Health Care Fraud Prevention and Enforcement Act

Senate Bill 5326, titled the **Health Care Fraud Prevention and Enforcement Act**, amends Title XVIII (Medicare) and related sections of the Social Security Act. It increases federal funding allocations, broadens the scope of investigations, and updates reporting mandates for federal programs dedicated to detecting and preventing healthcare fraud.

This legislation directly impacts federal agencies and specific administrative programs that oversee healthcare fraud prevention, including: * The Department of Health and Human Services (HHS) * The Department of Justice (DOJ) * The HHS Office of Inspector General (HHS-OIG) * The Federal Bureau of Investigation (FBI) * The Medicare Integrity Program * The Medicare-Medicaid Data Match Program

The bill establishes set funding schedules for healthcare oversight entities beginning in Fiscal Year (FY) 2027 through FY 2029. Starting in FY 2030, the law mandates automatic annual funding adjustments tied to inflation (measured by the Consumer Price Index for All Urban Consumers, or CPI-U) or statutory inflation formulas to maintain spending levels over time.

The bill outlines specific yearly funding amounts across several federal operations: * **Joint HHS and Department of Justice Operations:** * FY 2027: $490 million * FY 2028: $520 million * FY 2029: $570 million * FY 2030 and beyond: Adjusted annually for inflation based on the CPI-U. * **HHS Office of Inspector General (HHS-OIG):** * FY 2027: $320 million * FY 2028: $340 million * FY 2029: $370 million * FY 2030 and beyond: Previous year’s amount adjusted for CPI-U inflation at minimum. * **Federal Bureau of Investigation (FBI):** * FY 2027: $230 million * FY 2028: $250 million * FY 2029: $270 million * FY 2030 and beyond: Adjusted annually for inflation based on the CPI-U. * **Medicare Integrity Program:** * FY 2027: $1.28 billion * FY 2028: $1.38 billion * FY 2029: $1.48 billion * FY 2030 and beyond: Adjusted using the statutory inflation formula. * **Medicare-Medicaid Data Match Program:** * FY 2027: $110 million * FY 2028: $120 million * FY 2029 and beyond: *Unclear due to incomplete source text.*

* **Incomplete Information:** The funding details for the Medicare-Medicaid Data Match Program for FY 2029 and subsequent years cut off in the available text summary, making those specific future funding rules unclear. * **Inflation Rules:** Funding adjustments beginning in FY 2030 are strictly limited to official inflation calculations (CPI-U or designated statutory formulas). For the HHS-OIG, the inflation-adjusted amount serves as a strict funding floor (minimum requirement).

This bill sets mandatory multi-year funding increases from FY 2027 through FY 2029 for federal agencies (HHS, DOJ, FBI) and specialized programs targeting healthcare fraud, and mandates that these funding levels automatically increase with inflation starting in FY 2030.