US HB4222 | 2009-2010 | 111th Congress
Status
Spectrum: Strong Partisan Bill (Republican 11-1)
Status: Introduced on December 8 2009 - 25% progression, died in committee
Action: 2009-12-09 - Referred to the Subcommittee on Health.
Pending: House Subcommittee on Health Committee
Text: Latest bill text (Introduced) [PDF]
Status: Introduced on December 8 2009 - 25% progression, died in committee
Action: 2009-12-09 - Referred to the Subcommittee on Health.
Pending: House Subcommittee on Health Committee
Text: Latest bill text (Introduced) [PDF]
Summary
Prevent Health Care Fraud Act of 2009 - Establishes in the Department of Health and Human Services (HHS) the Office of the Deputy Secretary for Health Care Fraud Prevention. Requires the Office to: (1) direct the implementation within HHS of health care fraud prevention and detection recommendations made by federal and private sector antifraud and oversight entities; (2) routinely consult with HHS's Office of the Inspector General, the Attorney General, and private sector health care antifraud entities to identify emerging fraud issues requiring immediate action; (3) provide for the design, development, and operation of a predictive model antifraud system to analyze health care claims data in real-time to identify high risk claims activity and develop a comprehensive antifraud database for federal health agency activities; (4) promulgate and enforce regulations relating to the reporting of data claims to such system by federal health agencies; (5) establish thresholds for fraudulent, wasteful, or abusive claims for excluding providers or suppliers from participation in federal health programs and for the referral of claims to law enforcement entities; and (6) share antifraud information and best practices. Sets forth requirements for the fraud prevention system, including that it shall: (1) allow viewing of all provider and patient activities across all federal health program payers; (2) provide for a centralized file for data from all government health insurance claims data sources; (3) provide real-time ability to identify high-risk behavior patterns across markets, geographies, and specialty group providers; (4) involve the implementation of a predictive modeling technology that is designed to prevent waste, fraud, and abuse; (5) systematically present scores, reason codes, and treatment actions for high-risk scored transactions; (6) monitor consumer transactions in real-time and monitor provider behavior at different stages within the transaction flow based upon provider, transaction, and consumer trends; and (7) not be designed to deny health care services or to negatively impact prompt-pay laws because assessments are late. Directs the Deputy Secretary to: (1) prohibit the payment of any health care claim identified as potentially fraudulent, wasteful, or abusive until the claim has been verified as valid; and (2) provide maximum protection of personal privacy consistent with carrying out the Office's responsibilities. Directs the Secretary to establish procedures for the implementation of fraud and abuse detection methods under all federal health programs.
Title
Prevent Health Care Fraud Act of 2009
Sponsors
Rep. Ginny Brown-Waite [R-FL] | Rep. Vern Buchanan [R-FL] | Rep. Lincoln Diaz-Balart [R-FL] | Rep. Mario Diaz-Balart [R-FL] |
Rep. Jo Emerson [R-MO] | Rep. Steve Kagen [D-WI] | Rep. Connie Mack [R-FL] | Rep. Adam Putnam [R-FL] |
Rep. Thomas Rooney [R-FL] | Rep. Peter Roskam [R-IL] | Rep. Mark Souder [R-IN] | Rep. Robert Wittman [R-VA] |
History
Date | Chamber | Action |
---|---|---|
2009-12-09 | Referred to the Subcommittee on Health. | |
2009-12-08 | Referred to the House Committee on Energy and Commerce. |
Same As/Similar To
SB2128 (Related) 2009-10-30 - Sponsor introductory remarks on measure. (CR S10949-10951)
Subjects
Administrative law and regulatory procedures
Child health
Crime prevention
Criminal justice information and records
Department of Health and Human Services
Executive agency funding and structure
Federal officials
Fraud offenses and financial crimes
Health
Health care costs and insurance
Health information and medical records
Medicaid
Medicare
Public contracts and procurement
Child health
Crime prevention
Criminal justice information and records
Department of Health and Human Services
Executive agency funding and structure
Federal officials
Fraud offenses and financial crimes
Health
Health care costs and insurance
Health information and medical records
Medicaid
Medicare
Public contracts and procurement
US Congress State Sources
Type | Source |
---|---|
Summary | https://www.congress.gov/bill/111th-congress/house-bill/4222/all-info |
Text | https://www.congress.gov/111/bills/hr4222/BILLS-111hr4222ih.pdf |