I 
115TH CONGRESS 
2D SESSION 
H. R. 6753 
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 
SEPTEMBER 7, 2018 
Mr. WALDEN (for himself and Mr. PALLONE) 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 subse-
quently 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 2018’’. 
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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, and health care anti-fraud organiza-
tions (in this paragraph referred to as ‘part-
ners’) for purposes of detecting and preventing 
health care waste, fraud, and abuse. 
‘‘(B) CONTRACT
WITH
TRUSTED
THIRD 
PARTY.— 
‘‘(i) IN
GENERAL.—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 subparagraph 
(C). 
‘‘(ii) LENGTH OF CONTRACT.—A con-
tract with a trusted third party described 
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in clause (i) shall be for a period of 5 
years. Such contract with such party may 
be renewed as determined appropriate by 
the Secretary. 
‘‘(C) 
DUTIES
OF
PARTNERSHIP.—The 
partnership shall— 
‘‘(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 
criminal conduct to appropriate law en-
forcement entities; 
‘‘(vi) convene, not less than annually, 
meetings with partners in the partnership 
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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-
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 
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‘‘(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 2018, the trusted third party with a con-
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 described in 
subclause (III) and representatives of 
the private sector described in sub-
clause (IV). 
‘‘(II) 
CHAIRS.—The 
executive 
board shall be co-chaired by one Fed-
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eral Government official and one rep-
resentative from the private sector. 
‘‘(III) FEDERAL
GOVERNMENT 
REPRESENTATIVES.— 
‘‘(aa) 
REQUIRED
MEM-
BERS.—The executive board shall 
consist of the following members 
(or designees of the following) 
from the Federal Government: 
‘‘(AA) 
The 
Adminis-
trator of the Centers for 
Medicare & Medicaid Serv-
ices. 
‘‘(BB) The Deputy At-
torney General for the De-
partment of Justice. 
‘‘(CC) The Deputy Sec-
retary of the Department of 
Health and Human Services. 
‘‘(DD) The Inspector 
General for the Department 
of Health and Human Serv-
ices. 
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‘‘(EE) The Director of 
the Federal Bureau of In-
vestigation. 
‘‘(bb) 
PERMISSIVE
ADDI-
TIONAL
MEMBERS.—If 
deter-
mined by unanimous consent of 
the members of the executive 
board, the board may include 
other Federal or State Govern-
ment representation as appro-
priate, including senior-level rep-
resentation from the TRICARE 
Management Activity, the De-
partment of Veterans Affairs, the 
Office of Personnel Management, 
State Medicaid agencies, and 
State medicaid fraud control 
units. 
‘‘(IV) PRIVATE SECTOR MEMBER-
SHIP.— 
‘‘(aa) IN
GENERAL.—The 
executive board shall consist of at 
least three senior-level represent-
atives from various private sector 
health care related associations, 
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including any national association 
focusing on Medicaid fraud at 
the State level. The private 
health sector associations shall be 
national professional associations 
or trade groups that are focused 
on health care insurance, anti- 
fraud, or both. 
‘‘(bb) 
SELECTION.—The 
members of the board from pri-
vate sector health care related as-
sociations shall be jointly selected 
by the Federal Government mem-
bers 
described 
in 
subclause 
(III)(aa), 
after 
outreach 
to 
known relevant private sector 
health care related associations 
with a national scope. After con-
sidering any appropriate indi-
vidual input from private-sector 
partners, the Secretary and At-
torney General (or their des-
ignees) shall make all final execu-
tive decisions. In the case that 
the executive board expands the 
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number of members from the 
Federal Government pursuant to 
subclause (III)(bb), the number 
of members of the executive 
board from the private health 
sector may also increase by the 
same number of representatives, 
through the same process as de-
scribed in this item for purposes 
of selection of members from the 
private sector. 
‘‘(ii) 
MEETINGS.—The 
executive 
board of the partnership shall meet at 
least twice per year. 
‘‘(iii) EXECUTIVE
BOARD
DUTIES.— 
The duties of the executive board shall in-
clude the following: 
‘‘(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 
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Department of Justice and the var-
ious private health sector associations. 
‘‘(III) Sharing with partners top-
ics for studies and analysis. 
‘‘(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; 
‘‘(iii) any savings to the Federal gov-
ernment attributable to the partnership 
during such period; 
‘‘(iv) any other savings attributable to 
the partnership, as determined by the Sec-
retary, during such period; and 
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‘‘(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 10, 2012, by charter of the 
Secretary shall be transferred to the partner-
ship established under subparagraph (A) as of 
the date of the enactment of this paragraph. 
‘‘(I) DEFINITION.—For purposes of this 
paragraph, the term ‘trusted third party’ means 
an entity that— 
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‘‘(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 1 year after 
the date of the enactment of this Act, the Secretary of 
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 
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