,i #aacth ,,congress #b;d ,session ,h4 ,r4 #ecdj ,,in ,,the ,,house ,,of ,,representatives ,july #ca1 #bjad ,ms4 ,frankel of ,florida 7for herself and ,mr4 ,keating7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 to provide a criminal penalty for the illegal distribution of ,medicare1 ,medicaid1 or ,,chip beneficiary identification or provider numbers1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,fighting ,medicare ,fraud ,act of #bjad4 #b4 ,permissive exclusion from ,federal health programs expanded to certain individuals with prior interest in sanctioned entities and entities affiliated with sanctioned entities ,paragraph 7#ae7 of section #aabh7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g7;b77 is amended to read as follows3 7#ae7 ,individuals and entities affiliated with a sanctioned entity 7,a7 ,any of the following3 7i7 ,any individual who-- 7,i7 is a person with an ownership or control interest in a sanctioned entity or an affiliated entity of such sanctioned entity 7or 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 7,b772 and 7,,ii7 knows or should have known 7as defined in section #aabh;,a7i77#g77 7or knew or should have known7 of such conduct4 7ii7 ,any individual who is an officer or managing employee 7as defined in section #aabf7;b77 of a sanctioned entity or affiliated entity of such sanctioned entity 7or 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 7,b774 7iii7 ,any affiliated entity of a sanctioned entity4 7,b7 ,for purposes of this paragraph1 the term sanctioned entity means an entity-- 7i7 that has been convicted of any offense described in subsection 7a7 of this section or in paragraph 7#a71 7#b71 or 7#c7 of this subsection2 or 7ii7 that has been excluded from participation under a program under title ,,xviii or under a ,state health care program4 7,c7 ,for purposes of subparagraph 7,a71 the term affiliated entity means1 with respect to a sanctioned entity1 an entity that is 7or was at the time of any of the conduct that formed the basis for the conviction or exclusion described in subparagraph 7,b77 affiliated with such sanctioned entity1 and includes an entity-- 7i7 that is a person with an ownership or control interest in such sanctioned entity 7or 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 7,b772 7ii7 with respect to which a sanctioned entity is a person with an ownership or control interest in such entity 7or 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 7,b772 7iii7 with respect to which a person with an ownership or control interest in such entity also has such an interest in such sanctioned entity2 7iv7 with respect to which a person who is an officer or managing employee 7as defined in section #aabf7;b77 of such entity also is such an officer or managing employee of such sanctioned entity4 7,d7 ,for purposes of this paragraph1 the term person with an ownership or control interest has the meaning given such term in section #aabd7;a77#c74 4 #c4 ,criminal penalty for illegal distribution of ,medicare1 ,medicaid1 or ,,chip beneficiary identification or provider numbers ,section #aabh;,b7b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77 is amended by adding at the end the following3 7#d7 ,whoever knowingly and with the intent to defraud purchases1 sells or distributes1 or arranges for the purchase1 sale1 or distribution of two or more ,medicare1 ,medicaid1 or ,children's ,health ,insurance ,program beneficiary identification numbers or provider numbers under title ,,xviii1 ,,xix1 or ,,xxi shall be imprisoned for not more than #ae years or fined under title #ah1 ,united ,states ,code 7or1 if greater1 an amount equal to the monetary loss to the ,federal and any ,state government as a result of such acts71 or both4 4 #d4 ,reports on incidences of fraud and abuse under ,medicare parts ,c and ,d 7a7 ,in general ,section #aheg7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;d77 is amended by adding at the end the following new paragraph3 7#g7 ,report on incidences of fraud and abuse 7,a7 ,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 7or to any person or organization designated by the ,secretary for such purpose7 any instances of probable fraud or abuse related to the payment or delivery of health benefits under such contract not later than #fj days after such organization identifies such instance4 7,b7 ,guidance ,not later than #ij days after the date of the enactment of this paragraph1 the ,secretary1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services and the ,attorney ,general1 shall issue to ,,ma organizations 7and ,,pdp sponsors7 guidance for defining the terms fraud and abuse for purposes of subparagraph 7,a74 4 7b7 ,conforming amendment to part ,d ,section #ahfj;,d-#ab7;b77#c77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aab7;b77#c77;,c77 is amended by inserting before the period at the end the following3 1 except in applying paragraph 7#g7 of such section any reference to an ,,ma organization1 with respect to an ,,ma plan1 shall be deemed a reference to a ,,pdp sponsor or ,,ma organization1 with respect to a prescription drug plan or ,,ma-,,pd plan4 7c7 ,effective date ,the amendments made by subsections 7a7 and 7b7 shall apply with respect to plan years beginning on or after the date of the enactment of this ,act4