Title: Strengthening the Health Care Fraud Prevention Task Force Act of 2018
Policy area: Health

Summary:
Strengthening the Health Care Fraud Prevention Task Force Act of 2018
This bill establishes statutory authority for a partnership between health insurance plans, government agencies, law enforcement, and health care organizations in order to detect and prevent health care waste, fraud, and abuse. Among other requirements, the partnership must: (1) promote data sharing between partners, (2) analyze data to identify fraudulent practices, (3) refer potential criminal cases to law enforcement, and (4) conduct education and outreach.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6753 Introduced in House (IH)]

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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 
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 Representatives 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''.

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 adding 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 organizations (in this paragraph referred to 
                as `partners') 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 contract with 
                        a trusted third party described 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 identify 
                        fraudulent and aberrant billing patterns;
                            ``(iii) conduct aggregate analyses of 
                        health care data so shared across Federal, 
                        State, and private health plans for purposes of 
                        detecting fraud, waste, and abuse schemes;
                            ``(iv) identify outlier trends and 
                        potential vulnerabilities of partners in the 
                        partnership with respect to such schemes;
                            ``(v) refer specific cases of potential 
                        criminal conduct to appropriate law enforcement 
                        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 information 
                        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 ensure 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 
                        partnership with plan-specific, confidential 
                        feedback on any aberrant billing patterns or 
                        potential fraud identified by the partnership 
                        with respect to such partner;
                            ``(ix) establish a process by which 
                        entities described in subparagraph (A) may 
                        enter the partnership and requirements such 
                        entities must meet to enter the partnership;
                            ``(x) provide appropriate training, 
                        outreach, 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 treatment 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 
                contract in effect under subparagraph (B) shall perform 
                an analysis of aberrant or fraudulent billing patterns 
                and trends with respect to providers and suppliers of 
                substance use disorder treatments from data shared with 
                the partnership.
                    ``(E) Executive board.--
                            ``(i) Executive board composition.--
                                    ``(I) In general.--There shall be 
                                an executive board of the partnership 
                                comprised of representatives of the 
                                Federal Government described in 
                                subclause (III) and representatives of 
                                the private sector described in 
                                subclause (IV).
                                    ``(II) Chairs.--The executive board 
                                shall be co-chaired by one Federal 
                                Government official and one 
                                representative from the private sector.
                                    ``(III) Federal government 
                                representatives.--
                                            ``(aa) Required members.--
                                        The executive board shall 
                                        consist of the following 
                                        members (or designees of the 
                                        following) from the Federal 
                                        Government:

                                                    ``(AA) The 
                                                Administrator of the 
                                                Centers for Medicare & 
                                                Medicaid Services.

                                                    ``(BB) The Deputy 
                                                Attorney General for 
                                                the Department of 
                                                Justice.

                                                    ``(CC) The Deputy 
                                                Secretary of the 
                                                Department of Health 
                                                and Human Services.

                                                    ``(DD) The 
                                                Inspector General for 
                                                the Department of 
                                                Health and Human 
                                                Services.

                                                    ``(EE) The Director 
                                                of the Federal Bureau 
                                                of Investigation.

                                            ``(bb) Permissive 
                                        additional members.--If 
                                        determined by unanimous consent 
                                        of the members of the executive 
                                        board, the board may include 
                                        other Federal or State 
                                        Government representation as 
                                        appropriate, including senior-
                                        level representation from the 
                                        TRICARE Management Activity, 
                                        the Department of Veterans 
                                        Affairs, the Office of 
                                        Personnel Management, State 
                                        Medicaid agencies, and State 
                                        medicaid fraud control units.
                                    ``(IV) Private sector membership.--
                                            ``(aa) In general.--The 
                                        executive board shall consist 
                                        of at least three senior-level 
                                        representatives from various 
                                        private sector health care 
                                        related associations, 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 
                                        private sector health care 
                                        related associations shall be 
                                        jointly selected by the Federal 
                                        Government members described in 
                                        subclause (III)(aa), after 
                                        outreach to known relevant 
                                        private sector health care 
                                        related associations with a 
                                        national scope. After 
                                        considering any appropriate 
                                        individual input from private-
                                        sector partners, the Secretary 
                                        and Attorney General (or their 
                                        designees) shall make all final 
                                        executive decisions. In the 
                                        case that the executive board 
                                        expands the 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 
                                        described 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 include the 
                        following:
                                    ``(I) Providing strategic direction 
                                for the partnership, including 
                                membership criteria and a mission 
                                statement.
                                    ``(II) Communicating with the 
                                leadership of the Department of Health 
                                and Human Services and the Department 
                                of Justice and the various private 
                                health sector associations.
                                    ``(III) Sharing with partners 
                                topics for studies and analysis.
                    ``(F) Reports.--Not later than September 30, 2021, 
                and every 2 years thereafter, the Secretary shall 
                submit to Congress and make available on the public 
                website of the Centers for Medicare & Medicaid Services 
                a report containing--
                            ``(i) a review of activities conducted by 
                        the partnership over the 2-year period ending 
                        on the date of the submission of such report, 
                        including any progress to any objectives 
                        established by the partnership;
                            ``(ii) any savings voluntarily reported by 
                        health plans participating in the partnership 
                        attributable to the partnership during such 
                        period;
                            ``(iii) any savings to the Federal 
                        government attributable to the partnership 
                        during such period;
                            ``(iv) any other savings 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 described in paragraph (1).
                    ``(H) Transitional provisions.--To the extent 
                consistent with this subsection, all functions, 
                personnel, assets, liabilities, and administrative 
                actions applicable on the date before the date of the 
                enactment of this paragraph to the National Fraud 
                Prevention Partnership established on September 10, 
                2012, by charter of the Secretary shall be transferred 
                to the partnership 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--
                            ``(i) demonstrates the capability to carry 
                        out the duties of the partnership described in 
                        subparagraph (C);
                            ``(ii) complies with such conflict of 
                        interest 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 partnership (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.
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