By NextBestFitPhase 5: Stabilize & govern · Step 5.2
Run program integrity & fraud control
Year 1 onward · UHA Program Integrity; HHS-OIG; DOJDiscuss this step
With one payer, fraud schemes that exploit gaps between payers disappear, but every scheme now targets one payer. UHP funds fraud control at a higher rate than Medicare does today.
Legal vehicle
Universal Health Act; extends the False Claims Act, the Anti-Kickback Statute, and HHS-OIG authority.
Who does it
UHA Program Integrity; HHS-OIG; DOJ
When
Year 1 onward
In this step
Tasks
4 tasks
Trade-offs
1 pros · 1 cons · 1 trade-offs
Risks
2 risks with mitigations
What changes in the system
2 existing laws, programs, or institutions changed
Other countries
3 comparisons
Biggest risk for this step
Fraud concentrated on one payer. See risks.
Steps that depend on this one
None.
Sources: CMS (2024)