HR6906-119

What This Bill Does

The Protecting Patients from Rehab Fraud Act is an oversight bill focused on drug addiction treatment and recovery facilities. The Attorney General must report to Congress within one year on illegal tactics used to entice people into rehab, Affordable Care Act exchange insurance fraud involving people housed in facilities, brokers encouraging patients to commit insurance fraud to enroll in high-cost out-of-network plans, drug use and trafficking inside facilities, and patient dumping when insurance stops paying. The report must also address whether dumped patients become homeless, relapse, or are left far from their original location. GAO must separately report within one year on actions by HHS and other federal actors to curb insurance fraud, actions by states, the extent and effectiveness of federal spending for rehab facilities, and recommendations.

Who Benefits and How

People seeking addiction treatment benefit if the reports expose fraud, patient brokering, drug trafficking, and patient dumping that endanger patients. Patients dumped by rehab facilities benefit from congressional attention to homelessness, relapse, and transport away from home. HHS program-integrity staff, state insurance regulators, and law enforcement agencies benefit from clearer findings and recommendations. Honest addiction treatment providers benefit if oversight distinguishes legitimate care from fraudulent or abusive competitors.

Who Bears the Burden and How

Attorney General staff and GAO auditors must investigate complex fraud patterns, gather federal and state oversight information, and report to Congress within one year. HHS program-integrity staff, ACA marketplace officials, insurers, state regulators, and rehab facilities may need to provide records or respond to findings. Addiction treatment facilities using illegal tactics and insurance brokers pushing fraudulent enrollment face heightened scrutiny. Federal taxpayers bear the cost of the reports and any follow-up enforcement or oversight activity.

Key Provisions

• Requires an Attorney General report on illegal recruitment, insurance fraud, patient brokering, drug activity, and patient dumping in addiction treatment.
• Requires review of ACA exchange fraud and high-cost out-of-network enrollment schemes.
• Requires analysis of homelessness, relapse, and travel harms after patient dumping.
• Requires GAO to report on federal and state anti-fraud actions and federal spending effectiveness.
• Directs both reports to include recommendations for Congress.