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 juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to distribute 
additional information to Medicare beneficiaries to pre-
vent health care fraud, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Protecting Seniors from Health Care Fraud Act of 
2016’’. 
(b) FINDINGS.—Congress finds the following: 
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(1) Seniors are more vulnerable to fraud than 
the general population. 
(2) Because seniors require more health care 
services than the general population, they need more 
information on health care schemes so they can pro-
tect themselves. 
(3) The Department of Health and Human 
Services should provide more up-to-date information 
in order to educate seniors on health care scams. 
SEC. 2. DISTRIBUTION OF ADDITIONAL INFORMATION TO 
SENIORS TO PREVENT HEALTH CARE FRAUD. 
Section 1804 of the Social Security Act (42 U.S.C. 
1395b–2) is amended by adding at the end the following 
new subsection: 
‘‘(d) DISTRIBUTION OF ADDITIONAL INFORMATION 
ON HEALTH CARE FRAUD.— 
‘‘(1) ANNUAL
REPORTS
ON
HEALTH
CARE 
FRAUD SCHEMES.— 
‘‘(A) IN GENERAL.—In connection with the 
Health Care Fraud and Abuse Control Program 
established under section 1128C, the Secretary, 
acting through the Office of the Inspector Gen-
eral of the Department of Health and Human 
Services, and the Attorney General, shall trans-
mit to Congress, and make available to the pub-
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lic, an annual report on health care fraud 
schemes that are targeted to seniors and steps 
that are being taken to combat such schemes 
and 
to 
educate 
seniors 
concerning 
such 
schemes. The first such report shall be trans-
mitted and made available not later than 2 
years after the date of the enactment of this 
subsection. 
‘‘(B) CONTENTS OF REPORTS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), each annual report under subpara-
graph (A) shall include the following infor-
mation: 
‘‘(I) IDENTIFICATION
OF
MOST 
PREVALENT
FRAUD
SCHEMES.—The 
identification of the 10 most prevalent 
health care fraud schemes that are 
targeted to seniors and the prevalence 
and trends in such schemes. 
‘‘(II) 
PROTECTION
OF
SEN-
IORS.—Actions that seniors and law 
enforcement and government agencies 
are taking and can take to combat 
such schemes and to protect seniors 
against health care fraud schemes. 
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‘‘(III) 
ADDITIONAL
SUGGES-
TIONS.—Policy suggestions to improve 
protections 
for 
seniors, 
including 
whether the additional information 
provided under this subsection is help-
ing seniors in protecting them against 
fraud. 
‘‘(ii) LIMITATIONS.—The Secretary 
may— 
‘‘(I) omit information from an 
annual report on fraud schemes tar-
geting seniors if public disclosure of 
the information would compromise an 
ongoing investigation; and 
‘‘(II) report information on fraud 
schemes by categories in an annual 
report if a more detailed disclosure of 
such a scheme would educate crimi-
nals rather than seniors. 
‘‘(iii) 
PRIVATE-PUBLIC
PARTNER-
SHIP.—The Secretary, acting through the 
Office of the Inspector General of the De-
partment of Health and Human Services 
and the Attorney General, may enter into 
an arrangement between public and private 
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partners to develop the report that identi-
fies the top 10 most prevalent health care 
fraud schemes and the associated report 
information. 
‘‘(C) QUARTERLY UPDATING.—The infor-
mation described in clauses (i) and (ii) of sub-
paragraph (B) shall be updated quarterly to re-
flect changes in fraud schemes and methods to 
combat and educate seniors concerning such 
schemes. 
‘‘(D) LANGUAGES.—Such reports, as up-
dated, shall be available in English and Span-
ish. 
‘‘(2) DISSEMINATION OF REPORTS AND TOP 10 
LIST.— 
‘‘(A) IN GENERAL.—The Secretary shall— 
‘‘(i) disseminate the reports under 
paragraph (1) to Medicare beneficiaries 
through mechanisms that reach the most 
Medicare beneficiaries; and 
‘‘(ii) provide for the mailing to each 
Medicare beneficiary of a list of the top 10 
most prevalent health care fraud schemes. 
‘‘(B) QUARTERLY
UPDATES
OF
TOP
LIST INCLUDED WITH MEDICARE SUMMARY NO-
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TICES.—The Secretary shall include an updated 
list of the top 10 most prevalent health care 
fraud schemes under paragraph (1)(C) with the 
quarterly Medicare summary notices mailed to 
Medicare beneficiaries. 
‘‘(C) POSTING
OF
REPORTS
AND
QUAR-
TERLY
UPDATES
ON
WEBSITES.—The annual 
reports, and quarterly updates, under this sub-
section shall be posted on the website of the 
Health Care Fraud and Abuse Control Program 
and on other websites maintained or supported 
by the Secretary relating to the Medicare pro-
gram, the State Health Insurance Assistance 
Program, and Senior Medicare Patrol of the 
Administration on Aging. 
‘‘(3) SOURCES
OF
INFORMATION
FOR
RE-
PORTS.—Information for the reports and updates 
under paragraph (1) shall be gathered from at least 
the following sources: 
‘‘(A) DEPARTMENT
OF
HEALTH
AND 
HUMAN SERVICES.—The following sources with-
in the Department of Health and Human Serv-
ices: 
‘‘(i) Medicare hotlines, including 1– 
800–MEDICARE, 1–800–HHSTIPS, and 
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Medicare fraud toll-free hotlines and 
websites 
(such 
as 
www.stopmedicarefraud.gov) established by 
the Office of the Inspector General of the 
Department of Health and Human Serv-
ices and the Centers for Medicare & Med-
icaid Services. 
‘‘(ii) State Health Insurance Assist-
ance Programs (SHIPs). 
‘‘(iii) The Administration on Commu-
nity Living, including— 
‘‘(I) the Senior Medicare Patrol 
(SMP) of the Administration on 
Aging; and 
‘‘(II) Aging and Disability Re-
source Centers. 
‘‘(iv) Medicare administrative contrac-
tors, fiscal intermediaries, and other con-
tractors with the Centers for Medicare & 
Medicaid Services performing functions 
which may relate to fraud and abuse under 
the Medicare program. 
‘‘(v) The Indian Health Service. 
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‘‘(B) DEPARTMENT OF JUSTICE.—The De-
partment of Justice, including the Federal Bu-
reau of Investigation. 
‘‘(C) SSA.—The Social Security Adminis-
tration. 
‘‘(D) FTC.—The Federal Trade Commis-
sion. 
‘‘(E) OPTIONAL ADDITIONAL SOURCES.— 
At the option of the Secretary— 
‘‘(i) State agencies that deal with 
elder abuse; and 
‘‘(ii) other governmental and non-
governmental entities with expertise in the 
protection of seniors from health care 
fraud as deemed appropriate.’’. 
Æ 
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