Bills
| 3.23.22

Should the Healthcare Fraud Prevention Partnership be Given Explicit Authority? (H.R. 6753)

Do you support or oppose this bill?

What is H.R. 6753?

(Updated September 2, 2019)

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.

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.

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.

Impact

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

Cost of H.R. 6753

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

Additional Info

In-Depth: Rep. Greg Walden (R-OR) introduced this bill to codify the HFPP program with the support of original cosponsor Rep. Frank Pallone, Dr. (D-NJ), who expressed his support for this bill during its House Health Subcommittee markup:

“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 passed the House Committee on Energy and Commerce on a voice vote with the support of three cosponsors, including one Republican and two Democrats.


Of Note: The 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)