Putting an N to Learing about Fraud Act
Sponsored By: Senator Joni Ernst
Introduced
Summary
This bill would _combat fraud across federal programs_ by shifting how child care payments are billed, adding clear fraud triggers in health programs, and strengthening improper payment recovery and reporting.
Show full summary
- Families and child care providers would see payments shift from enrollment-based prepayments to attendance-based billing under the Child Care and Development Block Grant rules. Providers must keep attendance and service records for 7 years and make them available for audits by the Secretary of Health and Human Services, the Attorney General, and the Comptroller General, and they would receive reimbursement after services are delivered.
- Patients and health programs would face new numeric fraud triggers across Medicare, qualified health plans on the exchanges, Medicaid, and CHIP. A more-than-100 percent year-to-year rise in payments or in the number of providers in a zip code or county would require a 60-day notification to the HHS Inspector General, and the HHS Inspector General must identify programs with at least 400 percent growth over the prior 5 years and audit them annually.
- Federal agencies and states would get stronger recovery and reporting rules. The Director of the Office of Management and Budget must issue guidance to recover improper payments and Inspector General reports must show amounts recovered by each executive agency for the fiscal year. Key effective dates use 180 days for Medicare and exchange-plan rules and include a state-legislation timing mechanism for Medicaid and CHIP.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 0 costs, 2 mixed.
OMB guidance to recover improper payments
If enacted, the Director of the Office of Management and Budget would have to issue guidance to all executive agencies to recover improper federal payments. The guidance would apply across agencies and aim to strengthen how agencies collect money that was paid by mistake. This requirement would take effect upon enactment.
New checks for health payment spikes
If enacted, the bill would require HHS to flag local spikes when payments or the number of providers in a zip code and county more than double (over 100%) in one year. The Secretary would notify the HHS Inspector General within 60 days for Medicare and for qualified health plans, and State Medicaid agencies would also notify HHS and the Inspector General within 60 days. Health insurance Exchanges would have to send plan-level data each year so the Secretary can check for spikes. The HHS Inspector General would, not later than 5 years after enactment and annually after, audit any program where payments or provider counts rose at least 400% over the prior five years. The Medicare and Exchanges rules would start 180 days after enactment; the audit duty would start not later than 5 years after enactment.
Child care payments tied to attendance
If enacted, lead agencies would have to pay child care providers after services are provided, not before. Payments would be reimbursements and must be based on recorded attendance rather than enrollment alone. Child care providers who receive payments would have to keep attendance and service records for 7 years and make them available for audits by HHS, the Attorney General, and the Comptroller General. This change would take effect upon enactment.
Sponsors & CoSponsors
Sponsor
Joni Ernst
IA • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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