STRENGTHENING THE HEALTH CARE FRAUD PREVENTION TASK FORCE ACT OF 2018; Congressional Record Vol. 164, No. 187
(House of Representatives - November 28, 2018)

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[Pages H9671-H9673]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 STRENGTHENING THE HEALTH CARE FRAUD PREVENTION TASK FORCE ACT OF 2018

  Mr. BURGESS. Mr. Speaker, I move to suspend the rules and pass the 
bill (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, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 6753

       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, 
     health care anti-fraud organizations, and any other entity 
     determined appropriate by the Secretary (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.--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).
       ``(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 unlawful conduct to 
     appropriate governmental 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

[[Page H9672]]

     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 and representatives of the private sector selected 
     by the Secretary.
       ``(II) Chairs.--The executive board shall be co-chaired by 
     one Federal Government official and one representative from 
     the private sector.

       ``(ii) Meetings.--The executive board of the partnership 
     shall meet at least once 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.

       ``(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 outcomes 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 17, 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) Nonapplicability of faca.--The provisions of the 
     Federal Advisory Committee Act shall not apply to the 
     partnership established by subparagraph (A).
       ``(J) Implementation.--Notwithstanding any other provision 
     of law, the Secretary may implement the partnership 
     established by subparagraph (A) by program instruction or 
     otherwise.
       ``(K) 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 2 years 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.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas (Mr. Burgess) and the gentlewoman from Illinois (Ms. Kelly) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Texas.


                             General Leave

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today to speak in support of H.R. 6753, the 
Strengthening the Health Care Fraud Prevention Task Force Act of 2018, 
authored by Chairman  Greg Walden and Ranking Member Frank Pallone of 
the Energy and Commerce Committee.
  H.R. 6753 seeks to codify the Health Care Fraud Prevention 
Partnership, which would better equip public and private organizations 
to combat and prevent fraud and abuse in our healthcare system.
  Tens of billions of dollars are lost to healthcare fraud in the 
United States every year, and much of this fraud is preventable or, at 
the very least, detectable. Fraud and abuse within our healthcare 
system comes in various forms, ranging from telephone or email scams to 
obtain patient information to fraudulent billing practices.
  Healthcare fraud is not only costly to the Federal and State 
governments and an avoidable waste of taxpayer dollars. Fraud and abuse 
is costly for, and often hurtful to, American patients.
  For example, in May of this year, a doctor in Texas was indicted in a 
fraud case involving $240 million worth of claims. A Department of 
Justice investigation found that the rheumatologist had given patients 
false diagnoses, followed by chemotherapy and other treatments that 
they did not need.
  Americans should feel confident in and be able to trust their 
doctors. The unfortunate reality is that there are bad actors who make 
decisions based solely on financial interests and not on what is best 
for the patient or for their fellow citizens.
  Another Texas case was settled just last month as a hospital 
administrator in Houston was convicted for his involvement in a $16 
million fraud scheme. In this particular case, the hospital 
administrator had orchestrated a system of kickbacks with various 
individuals in return for sending Medicare patients to certain partial 
hospitalization program services. Thanks to various investigative 
bodies bridging the Departments of Justice and Health and Human 
Services, this fraud was uncovered and investigated in an effort to 
protect both patients and taxpayer dollars from exploitation.
  Lastly, near my district in north Texas, there was a scheme in which 
a semiretired doctor signed off on fraudulent paperwork, including 
payments for fake patients. What started as a retirement gig rubber-
stamping documents ended in his conviction, due to his involvement in a 
$13 million home healthcare scam. The scam in its entirety stole $373 
million from Medicare and Medicaid.
  I could go on with stories of healthcare fraud just in Texas, because 
these three examples are just the tip of the iceberg. Unfortunately, 
rampant healthcare fraud is not a Texas-specific issue. It is prevalent 
across our Nation. This is why we need to pass H.R. 6753 and codify the 
Health Care Fraud Prevention Partnership.
  The partnership was established by the Secretary of the Department of 
Health and Human Services and the United States Attorney General in 
September 2012 through the signing of a charter. It is currently 
operated by the Centers for Medicare and Medicaid Services and has 
allowed for increased coordination in addressing healthcare fraud, 
waste, and abuse, but has not been codified in statute.
  This partnership is voluntary among both private and public entities 
to reduce fraud in our healthcare system. Participants in this critical 
partnership include the Federal Government, State agencies, law 
enforcement, private health insurance plans, employer

