Protecting Seniors from Health Care Fraud Act of 2021
Bill: H.R.4401 | Sponsor: Rep. Ruiz, Raul (D-CA)
Policy area: Health

Summary:
Protecting Seniors from Health Care Fraud Act of 2021
This bill directs the Office of the Inspector General of the Department of Health and Human Services and the Attorney General to report annually to Congress and the public on health care fraud that targets seniors.
Specifically, the report must include (1) the 10 most prevalent health care fraud schemes targeted to seniors, (2) steps being taken to combat such schemes, and (3) policy suggestions to improve protections for seniors. The report may omit information or details that would compromise an ongoing investigation or would serve criminals rather than seniors.
The report must be posted on certain agency websites and disseminated to Medicare beneficiaries, as specified.

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.

    Be it enacted by the Senate and House of Representatives 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 2021''.
    (b) Findings.--Congress finds the following:
            (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 protect 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:
    ``(e) 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 General of the Department of Health 
                and Human Services, and the Attorney General, shall 
                transmit to Congress, and make available to the public, 
                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 
                transmitted 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 subparagraph (A) shall 
                        include the following information:
                                    ``(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 seniors.--
                                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.
                                    ``(III) Additional suggestions.--
                                Policy suggestions to improve 
                                protections for seniors, including 
                                whether the additional information 
                                provided under this subsection is 
                                helping seniors in protecting them 
                                against fraud.
                            ``(ii) Limitations.--The Secretary may--
                                    ``(I) omit information from an 
                                annual report on fraud schemes 
                                targeting 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 criminals 
                                rather than seniors.
                            ``(iii) Private-public partnership.--The 
                        Secretary, acting through the Office of the 
                        Inspector General of the Department of Health 
                        and Human Services and the Attorney General, 
                        may enter into an arrangement between public 
                        and private partners to develop the report that 
                        identifies the top 10 most prevalent health 
                        care fraud schemes and the associated report 
                        information.
                    ``(C) Quarterly updating.--The information 
                described in clauses (i) and (ii) of subparagraph (B) 
                shall be updated quarterly to reflect changes in fraud 
                schemes and methods to combat and educate seniors 
                concerning such schemes.
                    ``(D) Languages.--Such reports, as updated, shall 
                be available in English and Spanish.
            ``(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 10 list included 
                with medicare summary notices.--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 quarterly updates on 
                websites.--The annual reports, and quarterly updates, 
                under this subsection 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 program, the State Health 
                Insurance Assistance Program, and Senior Medicare 
                Patrol of the Administration on Aging.
            ``(3) Sources of information for reports.--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 within the Department of Health and 
                Human Services:
                            ``(i) Medicare hotlines, including 1-800-
                        MEDICARE, 1-800-HHSTIPS, and 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 Services and the 
                        Centers for Medicare & Medicaid Services.
                            ``(ii) State Health Insurance Assistance 
                        Programs (SHIPs).
                            ``(iii) The Administration on Community 
                        Living, including--
                                    ``(I) the Senior Medicare Patrol 
                                (SMP) of the Administration on Aging; 
                                and
                                    ``(II) Aging and Disability 
                                Resource Centers.
                            ``(iv) Medicare administrative contractors, 
                        fiscal intermediaries, and other contractors 
                        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.
                    ``(B) Department of justice.--The Department of 
                Justice, including the Federal Bureau of Investigation.
                    ``(C) SSA.--The Social Security Administration.
                    ``(D) FTC.--The Federal Trade Commission.
                    ``(E) Optional additional sources.--At the option 
                of the Secretary--
                            ``(i) State agencies that deal with elder 
                        abuse; and
                            ``(ii) other governmental and 
                        nongovernmental entities with expertise in the 
                        protection of seniors from health care fraud as 
                        deemed appropriate.''.
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