Like Countable?

Install the App
TRY NOW

house Bill H.R. 525

Should the Healthcare Fraud Prevention Partnership be Given Explicit Authority?

Argument in favor

By establishing explicit authority for HFPP and its activities, this bill would give HFPP better authority to define the rules for and responsibilities of its members. It’d also give HFPP more latitude to address fraud and abuse issues in the healthcare system.

Glowurm's Opinion
···
02/24/2019
We need to have ZERO TOLERANCE for Medicare fraud! If we had the billions of dollars the big corporations and private doctors bilked us for every year, Medicare would be sustainable. The Repugnants fail to address this problem because their lobbyists, and cronies, would rather see Medicare fail. Just like they’ve done, and are continuing to do, with the ACA and preexisting conditions, etc. Democratic socialism is not a problem. For many, it is a life-saving blessing. Read up on it, Ignorants, on UNBIASED sources, please. Your stubbornness is not one of your assets! I’m not sure private contractors should be the answer.
Like (12)
Follow
Share
Kodiwodi's Opinion
···
02/24/2019
The bill has no budgetary effect, simply codifies what has been in place since 2012 and appears to be bipartisan in nature, voluntary and a partnership between public and private. Sounds like a winner to me.
Like (7)
Follow
Share
Jeffrey's Opinion
···
02/24/2019
Medicare fraud should be looked into whether done privately or federally
Like (2)
Follow
Share

Argument opposed

Healthcare fraud investigations are best left to healthcare providers, healthcare payers (such as insurance companies and Medicaid) and state authorities. A federal program to coordinate these efforts is unnecessary, and only creates additional bureaucracy.

singinghawk926's Opinion
···
03/02/2019
We do not need any more public-private partnerships until the healthcare system is stabilized and a need for them becomes apparent during the reorganization. We do not even know yet what form the changes will take — Medicare for All, single-payer, some modified form of the existing ACA — and no decisions should be made about how to structure it until we know what direction we are taking!
Like (11)
Follow
Share
Doug's Opinion
···
02/24/2019
Why on earth would we give so much information and responsibility by way of law to a bunch of contractors? If this needs to be done, do it with federal employees and with federal data systems. This smells like it’s ripe for setting up sweet contracts for private industry at taxpayer expense.
Like (5)
Follow
Share
David's Opinion
···
02/24/2019
Sounds like a massive string of HIPAA violations will be occurring. Why give contractors that much authority especially when most government contracts are up for bid biennially?! Horrible idea that is clearly being driven by greedy contractors trying to defraud American taxpayers under the guise of fraud prevention.
Like (4)
Follow
Share

bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
      senate Committees
      Committee on Finance
  • The house has not voted
      house Committees
      Committee on Energy and Commerce
    IntroducedJanuary 11th, 2019

What is House Bill H.R. 525?

This bill — the Strengthening the Health Care Fraud Prevention Task Force Act of 2018 — would amend the Social Security Act to authorize a public-private partnership to detect and prevent healthcare fraud. The Secretary of Health and Human Services (HHS Secretary) would enter into a contract with a third party to carry out the duties of the partnership, including data analysis and sharing.

This partnership, including a contract with a third party, already exists to deter healthcare fraud. It’s operated by the Centers for Medicare and Medicaid Service (CMS), and is called the Healthcare Fraud Prevention Partnership (HFPP) and its membership includes several federal agencies, numerous state entities, and private firms. It was created in 2012 by CMS and the Dept. of Justice, although it hasn’t been codified into law.

Impact

Healthcare fraud; patients; states; private payers; healthcare associations; HFPP partners; HPFF program; and the HHS Secretary

Cost of House Bill H.R. 525

The CBO judges that this bill merely codifies existing HHS practice, and wouldn’t have a budgetary effect.

More Information

In-DepthRep. Greg Walden (R-OR) reintroduced this bill from the 115th Congress to codify the HFPP program with the support of original cosponsor Rep. Frank Pallone, Dr. (D-NJ) (who also cosponsored this bill in the 115th Congress). Rep. Pallone expressed his support for this bill during its House Health Subcommittee markup last Congress:

“This partnership is a public-private partnership between the Department of Health and Human Services, private pay[e]rs, federal and state law enforcement agencies, and state healthcare agencies.  It 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 and successful anti-fraud practices and methodologies.”

Blue Cross Shield Association (BCBSA) supports this bill, as it believes healthcare fraud causes the waste of valuable resources in the healthcare system. The organization’s Executive Director of Member Care and Benefits, Dr. David Yoder, testified to Congress:

“An essential step to ensure the affordability of healthcare is addressing, reducing, and to the extent possible preventing, the opportunity for fraud and abuse. According to the National Health Care Anti-Fraud Association (NHCAA), healthcare fraud costs taxpayers $68 billion every year and accounts for between three and 10 percent of all healthcare spending in the United States.”

Dr. Yoder adds that HFPP is needed to improve the detection of healthcare fraud, and argued that giving explicit authority for HFPP will strengthen the program:

"Among various governmental efforts, the Federal government established the Healthcare Fraud Prevention Partnership (HFPP) to improve the detection and prevention of healthcare fraud. BCBSA and several of our member companies are active participants in the HFPP. We support the HFPP for bringing together a diverse population of fraud management, control, and enforcement parties to identify areas of potential risk posed by healthcare fraud and abuse. We support Congress' desire to establish explicit authority for HFPP and its activities, better equipping them to define the rules and responsibilities of its members and expand the scope of allowable activities to address more in the spectrum of fraud and abuse in our healthcare system … BCBSA supports legislation to ban gag clauses and any prohibitions on allowing pharmacists to make information about cost savings known to the beneficiary at the point-of-sale. To the extent that some in the industry include such clauses in their contract, consumers may be deprived of information that will help them make prudent decisions when paying for prescription drugs. With this is mind, we would also encourage pharmacists to advise patients on generic substitution and alternative medications so long as this is done in direct communication with the dispensing physician."

