S. 5326

111 S5326 IS: Health Care Fraud Prevention and Enforcement Act
 U.S. Senate
 2026-08-06
 text/xml
 EN
 Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
 II  119th CONGRESS  2d Session  S. 5326  IN THE SENATE OF THE UNITED STATES   August 6, 2026   Ms. Cortez Masto  (for herself,  Mr. Grassley ,  Mr. Wyden , and  Mr. Crapo ) introduced the following bill; which was read twice and referred to the  Committee on Finance    A BILL
To amend title XVIII of the Social Security Act to strengthen program integrity oversight for the Health Care Fraud and Abuse Control Program, and for other purposes.
1.
Short title
This Act may be cited as the   Health Care Fraud Prevention and Enforcement Act  .
2.
Strengthening program integrity oversight for the Health Care Fraud and Abuse Control Program
(a)
Additional funding
(1)
Departments of Health and Human Services and Justice
Section 1817(k)(3)(A)(i) of the Social Security Act ( 42 U.S.C. 1395i(k)(3)(A)(i) ) is amended—
(A)
in subclause (III), by striking  and  at the end;
(B)
in subclause (IV)—
(i)
by inserting  and before fiscal year 2027  after  after fiscal year 2006 ; and
(ii)
by striking the period at the end and inserting a semicolon; and
(C)
by adding at the end the following new subclauses:
(V)
for fiscal year 2027, $490,000,000;
(VI)
for fiscal year 2028, $520,000,000;
(VII)
for fiscal year 2029, $570,000,000; and
(VIII)
for each fiscal year after fiscal year 2029, the limit under this clause for the preceding fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over the previous year.
  .
(2)
Office of the Inspector General of the Department of Health and Human Services
Section 1817(k)(3)(A)(ii) of the Social Security Act ( 42 U.S.C. 1395i(k)(3)(A)(ii) ) is amended—
(A)
in subclause (VIII), by striking  and  at the end;
(B)
in subclause (IX)—
(i)
by inserting  and before fiscal year 2027  after  after fiscal year 2007 ; and
(ii)
by striking the period at the end and inserting a semicolon; and
(C)
by adding at the end the following new subclauses:
(X)
for fiscal year 2027, $320,000,000;
(XI)
for fiscal year 2028, $340,000,000;
(XII)
for fiscal year 2029, $370,000,000; and
(XIII)
for each fiscal year after fiscal year 2029, not less than the amount required under this clause for the preceding fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over the previous year.
  .
(3)
Federal Bureau of Investigation
Section 1817(k)(3)(B) of the Social Security Act ( 42 U.S.C. 1395i(k)(3)(B) ) is amended—
(A)
in clause (vii), by striking  and  at the end;
(B)
in clause (viii)—
(i)
by inserting  and before fiscal year 2027  after  after fiscal year 2006 ; and
(ii)
by striking the period at the end and inserting a semicolon; and
(C)
by adding at the end the following new clauses:
(ix)
for fiscal year 2027, $230,000,000;
(x)
for fiscal year 2028, $250,000,000;
(xi)
for fiscal year 2029, $270,000,000; and
(xii)
for each fiscal year after fiscal year 2029, the amount to be appropriated under this subparagraph for the preceding fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over the previous year.
 .
(4)
Medicare Integrity Program
Section 1817(k)(4) of the Social Security Act ( 42 U.S.C. 1395i(k)(4) ) is amended—
(A)
in subparagraph (B)—
(i)
in clause (vii), by inserting  and before fiscal year 2027  after  after fiscal year 2002 ; and
(ii)
by adding at the end the following new clauses:
(viii)
For fiscal year 2027, $1,280,000,000.
(ix)
For fiscal year 2028, $1,380,000,000.
(x)
For fiscal year 2029, $1,480,000,000.
(xi)
For each fiscal year after fiscal year 2029, the amount appropriated under this subparagraph for the preceding fiscal year, as increased pursuant to subparagraph (C)(ii).
 ; and
(B)
in subparagraph (C)(ii), by striking  For each fiscal year after 2010  and inserting  For each of fiscal years 2011 through 2026, and for each fiscal year after fiscal year 2029 .
(5)
Medicare-Medicaid data match program
Section 1817(k)(4)(D) of the Social Security Act ( 42 U.S.C. 1395i(k)(4)(D) ) is amended—
(A)
in clause (v), by inserting  through fiscal year 2026  after  and each fiscal year thereafter ; and
(B)
by adding at the end the following new clauses:
(vi)
$110,000,000 for fiscal year 2027.
(vii)
$120,000,000 for fiscal year 2028.
(viii)
$130,000,000 for fiscal year 2029.
(ix)
For each fiscal year after fiscal year 2028, the amount appropriated under this subparagraph for the preceding fiscal year, as increased pursuant to subparagraph (C)(ii).
 .
