federal health agencies to measure the actual 
amount of waste, fraud, and abuse as well as 
the savings in the system and provide the abil-
ity to retrain future, enhanced models. Such 
feedback loop shall be an industry file that con-
tains information on previous fraud and abuse 
claims as well as abuse perpetrated by con-
sumers, providers, and fraud rings, to be used 
to alert other payers, as well as for subsequent 
fraud and abuse solution development. 
(M) TRACKING
AND
REPORTING.—The 
fraud prevention system shall ensure that the 
infrastructure exists to ascertain system, strat-
egy, and predictive model return on investment. 
Dynamic model validation and strategy valida-
tion analysis and reporting shall be made avail-
able to ensure a strategy or predictive model 
has not degraded over time or is no longer ef-
fective. Queue reporting shall be established 
and made available for population estimates of 
what claims were flagged, what claims received 
treatment, and ultimately what results oc-
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curred. The capability shall exist to complete 
tracking and reporting for prevention strategies 
and actions residing farther upstream in the 
health care payment flow. The fraud prevention 
system shall establish a reliable metric to meas-
ure the dollars that are never paid due to iden-
tification of fraud and abuse, as well as a capa-
bility to effectively test and estimate the impact 
from different actions and treatments utilized 
to detect and prevent fraud and abuse for legiti-
mate claims. Measuring results shall include 
waste and abuse. 
(N) OPERATING TENET.—The fraud pre-
vention system shall not be designed to deny 
health care services or to negatively impact 
prompt-pay laws because assessments are late. 
The database shall be designed to speed up the 
payment process. The fraud prevention system 
shall require the implementation of constant 
and consistent test and control strategies by 
stakeholders, with results shared with Federal 
health program leadership on a quarterly basis 
to validate improving progress in identifying 
and preventing waste, fraud, and abuse. Under 
such implementation, Federal health care pay-
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ers shall use standard industry waste, fraud, 
and abuse measures of success. 
(2) COORDINATION.—The Deputy Secretary 
shall coordinate the operation of the fraud preven-
tion system with the Department of Justice and 
other related Federal fraud prevention systems. 
(3) OPERATION.—The Deputy Secretary shall 
phase-in the implementation of the system under 
this subsection beginning not later than 18 months 
after the date of enactment of this Act, through the 
analysis of a limited number of Federal health pro-
gram claims. Not later than 5 years after such date 
of enactment, the Deputy Secretary shall ensure 
that such system is fully phased-in and applicable to 
all Federal health program claims. 
(4) NON-PAYMENT
OF
CLAIMS.—The Deputy 
Secretary shall promulgate regulations to prohibit 
the payment of any health care claim that has been 
identified as potentially ‘‘fraudulent’’, ‘‘wasteful’’, or 
‘‘abusive’’ until such time as the claim has been 
verified as valid. 
(5) APPLICATION.—The system under this sec-
tion shall only apply to all Federal health programs, 
including programs established after the date of en-
actment of this Act. 
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(6) REGULATIONS.—The Deputy Secretary 
shall promulgate regulations providing the maximum 
appropriate protection of personal privacy consistent 
with carrying out the Office’s responsibilities under 
this section. 
(e) PROTECTING PARTICIPATION IN HEALTH CARE 
ANTIFRAUD PROGRAMS.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, no person providing information to 
the Secretary under this section shall be held, by 
reason of having provided such information, to have 
violated any criminal law, or to be civilly liable under 
any law of the United States or of any State (or po-
litical subdivision thereof) unless such information is 
false and the person providing it knew, or had rea-
son to believe, that such information was false. 
(2) 
CONFIDENTIALITY.—The 
Office 
shall, 
through the promulgation of regulations, establish 
standards for— 
(A) the protection of confidential informa-
tion submitted or obtained with regard to sus-
pected or actual health care fraud; 
(B) the protection of the ability of rep-
resentatives the Office to testify in private civil 
actions concerning any such information; and 
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