Cortez Masto, Grassley, Wyden, Crapo Introduce Legislation to Crack Down on Health Care Fraud

The Health Care Fraud Prevention and Enforcement Act Would Save Taxpayers an Estimated $45 Billion Dollars

Washington, D.C. - U.S. Senators Catherine Cortez Masto (D-Nev.), Chuck Grassley (R-Iowa), Ron Wyden (D-Ore.), and Mike Crapo (R-Idaho) introduced the bipartisan Health Care Fraud Prevention and Enforcement Act, which would invest in and improve the Health Care Fraud and Abuse Control (HCFAC) Program. HCFAC was created to combat fraud, waste, and abuse across federal health programs, including Medicare and Medicaid.

"Medicaid and Medicare are lifelines for families. To ensure they are working as intended, we have to crack down on bad actors taking advantage of Americans," said Senator Cortez Masto. "Funding our national fraud and abuse investigation unit will save taxpayers billions and restore Americans' trust that the government can target and go after real fraud and abuse."

"My oversight has revealed fraud, waste and abuse across our health care system, including Medicare, Medicaid and the Obamacare marketplace. By bolstering efforts to go after these bad actors, our bipartisan legislation will crack down on people stealing the taxpayers' money and driving up health care costs for families," said Senator Grassley.

"The best way to fight health care fraud is to fund the cops on the beat who can identify and prosecute fraudsters quickly and efficiently. This common sense approach empowers independent watchdogs in the federal government to use their know-how to recoup taxpayer dollars from these bad actors, and widens the net to ensure every federal health care program has adequate protection from those seeking to bilk taxpayer dollars. I'm pleased that this approach is receiving bipartisan support and I will be working to fund these fighters quickly on a bipartisan basis," said Senator Wyden.

"Health care programs account for the federal government's largest source of improper payments, including through waste, fraud and abuse. This commonsense legislation equips the U.S. Department of Health and Human Services and U.S. Department of Justice with the resources they need to uncover and prevent fraud, preserving federal health care programs for those who depend on them while protecting taxpayer dollars," said Senator Crapo.

Federal health care spending is expected to exceed $24 trillion over the next decade. As health care fraud schemes continue to grow in scale and complexity, the HCFAC program needs long-term, stable funding to keep pace with evolving threats and strengthen efforts to prevent, detect, and prosecute fraud. This legislation would save taxpayers at least $45 billion, per estimates from the Congressional Budget Office (CBO). For the first time, the bill allows HCFAC partners to use mandatory funding to combat fraud in the ACA Health Insurance Marketplace and related private insurance programs. It also gives the Centers for Medicare and Medicaid Services (CMS) new tools to strengthen oversight and protect the integrity of the Children's Health Insurance Program (CHIP), requires timely reporting to track the HCFAC program's effectiveness, and asks the Government Accountability Office to report on HCFAC's performance.

In FY 2025, the Health and Human Services Office of Inspector General's (HHS-OIG) HCFAC activities recovered $12 for every $1 spent on Medicare program integrity efforts, resulting in $5.7 billion in expected recoveries and receivables. HHS-OIG also excluded more than 2,500 individuals and entities from doing business with federal health care programs for fraud, patient abuse, and other misconduct, including egregious neglect of nursing home residents, improper billing practices, and facilitating fraudulent providers and suppliers. Across all HCFAC partners, including HHS, CMS, HHS-OIG, DOJ, and the FBI, the program has had a positive return on investment since its inception, demonstrating the value of coordinated, multi-agency enforcement to fight fraud and protect taxpayer dollars.

Read the bill here.

Senator Cortez Masto has worked to strengthen the Medicare and Medicaid programs and go after legitimate fraud and abuse. She passed legislation to allow Medicare to negotiate lower drug prices and cap the cost of insulin at $35-a-month for Medicare recipients through the Inflation Reduction Act. She has also pushed pharmacy benefit managers to help continue to lower prescription drug costs. As Nevada Attorney General, Cortez Masto worked with the Nevada Medicaid Fraud Control Unit to go after bad actors within the system.

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