This bill has the support of three bipartisan cosponsors, including two Democrats and one Republican, n the current session of Congress. Last Congress, it passed the House on a voice vote with the support of three cosponsors, including one Republican and two Democrats.


Of NoteThe HFPP is a voluntary public-private partnership between the federal government, state agencies, law enforcement, private health insurance plans, and healthcare anti-fraud associations. Its mission is to detect and prevent healthcare fraud through public-private information-sharing, streamlining of analytic tools and data, and the provision of a forum for government and industry experts to exchange successful anti-fraud practices.

The HFPP exists to:

  • Deliver unique aggregate analyses of healthcare data across CMS, state Medicaid offices, and private payers;
  • Identify savings for insurers in unpaid or recovered claims; and
  • Increase detection of covert fraud, waste, and abuse schemes, and identify the perpetrators of such schemes

At present, 14 states, 39 private payers, seven federal partners, and 11 healthcare associations are members of the HFPP.


Media:

Summary by Lorelei Yang

(Photo Credit: iStockphoto.com / digicomphoto)

AKA

Strengthening the Health Care Fraud Prevention Task Force Act of 2019

Official Title

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.

    We need to have ZERO TOLERANCE for Medicare fraud! If we had the billions of dollars the big corporations and private doctors bilked us for every year, Medicare would be sustainable. The Repugnants fail to address this problem because their lobbyists, and cronies, would rather see Medicare fail. Just like they’ve done, and are continuing to do, with the ACA and preexisting conditions, etc. Democratic socialism is not a problem. For many, it is a life-saving blessing. Read up on it, Ignorants, on UNBIASED sources, please. Your stubbornness is not one of your assets! I’m not sure private contractors should be the answer.
    Like (12)
    Follow
    Share
    We do not need any more public-private partnerships until the healthcare system is stabilized and a need for them becomes apparent during the reorganization. We do not even know yet what form the changes will take — Medicare for All, single-payer, some modified form of the existing ACA — and no decisions should be made about how to structure it until we know what direction we are taking!
    Like (11)
    Follow
    Share
    The bill has no budgetary effect, simply codifies what has been in place since 2012 and appears to be bipartisan in nature, voluntary and a partnership between public and private. Sounds like a winner to me.
    Like (7)
    Follow
    Share
    Why on earth would we give so much information and responsibility by way of law to a bunch of contractors? If this needs to be done, do it with federal employees and with federal data systems. This smells like it’s ripe for setting up sweet contracts for private industry at taxpayer expense.
    Like (5)
    Follow
    Share
    Sounds like a massive string of HIPAA violations will be occurring. Why give contractors that much authority especially when most government contracts are up for bid biennially?! Horrible idea that is clearly being driven by greedy contractors trying to defraud American taxpayers under the guise of fraud prevention.
    Like (4)
    Follow
    Share
    No more government bureaucracy! The insurance companies are paid. They should be responsible for their system, and coordinate with other providers at their expense. Of course BCBS backs this bill. The taxp will foot the cost for their responsibility.
    Like (3)
    Follow
    Share
    Medicare fraud should be looked into whether done privately or federally
    Like (2)
    Follow
    Share
    Healthcare providers and payers are best suited to handle fraud without the interference of the government.
    Like (2)
    Follow
    Share
    Oppose this bill.
    Like (1)
    Follow
    Share
    DETECTING FRAUD WOULD KEEP PRICES DOWN AND SHARING INFORMATION ABOUT HEALTHCARE FRAUD THROUGH VARIOUS OFFICES SOUNDS LIKE A GOOD IDEA.
    Like
    Follow
    Share
    Why do we need federal involvement in a local or state issue? We need SINGLE PAYER NOW so insured people don’t lose their homes when they get cancer! We need to stop insurance companies making huge profits by denying medical care to all of us!
    Like
    Follow
    Share
    I had a Dr's office take up to 90% of my cash payments then send me a bill. I would be given the correct change When I was able to get insurance it billed my insurance. I never went back to that Doctor again.
    Like
    Follow
    Share
    I’m more concerned with how companies are defrauding patients than a tiny handful of patients defrauding a company. Taxpayers first!
    Like
    Follow
    Share
    Transparency is what we want!
    Like
    Follow
    Share
    Healthcare fraud investigations are best left to healthcare providers, healthcare payers (such as insurance companies and Medicaid) and state authorities. A federal program to coordinate these efforts is unnecessary, and only creates additional bureaucracy.
    Like
    Follow
    Share
    If we don’t have a third party moderating then we’re just letting the government controlling our Medicare. With this we can prevent fraud and let more people have health care.
    Like
    Follow
    Share
    It’s time for a single payer universal healthcare system.
    Like
    Follow
    Share
    The government should make sure that healthcare fraud is gone. Passing this. I’ll shows that healthcare is an important cause of this Congress.
    Like
    Follow
    Share
    Voting to codify HFPP does just that. It codifies a program that has been run out of the justice department for years already. If the law truly would not cost anything additional, I think it is vital to protect the programs already in place that reduce costs and frauds in healthcare.
    Like
    Follow
    Share
    more watchdogs the better it seems.
    Like
    Follow
    Share
    MORE