,,ii  #aaith ,,congress  #ast ,session  
,s4 #bhcf  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #ag 
7legislative day1 ,september #af71      
#bjbe,mr4 ,merkley 7for himself1 ,ms4   
,warren1 and ,mr4 ,markey7 introduced   
the following bill2 which was read twice
 and referred to the ,committee on the  
,judiciary  ,a ,,bill  ,to prohibit     
health insurance issuers and certain    
health care providers under ,medicare   
from being under common ownership1 and  
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,patients
 ,over ,profit ,act or the ,,pop ,act4  
#b4 ,prohibition on common ownership of 
health insurance issuers and certain    
health care providers under ,medicare   
7a7 ,in general ,it shall be unlawful   
for any person to both-- 7#a7 directly  
or indirectly own1 operate1 or control  
the whole or any part of an applicable  
provider or a management services       
organization that has a management      
services agreement with an applicable   

provider2 and  7#b7 directly or         
indirectly own1 operate1 or control the 
whole or any part of a health insurance 
issuer4  7b7 ,divestment ,any person in 
violation of subsection 7a7 shall divest
 either the applicable provider 7or1 if 
applicable1 the management services     
organization7 or the health insurance   
issuer of such person-- 7#a7 in the case
 of an applicable provider1 management  
services organization1 or health        
insurance issuer acquired on or before  
the date of enactment of this ,act1 not 
later than #b years after such date of  
enactment2 or  7#b7 in the case of an   
applicable provider1 management services
 organization1 or health insurance      
issuer acquired after the date of       
enactment of this ,act1 not later than  
#a year after the date of acquisition4  
7c7 ,civil actions  7#a7 ,in general    
,when the ,inspector ,general of the    
,department of ,health and ,human       
,services1 the ,assistant ,attorney     
,general in charge of the ,antitrust    

,division of the ,department of         
,justice1 the ,federal ,trade           
,commission1 or an ,attorney ,general of
 a ,state has reason to believe that a  
person is in violation of subsection 7a7
 or 7b71 such ,inspector ,general1      
,assistant ,attorney ,general1 ,federal 
,trade ,commission1 or ,attorney        
,general of a ,state may bring a civil  
action in an applicable district court  
of the ,united ,states for the relief   
described in paragraph 7#b74  7#b7      
,injunctive and equitable relief ,in any
 action described in paragraph 7#a71 the
 applicable court1 on a finding that a  
person is in violation of subsection 7a7
 or 7b71 shall issue an order requiring 
such person-- 7,a7 to cease and desist  
from such violation1 and divest either  
the applicable provider 7or1 if         
applicable1 the management services     
organization7 or the health insurance   
issuer of such person2 and  7,b7 to     
disgorge any revenue received from the  
provision of health care services during

 the period of such violation4  7#c7    
,deposit and distribution ,any revenue  
disgorged pursuant to an action under   
this subsection for a violation of      
subsection 7a7 or 7b7 shall be deposited
 into a fund created by the ,federal    
,trade ,commission and distributed by   
the ,federal ,trade ,commission to be   
put to use in the interest of serving   
the health care needs of the harmed     
community4 ,receipt of any funds under  
this paragraph shall not alter or       
diminish the rights of an individual to 
bring an action or recover any amount as
 otherwise authorized by law4  7d7 ,,ftc
 review  7#a7 ,reporting required ,any  
divestment of an applicable provider1   
management services organization1 or    
health insurance issuer required under  
subsection 7b7 shall be reported to the 
,federal ,trade ,commission and the     
,assistant ,attorney ,general in charge 
of the ,antitrust ,division of the      
,department of ,justice under section   
#g;,a of the ,clayton ,act 7#ae         

,u4,s4,c4 #ah;a7 without respect to the 
thresholds under subsection 7a77#b7 of  
that section4  7#b7 ,tolling of         
divestment period during review ,the    
divestment period under subsection 7b7  
shall be tolled during the pendency of  
any waiting period required under       
section #g;,a of the ,clayton ,act 7#ae 
,u4,s4,c4 #ah;a74  7#c7 ,review of      
effect of divestiture ,with respect to  
each divestiture undertaken pursuant to 
subsection 7b71 in addition to any      
applicable review under section #g;,a of
 the ,clayton ,act 7#ae ,u4,s4,c4       
#ah;a71 the ,federal ,trade ,commission 
and the ,assistant ,attorney ,general in
 charge of the ,antitrust ,division of  
the ,department of ,justice shall review
 the effect on competition1 financial   
viability1 and the public interest--    
7,a7 of the divestiture2 and  7,b7 of   
the subsequent acquisition of the       
applicable provider 7or1 if applicable1 
the management services organization7 or
 the health insurance issuer of such    

