Strengthening the Health Care Fraud Prevention Task Force Act of 2019

IIB 116TH CONGRESS 1ST SESSION H. R. 525 IN THE SENATE OF THE UNITED STATES FEBRUARY 26, 2019 Received; read twice and referred to the Committee on Finance AN ACT 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- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS 2 HR 525 RFS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Strengthening the 2 Health Care Fraud Prevention Task Force Act of 2019’’. 3 SEC. 2. PUBLIC-PRIVATE PARTNERSHIP FOR HEALTH CARE 4 WASTE, FRAUD, AND ABUSE DETECTION. 5 (a) IN GENERAL.—Section 1128C(a) of the Social 6 Security Act (42 U.S.C. 1320a–7c(a)) is amended by add- 7 ing at the end the following new paragraph: 8 ‘‘(6) PUBLIC-PRIVATE PARTNERSHIP FOR 9 WASTE, FRAUD, AND ABUSE DETECTION.— 10 ‘‘(A) IN GENERAL.—Under the program 11 described in paragraph (1), there is established 12 a public-private partnership (in this paragraph 13 referred to as the ‘partnership’) of health plans, 14 Federal and State agencies, law enforcement 15 agencies, health care anti-fraud organizations, 16 and any other entity determined appropriate by 17 the Secretary (in this paragraph referred to as 18 ‘partners’) for purposes of detecting and pre- 19 venting health care waste, fraud, and abuse. 20 ‘‘(B) CONTRACT WITH TRUSTED THIRD 21 PARTY.—In carrying out the partnership, the 22 Secretary shall enter into a contract with a 23 trusted third party for purposes of carrying out 24 the duties of the partnership described in sub- 25 paragraph (C). 26 VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS 3 HR 525 RFS ‘‘(C) DUTIES OF PARTNERSHIP.—The 1 partnership shall— 2 ‘‘(i) provide technical and operational 3 support to facilitate data sharing between 4 partners in the partnership; 5 ‘‘(ii) analyze data so shared to iden- 6 tify fraudulent and aberrant billing pat- 7 terns; 8 ‘‘(iii) conduct aggregate analyses of 9 health care data so shared across Federal, 10 State, and private health plans for pur- 11 poses of detecting fraud, waste, and abuse 12 schemes; 13 ‘‘(iv) identify outlier trends and poten- 14 tial vulnerabilities of partners in the part- 15 nership with respect to such schemes; 16 ‘‘(v) refer specific cases of potential 17 unlawful conduct to appropriate govern- 18 mental entities; 19 ‘‘(vi) convene, not less than annually, 20 meetings with partners in the partnership 21 for purposes of providing updates on the 22 partnership’s work and facilitating infor- 23 mation sharing between the partners; 24 VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS 4 HR 525 RFS ‘‘(vii) enter into data sharing and 1 data use agreements with partners in the 2 partnership in such a manner so as to en- 3 sure the partnership has access to data 4 necessary to identify waste, fraud, and 5 abuse while maintaining the confidentiality 6 and integrity of such data; 7 ‘‘(viii) provide partners in the partner- 8 ship with plan-specific, confidential feed- 9 back on any aberrant billing patterns or 10 potential fraud identified by the partner- 11 ship with respect to such partner; 12 ‘‘(ix) establish a process by which en- 13 tities described in subparagraph (A) may 14 enter the partnership and requirements 15 such entities must meet to enter the part- 16 nership; 17 ‘‘(x) provide appropriate training, out- 18 reach, and education to partners based on 19 the results of data analyses described in 20 clauses (ii) and (iii); and 21 ‘‘(xi) perform such other duties as the 22 Secretary determines appropriate. 23 ‘‘(D) SUBSTANCE USE DISORDER TREAT- 24 MENT ANALYSIS.—Not later than 2 years after 25 VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS 5 HR 525 RFS the date of the enactment of the Strengthening 1 the Health Care Fraud Prevention Task Force 2 Act of 2019, the trusted third party with a con- 3 tract in effect under subparagraph (B) shall 4 perform an analysis of aberrant or fraudulent 5 billing patterns and trends with respect to pro- 6 viders and suppliers of substance use disorder 7 treatments from data shared with the partner- 8 ship. 9 ‘‘(E) EXECUTIVE BOARD.— 10 ‘‘(i) EXECUTIVE BOARD COMPOSI- 11 TION.— 12 ‘‘(I) IN GENERAL.—There shall 13 be an executive board of the partner- 14 ship comprised of representatives of 15 the Federal Government and rep- 16 resentatives of the private sector se- 17 lected by the Secretary. 18 ‘‘(II) CHAIRS.