(b)
Expansion of investigative authority of the office of the inspector general of the department of health and human services
Section 1817(k)(3)(A)(ii) of the Social Security Act ( 42 U.S.C. 1395i(k)(3)(A)(ii) ) is amended—
(1)
in the heading, by striking
Medicare and medicaid activities   and inserting
Office of the inspector general of the department of health and human services  ; and
(2)
in the matter preceding subclause (I), by striking  title XIX  and inserting  title XIX and any program established under title I (or under the amendments made by such title) of the Patient Protection and Affordable Care Act ( Public Law 111–148 ) that is administered by the Secretary .
(c)
Clarification concerning the definition of health plan
Section 1128C of the Social Security Act ( 42 U.S.C. 1320a–7c ) is amended—
(1)
in subsection (a)(1)(B), by inserting  public and private  before  delivery ; and
(2)
in subsection (c), in the matter preceding paragraph (1), by inserting  public or private  before  plan or program .
(d)
Clarification of authority for the activities of the departments of justice and health and human services
Section 1817(k)(3) of the Social Security Act ( 42 U.S.C. 1395i(k)(3) ) is amended by adding at the end the following new subparagraph:
(D)
Rule of construction.—Nothing in this paragraph shall be construed to limit the authority of the Secretary, the Attorney General, or the Inspector General of the Department of Health and Human Services to use funds made available under this paragraph to—
(i)
detect or prosecute health care fraud and abuse; and
(ii)
communicate with the public about health care fraud.
 .
(e)
Annual report to congress
Section 1817(k)(5) of the Social Security Act ( 42 U.S.C. 1395i(k)(5) ) is amended—
(1)
by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and indenting appropriately;
(2)
by striking
report .—Not later than January 1  and inserting “
report .—
(A)
In general
Not later than April 1
 ; and
(3)
by adding at the end the following new subparagraph:
(B)
Required notice of delay
(i)
In general
If the annual report required under subparagraph (A) is not submitted to Congress by April 1 of the year, the Secretary and Attorney General shall jointly provide notice to the appropriate committees of Congress beginning not later than such April 1, and annually thereafter until such report is submitted to Congress, stating the reason for the delay.
(ii)
Applicable committees of Congress defined
For purposes of this subparagraph, the term  appropriate committees of Congress  means the Committees on Finance and the Budget of the Senate and the Committees on Ways and Means, the Budget, and Energy and Commerce of the House of Representatives.
 .
(f)
Process for determining funding allocation for departments of justice and health and human services
Section 1817(k)(3)(A)(i) of the Social Security Act ( 42 U.S.C. 1395i(k)(3)(A)(i) ) is amended, in the matter preceding subclause (I), by striking  certify  and inserting  agree .
(g)
Inclusion of children’s health insurance program in medicare-Medicaid data match program
Section 1893(g) of the Social Security Act ( 42 U.S.C. 1395ddd(g) ) is amended—
(1)
in paragraph (1)(A)—
(A)
in the matter preceding clause (i), by striking  under title XIX for the purpose of  and inserting  under title XIX, and beginning with 2027, with respect to the State Children's Health Insurance Program under title XXI, for the purpose of ;
(B)
in clause (i), by striking  under this title and the Medicaid program established under title XIX  and inserting  under this title, the Medicaid program established under title XIX, and the State Children's Health Insurance Program established under title XXI ;
(C)
in clause (ii), by inserting  and the State Children's Health Insurance Program under title XXI  after  under title XIX ; and
(D)
in clause (iii), by striking  both ; and
(2)
in paragraph (2), by striking  titles XI and XIX  and inserting  titles XI, XIX, and XXI .
3.
GAO study and report on performance and effectiveness of Health Care Fraud and Abuse Control Program
(a)
Study
The Comptroller General of the United States (in this section referred to as the  Comptroller General ) shall conduct a study regarding the performance and effectiveness of the Health Care Fraud and Abuse Control Program. To the extent feasible and data are available, the study shall include the following:
(1)
An analysis of how the Department of Health and Human Services and the Department of Justice have used their appropriations to achieve the goals of the Health Care Fraud and Abuse Control Program under section 1128C of the Social Security Act ( 42 U.S.C. 1320a–7c ).
(2)
An analysis of performance assessments and other metrics the Department of Health and Human Services and the Department of Justice use to determine the performance and effectiveness of the Health Care Fraud and Abuse Control Program.
(3)
A description of how the Department of Health and Human Services and the Department of Justice obligated funds for the Health Care Fraud and Abuse Control Program.
(4)
An analysis of how the Department of Health and Human Services and the Department of Justice assess Health Care Fraud and Abuse Control activities and whether key program outputs have changed over time since the most recent Government Accountability Office report under section 1817(k)(6) of the Social Security Act ( 42 U.S.C. 1395i(k)(6) ).
(5)
An analysis of evidence available regarding the effectiveness of the Health Care Fraud and Abuse Control Program in reducing health care fraud and abuse.
(6)
An analysis of the timeliness of the annual Health Care Fraud and Abuse Control report under section 1817(k)(5) of the Social Security Act ( 42 U.S.C. 1395i(k)(5) ) and how the Department of Health and Human Services and the Department of Justice could improve the timeliness of such report.
(b)
Report
Not later than 16 months after the date of enactment of this Act, the Comptroller General shall report to Congress the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.