LUGPA Policy Brief - The Health Care Fraud Prevention and Enforcement Act

August 2026

At a Glance

The Issue:
The bipartisan Health Care Fraud Prevention and Enforcement Act would strengthen the federal Health Care Fraud and Abuse Control (HCFAC) Program and provide additional resources to prevent, detect, investigate, and prosecute health care fraud.

The Opportunity:
LUGPA supports strong program-integrity efforts that protect taxpayers, Medicare beneficiaries, and legitimate providers from fraudulent activity.

The Consideration:
Enforcement should be targeted, evidence-based, and proportionate, distinguishing intentional fraud from inadvertent errors and good-faith compliance efforts.

Why It Matters:
Audits, investigations, and documentation requirements can impose significant administrative burdens on independent practices, which may have fewer compliance resources than large health systems. Effective enforcement should protect federal programs without creating unnecessary barriers to patient care.

The Issue

The Health Care Fraud Prevention and Enforcement Act, introduced by Senators Catherine Cortez Masto (D-NV), Chuck Grassley (R-IA), Ron Wyden (D-OR), and Mike Crapo (R-ID), would provide stable funding and additional tools to strengthen the federal HCFAC Program.

The legislation would expand efforts to prevent, detect, investigate, and prosecute fraud across federal health programs and is estimated by CBO to generate at least $45 billion in federal savings.

LUGPA supports providing federal agencies with the resources necessary to identify sophisticated fraud schemes and hold bad actors accountable. At the same time, Medicare's complex and frequently changing billing, coding, documentation, and coverage requirements can result in inadvertent errors. Enforcement should distinguish these good-faith compliance issues from intentional fraud and abuse.

Impact on Independent Urology

Medicare beneficiaries represent a significant portion of the patients served by LUGPA members. Strong program-integrity efforts help protect Medicare resources and ensure that fraudulent providers do not gain an unfair advantage.

However, enhanced enforcement can also create operational challenges for independent practices:

• Administrative burden: Audits, investigations, and documentation requests can divert physician and staff resources from patient care.
• Regulatory complexity: Technical errors or reasonable documentation disagreements should not be treated the same as intentional misconduct.
• Disproportionate impact: Independent practices may have fewer compliance resources than large health systems.
• Patient access: Enforcement policies should not inadvertently discourage Medicare participation or the provision of complex specialty services.

LUGPA’s Position

LUGPA supports strengthening federal efforts to prevent, detect, and prosecute health care fraud and abuse. Program-integrity policies should:

• Target intentional fraud and abuse and meaningful patterns of suspicious activity;
• Use data-driven, evidence-based enforcement to focus resources where they have the greatest impact;
• Distinguish intentional misconduct from inadvertent errors and good-faith compliance efforts;
• Ensure transparency, due process, and proportionality in audits and enforcement actions;
• Minimize unnecessary administrative burdens on physician practices; and
• Protect patient access by avoiding policies that could discourage Medicare participation or the delivery of medically necessary care.

The Bottom Line

Strong program integrity and strong patient access should go hand in hand.

LUGPA supports bipartisan efforts to strengthen the federal government’s ability to combat health care fraud and protect taxpayer resources. At the same time, enforcement should be targeted, transparent, evidence-based, and proportionate, allowing federal agencies to focus on genuine fraud and abuse without imposing unnecessary burdens on independent physician practices.

LUGPA supports strengthening program integrity while preserving the ability of independent urology practices to provide high-quality, accessible specialty care to Medicare beneficiaries.