What This Bill Does
This bill requires the federal government to create and distribute annual reports about health care fraud schemes that target seniors. The government must identify the 10 most common fraud schemes, explain how seniors can protect themselves and share this information through multiple channels including mail and websites.
Who It Affects
Medicare beneficiaries (people receiving Medicare benefits), the Department of Health and Human Services, the Attorney General, Congress, and the public.
Key Provisions
• The Secretary of Health and Human Services and the Attorney General must create an annual report identifying the 10 most prevalent health care fraud schemes targeting seniors and steps to combat them. The first report is due no later than 2 years after the bill becomes law. (Sec. 2(e)(1)(A))
• The annual report must include information about the most common fraud schemes, what seniors and government agencies can do to fight fraud, and suggestions to improve senior protections. (Sec. 2(e)(1)(B)(i))
• The government must update the list of the top 10 fraud schemes quarterly and include these updates in the Medicare summary notices mailed to all Medicare beneficiaries. (Sec. 2(e)(1)(C) and (2)(B))
• Reports and quarterly updates must be posted on websites for the Health Care Fraud and Abuse Control Program, Medicare program, State Health Insurance Assistance Program and Senior Medicare Patrol. (Sec. 2(e)(2)(C))
• Reports must be available in both English and Spanish. (Sec. 2(e)(1)(D))
What Changes
Medicare beneficiaries will receive regular information about current health care fraud schemes targeting seniors through multiple methods including mail and websites. The government will be required to identify emerging fraud trends and educate seniors about how to protect themselves.
Important Definitions
None defined in bill text.
I
118TH CONGRESS
1ST SESSION H. R. 2473
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.
IN THE HOUSE OF REPRESENTATIVES
APRIL 3, 2023
Mr. RUIZ 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 juris-
diction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to distribute
additional information to Medicare beneficiaries to pre-
vent health care fraud, and for other purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE; FINDINGS.
3
(a) SHORT TITLE.—This Act may be cited as the
4
‘‘Protecting Seniors from Health Care Fraud Act of
5
2023’’.
6
(b) FINDINGS.—Congress finds the following:
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(1) Seniors are more vulnerable to fraud than
1
the general population.
2
(2) Because seniors require more health care
3
services than the general population, they need more
4
information on health care schemes so they can pro-
5
tect themselves.
6
(3) The Department of Health and Human
7
Services should provide more up-to-date information
8
in order to educate seniors on health care scams.
9
SEC. 2. DISTRIBUTION OF ADDITIONAL INFORMATION TO
10
SENIORS TO PREVENT HEALTH CARE FRAUD.
11
Section 1804 of the Social Security Act (42 U.S.C.
12
1395b–2) is amended by adding at the end the following
13
new subsection:
14
‘‘(e) DISTRIBUTION OF ADDITIONAL INFORMATION
15
ON HEALTH CARE FRAUD.—
16
‘‘(1) ANNUAL
REPORTS
ON
HEALTH
CARE
17
FRAUD SCHEMES.—
18
‘‘(A) IN GENERAL.—In connection with the
19
Health Care Fraud and Abuse Control Program
20
established under section 1128C, the Secretary,
21
acting through the Office of the Inspector Gen-
22
eral of the Department of Health and Human
23
Services, and the Attorney General, shall trans-
24
mit to Congress, and make available to the pub-
25
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lic, an annual report on health care fraud
1
schemes that are targeted to seniors and steps
2
that are being taken to combat such schemes
3
and
to
educate
seniors
concerning
such
4
schemes. The first such report shall be trans-
5
mitted and made available not later than 2
6
years after the date of the enactment of this
7
subsection.
8
‘‘(B) CONTENTS OF REPORTS.—
9
‘‘(i) IN GENERAL.—Subject to clause
10
(ii), each annual report under subpara-
11
graph (A) shall include the following infor-
12
mation:
13
‘‘(I) IDENTIFICATION
OF
MOST
14
PREVALENT
FRAUD
SCHEMES.—The
15
identification of the 10 most prevalent
16
health care fraud schemes that are
17
targeted to seniors and the prevalence
18
and trends in such schemes.
19
‘‘(II)
PROTECTION
OF
SEN-
20
IORS.—Actions that seniors and law
21
enforcement and government agencies
22
are taking and can take to combat
23
such schemes and to protect seniors
24
against health care fraud schemes.
25
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‘‘(III)
ADDITIONAL
SUGGES-
1
TIONS.—Policy suggestions to improve
2
protections
for
seniors,
including
3
whether the additional information
4
provided under this subsection is help-
5
ing seniors in protecting them against
6
fraud.
