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

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

The Health Care Fraud Prevention and Enforcement Act would save taxpayers an estimated $45 billion dollars.

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

Grassley and Cortez Masto are members of the Senate Finance Committee. Crapo and Wyden serve as the committee's chairman and ranking member, respectively.

"My oversight has revealed fraud, waste and abuse across our healthcare 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 healthcare costs for families," Grassley said.

"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," Cortez Masto said. "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."

"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," Wyden said.

"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," Crapo said.

Background:

Federal healthcare spending is expected to exceed $24 trillion over the next decade. As healthcare 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. The legislation includes additional measures giving 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). It also requires timely reporting to track the HCFAC program's effectiveness and asks the Government Accountability Office to report on HCFAC's performance.

In Fiscal Year 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 healthcare programs for fraud and patient abuse and other misconduct. That conduct includes 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.

Download bill text HERE.

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