Health Care Fraud Prevention and Enforcement Act

This bill, known as the Health Care Fraud Prevention and Enforcement Act, aims to strengthen oversight and enforcement within the Health Care Fraud and Abuse Control Program (HCFAC). A primary provision is the substantial increase in annual appropriations for various federal entities involved in combating health care fraud, beginning in fiscal year 2027. These include the Departments of Health and Human Services and Justice, the HHS Office of Inspector General, the Federal Bureau of Investigation, the Medicare Integrity Program, and the Medicare-Medicaid Data Match Program, with future funding tied to inflation.

The legislation expands the investigative authority of the Office of the Inspector General of the Department of Health and Human Services to cover programs established under Title I of the Patient Protection and Affordable Care Act. It also clarifies that the definition of a health plan for fraud and abuse purposes encompasses both public and private delivery systems and programs. Furthermore, the bill explicitly states that appropriated funds can be used for detecting, prosecuting, and public communication regarding health care fraud and abuse.

To enhance program integrity, the bill integrates the State Children's Health Insurance Program (CHIP) into the Medicare-Medicaid Data Match Program starting in 2027, allowing for cross-program data analysis to identify fraud. It also revises the annual report to Congress on HCFAC activities, moving the deadline to April 1 and requiring a notice of delay if the report is not submitted on time.

Finally, the bill mandates that the Comptroller General of the United States conduct a comprehensive study on the performance and effectiveness of the Health Care Fraud and Abuse Control Program. This study will analyze how appropriated funds are used, assess performance metrics, and evaluate the program's overall success in reducing health care fraud and abuse, with a report and recommendations due to Congress within 16 months.