7
‘‘(ii) LIMITATIONS.—The Secretary
8
may—
9
‘‘(I) omit information from an
10
annual report on fraud schemes tar-
11
geting seniors if public disclosure of
12
the information would compromise an
13
ongoing investigation; and
14
‘‘(II) report information on fraud
15
schemes by categories in an annual
16
report if a more detailed disclosure of
17
such a scheme would educate crimi-
18
nals rather than seniors.
19
‘‘(iii)
PRIVATE-PUBLIC
PARTNER-
20
SHIP.—The Secretary, acting through the
21
Office of the Inspector General of the De-
22
partment of Health and Human Services
23
and the Attorney General, may enter into
24
an arrangement between public and private
25
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partners to develop the report that identi-
1
fies the top 10 most prevalent health care
2
fraud schemes and the associated report
3
information.
4
‘‘(C) QUARTERLY UPDATING.—The infor-
5
mation described in clauses (i) and (ii) of sub-
6
paragraph (B) shall be updated quarterly to re-
7
flect changes in fraud schemes and methods to
8
combat and educate seniors concerning such
9
schemes.
10
‘‘(D) LANGUAGES.—Such reports, as up-
11
dated, shall be available in English and Span-
12
ish.
13
‘‘(2) DISSEMINATION OF REPORTS AND TOP 10
14
LIST.—
15
‘‘(A) IN GENERAL.—The Secretary shall—
16
‘‘(i) disseminate the reports under
17
paragraph (1) to Medicare beneficiaries
18
through mechanisms that reach the most
19
Medicare beneficiaries; and
20
‘‘(ii) provide for the mailing to each
21
Medicare beneficiary of a list of the top 10
22
most prevalent health care fraud schemes.
23
‘‘(B) QUARTERLY
UPDATES
OF
TOP
10
24
LIST INCLUDED WITH MEDICARE SUMMARY NO-
25
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TICES.—The Secretary shall include an updated
1
list of the top 10 most prevalent health care
2
fraud schemes under paragraph (1)(C) with the
3
quarterly Medicare summary notices mailed to
4
Medicare beneficiaries.
5
‘‘(C) POSTING
OF
REPORTS
AND
QUAR-
6
TERLY
UPDATES
ON
WEBSITES.—The annual
7
reports, and quarterly updates, under this sub-
8
section shall be posted on the website of the
9
Health Care Fraud and Abuse Control Program
10
and on other websites maintained or supported
11
by the Secretary relating to the Medicare pro-
12
gram, the State Health Insurance Assistance
13
Program, and Senior Medicare Patrol of the
14
Administration on Aging.
15
‘‘(3) SOURCES
OF
INFORMATION
FOR
RE-
16
PORTS.—Information for the reports and updates
17
under paragraph (1) shall be gathered from at least
18
the following sources:
19
‘‘(A) DEPARTMENT
OF
HEALTH
AND
20
HUMAN SERVICES.—The following sources with-
21
in the Department of Health and Human Serv-
22
ices:
23
‘‘(i) Medicare hotlines, including 1–
24
800–MEDICARE, 1–800–HHSTIPS, and
25
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Medicare fraud toll-free hotlines and
1
websites
(such
as
2
www.stopmedicarefraud.gov) established by
3
the Office of the Inspector General of the
4
Department of Health and Human Serv-
5
ices and the Centers for Medicare & Med-
6
icaid Services.
7
‘‘(ii) State Health Insurance Assist-
8
ance Programs (SHIPs).
9
‘‘(iii) The Administration on Commu-
10
nity Living, including—
11
‘‘(I) the Senior Medicare Patrol
12
(SMP) of the Administration on
13
Aging; and
14
‘‘(II) Aging and Disability Re-
15
source Centers.
16
‘‘(iv) Medicare administrative contrac-
17
tors, fiscal intermediaries, and other con-
18
tractors with the Centers for Medicare &
19
Medicaid Services performing functions
20
which may relate to fraud and abuse under
21
the Medicare program.
22
‘‘(v) The Indian Health Service.
23
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‘‘(B) DEPARTMENT OF JUSTICE.—The De-
1
partment of Justice, including the Federal Bu-
2
reau of Investigation.
3
‘‘(C) SSA.—The Social Security Adminis-
4
tration.
5
‘‘(D) FTC.—The Federal Trade Commis-
6
sion.
7
‘‘(E) OPTIONAL ADDITIONAL SOURCES.—
8
At the option of the Secretary—
9
‘‘(i) State agencies that deal with
10
elder abuse; and
11
‘‘(ii) other governmental and non-
12
governmental entities with expertise in the
13
protection of seniors from health care
14
fraud as deemed appropriate.’’.
15
Æ
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