Health Care Fraud Prevention and Enforcement Act

This legislation aims to strengthen program integrity oversight for the Health Care Fraud and Abuse Control Program (HCFAC) by significantly increasing its funding and expanding its scope. It provides substantial new annual appropriations for key federal entities involved in combating healthcare fraud, including the Departments of Health and Human Services and Justice, the HHS Office of the Inspector General, and the Federal Bureau of Investigation. These funding increases commence in fiscal year 2027 and are designed to continue with annual adjustments based on the consumer price index. The bill expands the investigative authority of the HHS Inspector General to cover programs established under the Patient Protection and Affordable Care Act, alongside existing Medicare and Medicaid oversight. It also clarifies the definition of a "health plan" to explicitly include both public and private delivery systems and programs, broadening the reach of fraud prevention efforts. Furthermore, the legislation integrates the Children's Health Insurance Program (CHIP) into the Medicare-Medicaid data match program, enhancing fraud detection across these critical health programs starting in 2027. To improve accountability and transparency, the bill revises the deadline for the annual HCFAC report to Congress, requiring a notice of delay if the report is not submitted by April 1. Finally, it mandates a comprehensive study by the Government Accountability Office (GAO) to assess the performance and effectiveness of the HCFAC program. This study will analyze how funds are utilized, evaluate performance metrics, and provide recommendations to Congress on improving fraud prevention and enforcement efforts.