2)? • What evidence exists for and against establishing a centralized health care fraud database to enhance information sharing and support enforcement efforts (see ch. However, there are some related immunity provisions on the federal level. Immunity Protects Persons Who Report Suspected Fraud

Broadly viewed, public policy supports both encouraging private entities to participate in the investigation and prosecution of fraud and providing protection to innocent people against unsubstantiated allegations made in bad faith or with malice. For that reason, the Department of Health and Human Services will ordinarily request, and the Department of Justice will ordinarily agree, that the Department of Justice will defend, at its own expense, any Medicare contractor or employee of a contractor, who is sued in connection with activities undertaken within the scope of the Medicare contract.”
Further, the federal statutory immunity provision does not protect persons who report suspected fraud involving private sector insurance plans, even if the suspected fraud is reported to a federal agency such as the FBI or the U.S. 1320c-6(a) to provide immunity for, among other things, “health plans sharing information in good faith and without malice with any other health plan with respect to matters relating to health care fraud detection, investigation and prosecution.”

		Industry and Law Enforcement Officials Generally Favor Broad Federal Immunity Legislation With Appropriate Safeguards

Industry organizations, such as NHCAA and the Health Insurance Association of America, have stated that due to the potential for civil lawsuits, private insurers are concerned about sharing fraud-related information with law enforcement agencies. This piecemeal state legislation simply does not protect insurers and other payers in many states or in multi-state investigations. Also, federal officials at four of the field offices said that S. 1088 should be expanded to provide immunity for insurers sharing fraud-related information with other insurers. Currently, there is no federal immunity protection for persons who report fraud-related information to law enforcement agencies. While most states have enacted immunity laws that provide some immunity protection to insurers, these laws vary from state to state. The proposed database would contain information about final adverse actions—such as license revocations, administrative sanctions, civil judgments, and criminal convictions—involving health care system participants. Recent Proposals Would Create a National Database of Health Care Fraud-Related Information

To address the issue of access to health care fraud-related information, recent proposals (see table 3.1) have supported the establishment of a centralized repository for health care fraud information. In addition to the issues noted above, centralized databases also pose uncertainties about development and operating costs.
Why GAO Did This Study

Pursuant to a congressional request, GAO discussed: (1) the extent of federal and state immunity laws protecting persons who report health care fraud; and (2) evidence for and against establishing a centralized health care fraud database.

What GAO Found

GAO found that: (1) there are no federal immunity protections for persons who report alleged health care fraud to law enforcement agencies; (2) the only federal provision that could protect such persons applies to persons reporting Medicare and Medicaid fraud; (3) private insurers and health care claims processors are also not provided any federal immunity protection if they report suspected fraud; (4) many states have enacted immunity protection, but the amount of protection varies by state; (5) Congress is considering legislation that would protect persons providing health care fraud information to the Departments of Health and Human Services or Justice; (6) most federal and state officials support the proposed immunity provisions and safeguards to protect against persons who make unsubstantiated allegations in bad faith; (7) many federal officials believe that the legislation should be expanded to provide immunity to persons sharing fraud-related information with any state or federal enforcement entity and insurers sharing information with other insurers; (8) the proposed legislation would create a central database to track criminal activity in the health care system; (9) the database would provide information on criminal convictions, civil judgments, and negative licensing actions and be accessible to federal and state agencies and health insurers; and (10) most law enforcement officials support the database's establishment and believe that enforcement benefits would accrue, but many are concerned about the potential for unauthorized disclosure of information and high development and operating costs.