,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #ecdj  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #ca1 #bjad ,ms4 
,frankel ( ,florida 7= h]self & ,mr4    
,keat+7 introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title ,,xi 
( ! ,social ,security ,act to exp& !    
p]missive exclusion f ,f$]al heal?      
programs to include c]ta9 individuals ) 
prior int]e/ 9 sanction$ entities &     
entities affiliat$ ) sanction$ entities 
& to provide a crim9al p5alty = !       
illegal di/ribution ( ,m$ic>e1 ,m$icaid1
 or ,,*ip b5efici>y id5tification or    
provid] numb]s1 & = o!r purposes4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,fight+ ,m$ic>e ,fraud ,act ( #bjad4    
#b4 ,p]missive exclusion f ,f$]al heal? 
programs exp&$ to c]ta9 individuals )   

prior int]e/ 9 sanction$ entities &     
entities affiliat$ ) sanction$ entities 
,p>agraph 7#ae7 ( section #aabh7;b7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g7;b77 is am5d$ to read z      
foll[s3  7#ae7 ,individuals & entities  
affiliat$ ) a sanction$ entity  7,a7    
,any ( ! foll[+3  7i7 ,any individual   
:o--  7,i7 is a p]son ) an own]%ip or   
control int]e/ 9 a sanction$ entity or  
an affiliat$ entity ( su* sanction$     
entity 7or 0 a p]son ) su* an own]%ip or
 control int]e/ at ! "t ( any ( !       
conduct t =m$ a basis = ! conviction or 
exclusion describ$ 9 subp>agraph 7,b772 
&  7,,ii7 kn[s or %\ld h kn[n 7z def9$ 9
 section #aabh;,a7i77#g77 7or knew or   
%\ld h kn[n7 ( su* conduct4  7ii7 ,any  
individual :o is an (fic] or manag+     
employee 7z def9$ 9 section #aabf7;b77 (
 a sanction$ entity or affiliat$ entity 
( su* sanction$ entity 7or 0 su* an     
(fic] or manag+ employee at ! "t ( any (
 ! conduct t =m$ a basis = ! conviction 
or exclusion describ$ 9 subp>agraph     

7,b774  7iii7 ,any affiliat$ entity ( a 
sanction$ entity4  7,b7 ,= purposes (   
?is p>agraph1 ! t]m sanction$ entity    
means an entity--  7i7 t has be5        
convict$ ( any (f5se describ$ 9         
subsection 7a7 ( ?is section or 9       
p>agraph 7#a71 7#b71 or 7#c7 ( ?is      
subsection2 or  7ii7 t has be5 exclud$ f
 p>ticipation "u a program "u title     
,,xviii or "u a ,/ate heal? c>e program4
  7,c7 ,= purposes ( subp>agraph 7,a71 !
 t]m affiliat$ entity means1 ) respect  
to a sanction$ entity1 an entity t is   
7or 0 at ! "t ( any ( ! conduct t =m$ ! 
basis = ! conviction or exclusion       
describ$ 9 subp>agraph 7,b77 affiliat$ )
 su* sanction$ entity1 & includes an    
entity--  7i7 t is a p]son ) an own]%ip 
or control int]e/ 9 su* sanction$ entity
 7or 0 su* a p]son ) respect to su*     
sanction$ entity at ! "t ( any conduct t
 =m$ ! basis = ! conviction describ$ 9  
subp>agraph 7,b772  7ii7 ) respect to   
:i* a sanction$ entity is a p]son ) an  
own]%ip or control int]e/ 9 su* entity  

7or 0 su* a p]son ) respect to su*      
entity at ! "t ( any conduct t =m$ !    
basis = ! conviction describ$ 9         
subp>agraph 7,b772  7iii7 ) respect to  
:i* a p]son ) an own]%ip or control     
int]e/ 9 su* entity also has su* an     
int]e/ 9 su* sanction$ entity2  7iv7 )  
respect to :i* a p]son :o is an (fic] or
 manag+ employee 7z def9$ 9 section     
#aabf7;b77 ( su* entity also is su* an  
(fic] or manag+ employee ( su* sanction$
 entity4  7,d7 ,= purposes ( ?is        
p>agraph1 ! t]m p]son ) an own]%ip or   
control int]e/ has ! mean+ giv5 su* t]m 
9 section #aabd7;a77#c74  4  #c4        
,crim9al p5alty = illegal di/ribution ( 
,m$ic>e1 ,m$icaid1 or ,,*ip b5efici>y   
id5tification or provid] numb]s ,section
 #aabh;,b7b7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acbj;a-#g;b7b77 is am5d$
 by add+ at ! end ! foll[+3  7#d7 ,:oev]
 kn[+ly & ) ! int5t to defraud pur*ases1
 sells or di/ributes1 or arranges = !   
pur*ase1 sale1 or di/ribution ( two or m
 ,m$ic>e1 ,m$icaid1 or ,*ildr5's ,heal? 

,insurance ,program b5efici>y           
id5tification numb]s or provid] numb]s  
"u title ,,xviii1 ,,xix1 or ,,xxi %all  
be imprison$ = n m ?an #ae ye>s or f9$  
"u title #ah1 ,unit$ ,/ates ,code 7or1  
if great]1 an am\nt equal to ! monet>y  
loss to ! ,f$]al & any ,/ate gov]nm5t z 
a result ( su* acts71 or bo?4  4  #d4   
,reports on incid5ces ( fraud & abuse "u
 ,m$ic>e p>ts ,c & ,d  7a7 ,9 g5]al     
,section #aheg7;d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciew-#bg7;d77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#g7 ,report on incid5ces (  
fraud & abuse  7,a7 ,9 g5]al ,a contract
 "u ?is section ) an ,,ma organization  
(f]+ an ,,ma plan %all provide t su*    
,,ma organization report to ! ,secret>y 
7or to any p]son or organization        
designat$ by ! ,secret>y = su* purpose7 
any in/ances ( probable fraud or abuse  
relat$ to ! paym5t or deliv]y ( heal?   
b5efits "u su* contract n lat] ?an #fj  
days aft] su* organization id5tifies su*
 in/ance4  7,b7 ,guidance ,n lat] ?an   

#ij days aft] ! date ( ! enactm5t ( ?is 
p>agraph1 ! ,secret>y1 9 consultation ) 
! ,inspector ,g5]al ( ! ,dep>tm5t (     
,heal? & ,human ,s]vices & ! ,attorney  
,g5]al1 %all issue to ,,ma organizations
 7& ,,pdp sponsors7 guidance = def9+ !  
t]ms fraud & abuse = purposes (         
subp>agraph 7,a74  4  7b7 ,con=m+       
am5dm5t to "p ,d ,section               
#ahfj;,d-#ab7;b77#c77;,c7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciew-#aab7;b77#c77;,c77 is am5d$ by   
ins]t+ be=e ! p]iod at ! end ! foll[+3 1
 except 9 apply+ p>agraph 7#g7 ( su*    
section any ref]5ce to an ,,ma          
organization1 ) respect to an ,,ma plan1
 %all be deem$ a ref]5ce to a ,,pdp     
sponsor or ,,ma organization1 ) respect 
to a prescription drug plan or ,,ma-,,pd
 plan4  7c7 ,effective date ,! am5dm5ts 
made by subsections 7a7 & 7b7 %all apply
 ) respect to plan ye>s beg9n+ on or    
aft] ! date ( ! enactm5t ( ?is ,act4