[[Page H9673]]

organizations, and other associations. The partnership allows for 
robust analyses of healthcare across different players, including 
Medicare, Medicaid, and private insurers.
  While these partners have access to their own data, cross-payer 
analyses are crucial in identifying savings and increasing detection of 
fraud, waste, and abuse. Collaborating through data sharing and other 
methods, the partners can paint a broad picture of the fraud networks 
and cast a wide net, increasing the ability to intervene and stop 
payments, and establish new and effective fraud prevention techniques.
  It is worth noting that, in addition to codifying and formalizing the 
Health Care Fraud Prevention Task Force, the bill requires the task 
force to perform an analysis of abnormal or fraudulent billing patterns 
and trends by providers and suppliers of substance use disorder 
treatments. This effort fits nicely into what Congress has accomplished 
this year with the SUPPORT for Patients and Communities Act being 
signed into law.
  H.R. 6753 will make a difference in cutting waste, fraud, and abuse 
in our healthcare system. I support this legislation and urge fellow 
Members to do the same.
  Mr. Speaker, I reserve the balance of my time.
  Ms. KELLY of Illinois. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of the Strengthening the Health 
Care Fraud Prevention Task Force Act of 2018. This bipartisan bill 
would authorize the Healthcare Fraud Prevention Partnership and expand 
and enhance the task force's capabilities to fight waste, fraud, and 
abuse throughout our healthcare system. This, in turn, will reduce 
costs for families and taxpayers.
  The Healthcare Fraud Prevention Partnership is a public-private 
partnership between the Department of Health and Human Services, 
private payers, Federal and State law enforcement agencies, and State 
healthcare agencies. The partnership aims to improve the detection and 
prevention of healthcare fraud by promoting the exchange of data and 
information between the public and private sectors on fraud trends, as 
well as successful anti-fraud practices.

  The legislation we are considering today would require the 
partnership to report regularly to Congress and give the agency the 
tools it needs to enhance and expand its capability. This is a good 
bill that makes sense, a bill that will work.
  We must continue to work, on a bipartisan basis, to enhance our fraud 
detection capabilities. I support this legislation and urge my 
colleagues to continue working together to find meaningful solutions to 
reduce costs by rooting out fraud, waste, and abuse in our healthcare 
system.
  Mr. Speaker, I yield back the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield back the balance of my time.
  Mr. WALDEN. Mr. Speaker, I rise in support of H.R. 6753, the Health 
Care Fraud Prevention Task Force Act. This bipartisan bill--which I 
introduced with Ranking Member Frank Pallone, and is supported by Ways 
and Means Chairman Kevin Brady and Ranking Member Richard Neal--passed 
the Energy and Commerce Committee unanimously earlier this year. This 
will be the 132nd bill that our committee has passed this Congress, 92 
percent of which have been bipartisan just like this one. I look 
forward to continuing in that vein over the next two years.
  By passing this bill, we will be codifying a program that already 
works. The Centers for Medicare and Medicaid Services (CMS) currently 
operates the Health Care Fraud Prevention Partnership--a voluntary 
collaboration between the federal government, state agencies, law 
enforcement, private health insurance plans, and anti-fraud 
associations. Together, this group works to detect and prevent fraud 
that threatens to undermine our nation's health care system. This 
program was created by the Obama Administration, and the Trump 
Administration has recommended codifying it into law. The bill before 
us today does just that, also strengthening and expanding the scope of 
partnership's work.
  Mr. Speaker, I urge passage of this commonsense, bipartisan bill to 
improve the integrity of our nation's health care system.

  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Texas (Mr. Burgess) that the House suspend the rules and 
pass the bill, H.R. 6753, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________