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) intro-
duced 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Strengthening the 
Health Care Fraud Prevention Task Force Act of 2019’’. 
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS
SEC. 2. PUBLIC-PRIVATE PARTNERSHIP FOR HEALTH CARE 
WASTE, FRAUD, AND ABUSE DETECTION. 
(a) IN GENERAL.—Section 1128C(a) of the Social 
Security Act (42 U.S.C. 1320a–7c(a)) is amended by add-
ing at the end the following new paragraph: 
‘‘(6) 
PUBLIC-PRIVATE
PARTNERSHIP
FOR 
WASTE, FRAUD, AND ABUSE DETECTION.— 
‘‘(A) IN
GENERAL.—Under the program 
described in paragraph (1), there is established 
a public-private partnership (in this paragraph 
referred to as the ‘partnership’) of health plans, 
Federal and State agencies, law enforcement 
agencies, health care anti-fraud organizations, 
and any other entity determined appropriate by 
the Secretary (in this paragraph referred to as 
‘partners’) for purposes of detecting and pre-
venting health care waste, fraud, and abuse. 
‘‘(B) CONTRACT
WITH
TRUSTED
THIRD 
PARTY.—In carrying out the partnership, the 
Secretary shall enter into a contract with a 
trusted third party for purposes of carrying out 
the duties of the partnership described in sub-
paragraph (C). 
‘‘(C) 
DUTIES
OF
PARTNERSHIP.—The 
partnership shall— 
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS
‘‘(i) provide technical and operational 
support to facilitate data sharing between 
partners in the partnership; 
‘‘(ii) analyze data so shared to iden-
tify fraudulent and aberrant billing pat-
terns; 
‘‘(iii) conduct aggregate analyses of 
health care data so shared across Federal, 
State, and private health plans for pur-
poses of detecting fraud, waste, and abuse 
schemes; 
‘‘(iv) identify outlier trends and poten-
tial vulnerabilities of partners in the part-
nership with respect to such schemes; 
‘‘(v) refer specific cases of potential 
unlawful conduct to appropriate govern-
mental entities; 
‘‘(vi) convene, not less than annually, 
meetings with partners in the partnership 
for purposes of providing updates on the 
partnership’s work and facilitating infor-
mation sharing between the partners; 
‘‘(vii) enter into data sharing and 
data use agreements with partners in the 
partnership in such a manner so as to en-
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS
sure the partnership has access to data 
necessary to identify waste, fraud, and 
abuse while maintaining the confidentiality 
and integrity of such data; 
‘‘(viii) provide partners in the partner-
ship with plan-specific, confidential feed-
back on any aberrant billing patterns or 
potential fraud identified by the partner-
ship with respect to such partner; 
‘‘(ix) establish a process by which en-
tities described in subparagraph (A) may 
enter the partnership and requirements 
such entities must meet to enter the part-
nership; 
‘‘(x) provide appropriate training, out-
reach, and education to partners based on 
the results of data analyses described in 
clauses (ii) and (iii); and 
‘‘(xi) perform such other duties as the 
Secretary determines appropriate. 
‘‘(D) SUBSTANCE USE DISORDER TREAT-
MENT ANALYSIS.—Not later than 2 years after 
the date of the enactment of the Strengthening 
the Health Care Fraud Prevention Task Force 
Act of 2019, the trusted third party with a con-
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS
tract in effect under subparagraph (B) shall 
perform an analysis of aberrant or fraudulent 
billing patterns and trends with respect to pro-
viders and suppliers of substance use disorder 
treatments from data shared with the partner-
ship. 
‘‘(E) EXECUTIVE BOARD.— 
‘‘(i) EXECUTIVE
BOARD
COMPOSI-
TION.— 
‘‘(I) IN
GENERAL.—There shall 
be an executive board of the partner-
ship comprised of representatives of 
the Federal Government and rep-
resentatives of the private sector se-
lected by the Secretary. 