person by the acquiring person4  7e7    
,rulemaking authority ,the ,federal     
,trade ,commission shall promulgate     
rules to carry out this section4 ,such  
rules shall not diminish any obligation 
under this section4  7f7 ,rule of       
construction ,nothing in this section   
shall be construed to limit the         
authority of the ,federal ,trade        
,commission1 the ,inspector ,general of 
the ,department of ,justice1 the        
,department of ,health and ,human       
,services1 or the ,attorney ,general of 
a ,state under any other provision of   
law4  7g7 ,enforcement under ,medicare  
,advantage and ,medicare part ,d  7#a7  
,medicare ,advantage ,section #aheg of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#bg7 is amended by     
adding at the end the following new     
subsection3  7j7 ,prohibition on common 
ownership of ,,ma organizations and     
applicable providers  7#a7 ,in general  
,for plan years beginning on or after   
,january #a1 #bjbf1 the ,secretary may  

not contract with1 or provide payment   
under this part to1 a ,medicare         
,advantage organization with respect to 
offering an ,,ma plan or ,,ma-,,pd plan 
under this part if the organization--   
7,a7 directly or indirectly owns1       
operates1 or controls the whole or any  
part of an applicable provider or a     
management services organization that   
has a management services agreement with
 an applicable provider2 or  7,b7 is    
directly or indirectly owned1 operated1 
or controlled in whole or part by a     
person who also directly or indirectly  
owns1 operates1 or controls the whole or
 any part of an applicable provider or a
 management services organization that  
has a management services agreement with
 an applicable provider4  7#b7          
,certification ,each ,medicare          
,advantage organization shall furnish to
 the ,secretary 7in a form and manner1  
and at a time1 specified by the         
,secretary7 a certification of          
compliance with this subsection1 as well

 as such information as the ,secretary  
determines necessary to carry out this  
subsection4  7#c7 ,false claims         
submitted by entities in violation of   
prohibition on common ownership ,any    
claim for payment from an entity in     
violation of paragraph 7#a7 constitutes 
a false or fraudulent claim for purposes
 of subchapter ,,iii of title #ca1      
,united ,states ,code4  7#d7            
,definitions ,in this subsection3 7,a7  
,applicable provider  7i7 ,in general   
,subject to clause 7ii71 the term       
applicable provider means any entity    
that receives payment for furnishing    
services covered under part ,b or under 
a ,medicare ,advantage plan under part  
,c4  7ii7 ,exclusions ,such term does   
not include-- 7,i7 a hospital 7as       
defined in section #ahfa7;e771 a        
critical access hospital 7as defined in 
section #ahfa7mm77#a771 or a rural      
emergency hospital 7as defined in       
section #ahfa7kkk77#b772  7,,ii7 a      
supplier of durable medical equipment1  

prosthetics1 orthotics1 or supplies2 or 
7,,iii7 a pharmacy4  7,b7 ,management   
services agreement ,the term management 
services agreement means a contract     
between a management services           
organization and an applicable provider 
for management or administrative        
services relating to1 supporting1 or    
facilitating the provision of health    
care services4  7,c7 ,management        
services organization ,the term         
management services organization means  
any organization or entity that         
contracts with an applicable provider to
 perform management or administrative   
services relating to1 supporting1 or    
facilitating the provision of health    
care services4  4  7#b7 ,medicare part  
,d ,section #ahfj;,d-#ab7;b77#c7 of the 
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aab7;b77#c77 is amended by      
adding at the end the following new     
subparagraph3  7,g7 ,prohibition on     
common ownership ,section #aheg7;j74  4 
7h7 ,definitions ,in this section3 7#a7 

,applicable provider  7,a7 ,in general  
,subject to subparagraph 7,b71 the term 
applicable provider means any entity    
that receives payment for furnishing    
services covered under part ,b of title 
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie;j et seq47 or under
 a ,medicare ,advantage plan under part 
,c of such title 7#db ,u4,s4,c4         
#aciew-#ba et seq474  7,b7 ,exclusions  
,such term does not include-- 7i7 a     
hospital 7as defined in section         
#ahfa7;e7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #aciex7e7771 a critical  
access hospital 7as defined in section  
#ahfa7mm77#a7 of such ,act 7#db         
,u4,s4,c4 #aciex7mm77#a7771 or a rural  
emergency hospital 7as defined in       
section #ahfa7kkk77#b772  7ii7 a        
supplier of durable medical equipment1  
prosthetics1 orthotics1 and supplies2 or
  7iii7 a pharmacy4  7#b7 ,health       
insurance issuer ,the term health       
insurance issuer has the meaning given  
that term in section #bgia of the       

,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg-#ia74  7#c7           
,management services agreement ,the term
 management services agreement means a  
contract between a management services  
organization and an applicable provider 
for management or administrative        
services relating to1 supporting1 or    
facilitating the provision of health    
care services4  7#d7 ,management        
services organization ,the term         
management services organization means  
any organization or entity that         
contracts with an applicable provider to
 perform management or administrative   
services relating to1 supporting1 or    
facilitating the provision of health    
care services4  7#e7 ,person ,the term  
person has the meaning given the term in
 section #h of the ,sherman ,act 7#ae   
,u4,s4,c4 #g74