Healthcare Fraud Prevention Partnership (HFPP): Data Sharing and Information Exchange (CMS-10501)

Forms and Documents

Document Name	Status
CMS-10501 - Change Justification.docx Justification for No Material/Nonsubstantive Change	2018-12-07
CMS-10501 - Data Submission Template PRA (Professional Claims).docx Supplementary Document	2018-12-07
CMS-10501 - Appendix B Data Elements (NEW).docx Supplementary Document	2018-12-07
CMS-10501 - HFFP Supporting Statement - Final 2018.docx Supporting Statement A	2018-12-07
CMS-10501 - Appendix A - Public Comment Tracking Tool.doc Supplementary Document	2017-08-24
CMS-10501 - SS-B 417.docx Supporting Statement B	2017-08-24

IC Document Collections

IC ID	Document Title	Status

ICR Details

OMB Control No: 0938-1251	ICR Reference No: 201812-0938-005
Status: Active	Previous ICR Reference No: 201708-0938-019
Agency/Subagency: HHS/CMS	Agency Tracking No: 21327
Title: Healthcare Fraud Prevention Partnership (HFPP): Data Sharing and Information Exchange (CMS-10501)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/10/2018
	Date Received in OIRA: 12/10/2018
Terms of Clearance: Previous terms continue: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	12/31/2021	12/31/2021
Responses	55	0	55
Time Burden (Hours)	176,800	0	176,800
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1128C(a)(2) of the Social Security Act (42 U.S.C. 1320a-7c(a)(2)) authorizes the Secretary and the Attorney General to consult with, and arrange for the sharing of data with representatives of health plans to establish a Fraud and Abuse Control Program as specified in Section 1128(C)(a)(1) of the Social Security Act. This is known as the Healthcare Fraud Prevention Partnership (HFPP). It was officially established by a Charter in fall 2012 and signed by HHS Secretary Sibelius and US Attorney General Holder. The HFPP is a joint initiative established by the Department of Health and Human Services and Department of Justice to detect and prevent the prevalence of healthcare fraud through data and information-sharing and applying analytic capabilities by the public and private sectors. The HFPP collaboration provides a unique opportunity to transition from traditional "pay and chase" approaches for fraud detection and recovery towards a data-driven model for identifying and predicting aberrant activity. A central goal of the HFPP is to identify the optimal way to coordinate nationwide sharing of health care claims information, including aggregating claims and payment information from large public healthcare programs and private insurance payers. In addition to sharing data and information, the HFPP is focused on advancing analytics, training, outreach, education to support anti-fraud efforts and achieving its objectives, primarily through goal-oriented, well-designed fraud studies. The HFPP's organizational structure is made up of an Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee. The HFPP will also include a Trusted Third Party that CMS will engage to provide the technical and operational platform to support the partnerships' data sharing, collaboration and study outreach activities. Enabling data sharing and providing analytical computing capabilities of the TTP is central to the success of the HFPP.

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Authorizing Statute(s): PL: Pub.L. 104 - 191 201 Name of Law: Fraud and abuse control program
   US Code: 42 USC 1320a-7c Name of Law: Fraud and abuse control program
  

Citations for New Statutory Requirements: PL: Pub.L. 104 - 191 201 Name of Law: Fraud and abuse control program
US Code: 42 USC 1320a-7c Name of Law: Fraud and abuse control program

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 6559	01/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 16844	04/06/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 0

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	55	55	0	0	0	0
Annual Time Burden (Hours)	176,800	176,800	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The HFPP TTP is implementing a shift in the way studies are conducted for the purpose of detecting and deterring fraud, waste, and abuse among its partners. Moving to a framework with frequently updated data, including PHI and PII, the TTP will enable the HFPP to proactively identify vulnerabilities across participating entities in real time, significantly increasing the value of the HFPP to its partners. The TTP has developed a new process and expanded the set of data elements for submission by partners using a Cloud environment and resources that allows it to analyze data that is stored in many formats in the same file. It also allows for the partners to choose how to provide the data taking advantage of files, formats, and processes that the partners’ IT departments are using, either with the Special Investigations Unit (SIU), other internal components, or with third parties. As a result of this new streamlined process which incorporates procedures aimed at reducing the time and effort involved in retrieving claims data, the annual burden hours per partner has decreased from 1200 to 160 while allowing for the number of respondents to be increased from 15 to 20. The centers anticipate this to be an ongoing collection and request OMB approval for an additional three years.

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Annual Cost to Federal Government: $6,614,695

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/10/2018

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