[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5757 Introduced in House (IH)]
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115th CONGRESS
2d Session
H. R. 5757
To amend title XI of the Social Security Act to expand the permissive
exclusion from Federal health programs to include certain individuals
with prior interest in sanctioned entities and entities affiliated with
sanctioned entities, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 10, 2018
Ms. Frankel of Florida (for herself and Mr. Keating) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to expand the permissive
exclusion from Federal health programs to include certain individuals
with prior interest in sanctioned entities and entities affiliated with
sanctioned entities, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Fighting Medicare Fraud Act of
2018''.
SEC. 2. PERMISSIVE EXCLUSION FROM FEDERAL HEALTH PROGRAMS EXPANDED TO
CERTAIN INDIVIDUALS WITH PRIOR INTEREST IN SANCTIONED
ENTITIES AND ENTITIES AFFILIATED WITH SANCTIONED
ENTITIES.
Paragraph (15) of section 1128(b) of the Social Security Act (42
U.S.C. 1320a-7(b)) is amended to read as follows:
``(15) Individuals and entities affiliated with a
sanctioned entity.--(A) Any of the following:
``(i) Any individual who--
``(I) is a person with an ownership or
control interest in a sanctioned entity or an
affiliated entity of such sanctioned entity (or
was a person with such an ownership or control
interest at the time of any of the conduct that
formed a basis for the conviction or exclusion
described in subparagraph (B)); and
``(II) knows or should have known (as
defined in section 1128A(i)(7)) (or knew or
should have known) of such conduct.
``(ii) Any individual who is an officer or managing
employee (as defined in section 1126(b)) of a
sanctioned entity or affiliated entity of such
sanctioned entity (or was such an officer or managing
employee at the time of any of the conduct that formed
a basis for the conviction or exclusion described in
subparagraph (B)).
``(iii) Any affiliated entity of a sanctioned
entity.
``(B) For purposes of this paragraph, the term `sanctioned
entity' means an entity--
``(i) that has been convicted of any offense
described in subsection (a) of this section or in
paragraph (1), (2), or (3) of this subsection; or
``(ii) that has been excluded from participation
under a program under title XVIII or under a State
health care program.
``(C) For purposes of subparagraph (A), the term
`affiliated entity' means, with respect to a sanctioned entity,
an entity that is (or was at the time of any of the conduct
that formed the basis for the conviction or exclusion described
in subparagraph (B)) affiliated with such sanctioned entity,
and includes an entity--
``(i) that is a person with an ownership or control
interest in such sanctioned entity (or was such a
person with respect to such sanctioned entity at the
time of any conduct that formed the basis for the
conviction described in subparagraph (B));
``(ii) with respect to which a sanctioned entity is
a person with an ownership or control interest in such
entity (or was such a person with respect to such
entity at the time of any conduct that formed the basis
for the conviction described in subparagraph (B));
``(iii) with respect to which a person with an
ownership or control interest in such entity also has
such an interest in such sanctioned entity; and
``(iv) with respect to which a person who is an
officer or managing employee (as defined in section
1126(b)) of such entity also is such an officer or
managing employee of such sanctioned entity.
``(D) For purposes of this paragraph, the term `person with
an ownership or control interest' has the meaning given such
term in section 1124(a)(3).''.
SEC. 3. REPORTS ON INCIDENCES OF FRAUD AND ABUSE UNDER MEDICARE PARTS C
AND D.
(a) In General.--Section 1857(d) of the Social Security Act (42
U.S.C. 1395w-27(d)) is amended by adding at the end the following new
paragraph:
``(7) Report on incidences of fraud and abuse.--
``(A) In general.--A contract under this section
with an MA organization offering an MA plan shall
provide that such MA organization report to the
Secretary (or to any person or organization designated
by the Secretary for such purpose) any instances of
fraud or abuse related to the payment or delivery of
health benefits under such contract not later than 60
days after such organization identifies such instance.
``(B) Guidance.--Not later than 90 days after the
date of the enactment of this paragraph, the Secretary,
in consultation with the Inspector General of the
Department of Health and Human Services and the
Attorney General, shall issue to MA organizations (and
PDP sponsors) guidance for defining the terms `fraud'
and `abuse' for purposes of subparagraph (A).''.
(b) Conforming Amendment to Part D.--Section 1860D-12(b)(3)(C) of
the Social Security Act (42 U.S.C. 1395w-112(b)(3)(C)) is amended by
inserting before the period at the end the following: ``, except in
applying paragraph (7) of such section any reference to an MA
organization, with respect to an MA plan, shall be deemed a reference
to a PDP sponsor or MA organization, with respect to a prescription
drug plan or MA-PD plan''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall apply with respect to plan years beginning on or after the date
of the enactment of this Act.
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