‘‘(II) 
CHAIRS.—The 
executive 
board shall be co-chaired by one Fed-
eral Government official and one rep-
resentative from the private sector. 
‘‘(ii) 
MEETINGS.—The 
executive 
board of the partnership shall meet at 
least once per year. 
‘‘(iii) EXECUTIVE
BOARD
DUTIES.— 
The duties of the executive board shall in-
clude the following: 
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS
‘‘(I) Providing strategic direction 
for the partnership, including mem-
bership criteria and a mission state-
ment. 
‘‘(II) Communicating with the 
leadership of the Department of 
Health and Human Services and the 
Department of Justice and the var-
ious private health sector associations. 
‘‘(F) REPORTS.—Not later than September 
30, 2021, and every 2 years thereafter, the Sec-
retary shall submit to Congress and make avail-
able on the public website of the Centers for 
Medicare & Medicaid Services a report con-
taining— 
‘‘(i) a review of activities conducted by 
the partnership over the 2-year period end-
ing on the date of the submission of such 
report, including any progress to any ob-
jectives established by the partnership; 
‘‘(ii) any savings voluntarily reported 
by health plans participating in the part-
nership attributable to the partnership 
during such period; 
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS
‘‘(iii) any savings to the Federal Gov-
ernment attributable to the partnership 
during such period; 
‘‘(iv) any other outcomes attributable 
to the partnership, as determined by the 
Secretary, during such period; and 
‘‘(v) a strategic plan for the 2-year 
period beginning on the day after the date 
of the submission of such report, including 
a description of any emerging fraud and 
abuse schemes, trends, or practices that 
the partnership intends to study during 
such period. 
‘‘(G) FUNDING.—The partnership shall be 
funded by amounts otherwise made available to 
the Secretary for carrying out the program de-
scribed in paragraph (1). 
‘‘(H) TRANSITIONAL PROVISIONS.—To the 
extent consistent with this subsection, all func-
tions, personnel, assets, liabilities, and adminis-
trative actions applicable on the date before the 
date of the enactment of this paragraph to the 
National Fraud Prevention Partnership estab-
lished on September 17, 2012, by charter of the 
Secretary shall be transferred to the partner-
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS
ship established under subparagraph (A) as of 
the date of the enactment of this paragraph. 
‘‘(I) NONAPPLICABILITY
OF
FACA.—The 
provisions of the Federal Advisory Committee 
Act shall not apply to the partnership estab-
lished by subparagraph (A). 
‘‘(J) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement the partnership established by sub-
paragraph (A) by program instruction or other-
wise. 
‘‘(K) DEFINITION.—For purposes of this 
paragraph, the term ‘trusted third party’ means 
an entity that— 
‘‘(i) demonstrates the capability to 
carry out the duties of the partnership de-
scribed in subparagraph (C); 
‘‘(ii) complies with such conflict of in-
terest standards determined appropriate by 
the Secretary; and 
‘‘(iii) meets such other requirements 
as the Secretary may prescribe.’’. 
(b) POTENTIAL EXPANSION
OF PUBLIC-PRIVATE 
PARTNERSHIP ANALYSES.—Not later than 2 years after 
the date of the enactment of this Act, the Secretary of 
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS
Health and Human Services shall conduct a study and 
submit to Congress a report on the feasibility of the part-
nership (as described in section 1128C(a)(6) of the Social 
Security Act, as added by subsection (a)) establishing a 
system to conduct real-time data analysis to proactively 
identify ongoing as well as emergent fraud trends for the 
entities participating in the partnership and provide such 
entities with real-time feedback on potentially fraudulent 
claims. Such report shall include the estimated cost of and 
any potential barriers to the partnership establishing such 
a system. 
Æ 
VerDate Sep 11 2014 
01:21 Jan 26, 2019
Jkt 089200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6301
E:\BILLS\H525.IH
H525
pamtmann on DSKBFK8HB2PROD with BILLS