Despite the many differences between the House-passed health care reform bill1 and the Senate bill passed on December 24, 2009,2 the two are remarkably similar with respect to the enhanced fraud and abuse enforcement provisions. This solidarity is not surprising given that many experts estimate that losses resulting from health care fraud could pay for much, or even all, of health care reform.3 Thus, legislators may see taking a tough stance on health care fraud as a more palatable way to pay for health care reform, as opposed to seeking more reimbursement cuts.

This Advisory discusses the major provisions in the two bills that target fraud and abuse. If health care reform passes, these provisions likely will appear in the final legislation. Where the two bills differ, the Senate bill’s provisions likely will trump the House bill’s provisions due to the Senate Majority leader’s tenuous grasp on the 60 votes needed for passage and the behind-the-scenes discussions with the House leadership about the current differences.