—The executive 19 board shall be co-chaired by one Fed- 20 eral Government official and one rep- 21 resentative from the private sector. 22 ‘‘(ii) MEETINGS.—The executive 23 board of the partnership shall meet at 24 least once per year. 25 VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS 6 HR 525 RFS ‘‘(iii) EXECUTIVE BOARD DUTIES.— 1 The duties of the executive board shall in- 2 clude the following: 3 ‘‘(I) Providing strategic direction 4 for the partnership, including mem- 5 bership criteria and a mission state- 6 ment. 7 ‘‘(II) Communicating with the 8 leadership of the Department of 9 Health and Human Services and the 10 Department of Justice and the var- 11 ious private health sector associations. 12 ‘‘(F) REPORTS.—Not later than September 13 30, 2021, and every 2 years thereafter, the Sec- 14 retary shall submit to Congress and make avail- 15 able on the public website of the Centers for 16 Medicare & Medicaid Services a report con- 17 taining— 18 ‘‘(i) a review of activities conducted by 19 the partnership over the 2-year period end- 20 ing on the date of the submission of such 21 report, including any progress to any ob- 22 jectives established by the partnership; 23 ‘‘(ii) any savings voluntarily reported 24 by health plans participating in the part- 25 VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS 7 HR 525 RFS nership attributable to the partnership 1 during such period; 2 ‘‘(iii) any savings to the Federal Gov- 3 ernment attributable to the partnership 4 during such period; 5 ‘‘(iv) any other outcomes attributable 6 to the partnership, as determined by the 7 Secretary, during such period; and 8 ‘‘(v) a strategic plan for the 2-year 9 period beginning on the day after the date 10 of the submission of such report, including 11 a description of any emerging fraud and 12 abuse schemes, trends, or practices that 13 the partnership intends to study during 14 such period. 15 ‘‘(G) FUNDING.—The partnership shall be 16 funded by amounts otherwise made available to 17 the Secretary for carrying out the program de- 18 scribed in paragraph (1). 19 ‘‘(H) TRANSITIONAL PROVISIONS.—To the 20 extent consistent with this subsection, all func- 21 tions, personnel, assets, liabilities, and adminis- 22 trative actions applicable on the date before the 23 date of the enactment of this paragraph to the 24 National Fraud Prevention Partnership estab- 25 VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS 8 HR 525 RFS lished on September 17, 2012, by charter of the 1 Secretary shall be transferred to the partner- 2 ship established under subparagraph (A) as of 3 the date of the enactment of this paragraph. 4 ‘‘(I) NONAPPLICABILITY OF FACA.—The 5 provisions of the Federal Advisory Committee 6 Act shall not apply to the partnership estab- 7 lished by subparagraph (A). 8 ‘‘(J) IMPLEMENTATION.—Notwithstanding 9 any other provision of law, the Secretary may 10 implement the partnership established by sub- 11 paragraph (A) by program instruction or other- 12 wise. 13 ‘‘(K) DEFINITION.—For purposes of this 14 paragraph, the term ‘trusted third party’ means 15 an entity that— 16 ‘‘(i) demonstrates the capability to 17 carry out the duties of the partnership de- 18 scribed in subparagraph (C); 19 ‘‘(ii) complies with such conflict of in- 20 terest standards determined appropriate by 21 the Secretary; and 22 ‘‘(iii) meets such other requirements 23 as the Secretary may prescribe.’’. 24 VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS 9 HR 525 RFS (b) POTENTIAL EXPANSION OF PUBLIC-PRIVATE 1 PARTNERSHIP ANALYSES.—Not later than 2 years after 2 the date of the enactment of this Act, the Secretary of 3 Health and Human Services shall conduct a study and 4 submit to Congress a report on the feasibility of the part- 5 nership (as described in section 1128C(a)(6) of the Social 6 Security Act, as added by subsection (a)) establishing a 7 system to conduct real-time data analysis to proactively 8 identify ongoing as well as emergent fraud trends for the 9 entities participating in the partnership and provide such 10 entities with real-time feedback on potentially fraudulent 11 claims. Such report shall include the estimated cost of and 12 any potential barriers to the partnership establishing such 13 a system. 14 Passed the House of Representatives February 25, 2019. Attest: CHERYL L. JOHNSON, Clerk. VerDate Sep 11 2014 22:43 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H525.RFS H525 kjohnson on DSK79L0C42 with BILLS