,,ii #aaith ,,congress #b;d ,session ,s4 #chbi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #aa1 #bjbf,ms4 ,warren 7for herself1 ,mr4 ,blumenthal1 ,mr4 ,markey1 ,mr4 ,merkley1 and ,mr4 ,welch7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to prevent exploitative private equity practices1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,corporate ,crimes ,against ,health ,care ,act4 #b4 ,unjust enrichment clawback authority and criminal penalty 7a7 ,unjust enrichment clawback ,chapter #ca of title #ah1 ,united ,states ,code1 is amended by adding at the end the following3 #fga4 ,unjust enrichment clawback and criminal penalty 7a7 ,definitions ,in this section1 the terms covered party1 target firm1 and triggering event have the meanings given those terms in section #fgd7;b74 7b7 ,prohibited conduct ,any covered party whose actions contributed to a triggering event that results in the death or injury of a patient or patients under the care of the target firm1 shall be punished in accordance with sections #fgb and #fgc4 #fgb4 ,criminal penalty ,whoever violates section #fga7;b7 shall be imprisoned for not less than #a year or greater than #f years4 #fgc4 ,civil penalty 7a7 ,amount of penalty ,whoever violates section #fga7;b7 shall be subject to a civil penalty in an amount of not more than #e times the amount of any clawback authorized under section #fgd4 7b7 ,deposit ,any amount of civil penalty collected under this section shall be deposited as miscellaneous receipts in the ,treasury of the ,united ,states4 #fgd4 ,clawback 7a7 ,in general 7#a7 ,prohibition ,it shall be unlawful for any covered party to acquire from a target firm covered compensation by unjust enrichment1 and any such covered party shall be subject to the penalties described in sections #fgb and #fgc in addition to the required clawbacks under this section4 7#b7 ,penalty 7,a7 ,required clawbacks ,if a target firm experiences a triggering event1 the ,attorney ,general or a ,state attorney general may claw back all or part of the covered compensation received by the covered party that is obtained from the target firm during the preceding or succeeding #aj years4 7,b7 ,actions to recover required clawbacks 7i7 ,powers of the ,attorney ,general 7,i7 ,in general ,except as provided in clause 7ii71 the ,attorney ,general may enforce this section4 7,,ii7 ,authority preserved ,nothing in this section shall be construed to limit the authority of the ,attorney ,general under any provision of law4 7,,iii7 ,penalty ,in an action brought by the ,attorney ,general to enforce this section and the regulations promulgated under this section1 a covered party shall be liable for all or part of the covered compensation received by the covered party that is obtained from the target firm during the preceding or succeeding #aj years4 7ii7 ,enforcement by ,state attorneys general 7,i7 ,civil action ,if an attorney general of a ,state has reason to believe that a triggering event has harmed the residents of that ,state1 the attorney general of the ,state may1 as parens patriae1 bring a civil action on behalf of the residents of the ,state in an appropriate district court of the ,united ,states to recover all or part of the covered compensation received by the covered party that is obtained from the target firm during the preceding or succeeding #aj years4 7,,ii7 ,rights of the ,attorney ,general 7aa7 ,notice to ,attorney ,general 7,,aa7 ,in general ,except as provided in subitem 7,,cc71 the attorney general of a ,state shall notify the ,attorney ,general in writing that the attorney general of the ,state intends to bring a civil action under subclause 7,i7 not later than #aj days before initiating the civil action4 7,,bb7 ,contents ,the notification required under subitem 7,,aa7 with respect to a civil action shall include a copy of the complaint to be filed to initiate the civil action4 7,,cc7 ,exception ,if it is not feasible for the attorney general of a ,state to provide the notification required by subitem 7,,aa7 before initiating an action under subclause 7,i71 the attorney general of the ,state shall notify the ,attorney ,general immediately upon instituting the civil action4 7bb7 ,intervention by the ,attorney ,general ,the ,attorney ,general may-- 7,,aa7 intervene in any action brought by the attorney general of a ,state under subclause 7,i72 and 7,,bb7 upon intervening under subitem 7,,aa71 be heard on all matters arising in the civil action and file petitions for appeal of a decision in the action4 7iii7 ,limitation on ,state action while ,federal action is pending ,if the ,attorney ,general institutes an action under clause 7i7 with respect to a triggering event1 a ,state may not1 during the pendency of that action1 institute an action under clause 7ii7 against any defendant named in the complaint in the action instituted by the ,attorney ,general based on the same set of facts giving rise to the triggering event with respect to which the ,attorney ,general instituted the action4 7iv7 ,affirmative defense ,it shall be an affirmative defense in an action under this section if the applicable covered party shows by clear and convincing evidence that the covered party could not prevent the triggering event4 7,c7 ,deposit 7i7 ,in general ,subject to clause 7ii71 any covered compensation clawed back in an action under this section shall be deposited in a fund created by the ,attorney ,general and distributed by the ,attorney ,general1 in the interests of justice-- 7,i7 to cover shortfalls in the salaries1 employee benefit plans1 or other benefits owed to current or past employees of the target firm negatively affected by the behavior that is the basis of the action2 and 7,,ii7 to be put to use in the interest of serving the health care needs of the harmed community4 7ii7 ,bankruptcy as a triggering event ,notwithstanding any other provision of law1 if the entry of an order for relief under title #aa or the commencement of any other insolvency proceeding is the triggering event that a target firm experiences1 the ,attorney ,general shall prioritize covering funding shortfalls in any pension funds benefitting harmed current or past employees of the target firm4 7b7 ,definitions ,in this section3 7#a7 ,affiliate ,the term affiliate means-- 7,a7 a person that directly or indirectly owns1 controls1 or holds with power to vote1 #e percent or more of the outstanding voting securities of another entity1 other than a person that holds such securities-- 7i7 in a fiduciary or agency capacity without sole discretionary power to vote such securities2 or 7ii7 solely to secure a debt1 if such entity has not in fact exercised such power to vote2 7,b7 a corporation #aj percent or more of whose outstanding voting securities are directly or indirectly owned1 controlled1 or held with power to vote1 by another entity 7referred to in this subparagraph as a covered entity71 or by an entity that directly or indirectly owns1 controls1 or holds with power to vote1 #aj percent or more of the outstanding voting securities of the covered entity1 other than an entity that holds such securities-- 7i7 in a fiduciary or agency capacity without sole discretionary power to vote such securities2 or 7ii7 solely to secure a debt1 if such entity has not in fact exercised such power to vote2 7,c7 a person whose business is operated under a lease or operating agreement by another entity1 or person substantially all of whose property is operated under an operating agreement with that other entity2 or 7,d7 an entity that operates the business or substantially all of the property of another entity under a lease or operating agreement4 7#b7 ,change in control ,the term change in control means a change in a legal right with respect to-- 7,a7 the power to vote more than #ej per centum of any class of voting securities of a corporation that engages in interstate commerce2 or 7,b7 any lesser per centum of any class of voting securities of a corporation that engages in interstate commerce that is sufficient to make the acquirer of such an interest a person that has the ability to direct the actions of that corporation4 7#c7 ,control person ,the term control person-- 7,a7 means-- 7i7 a person-- 7,i7 that directly or indirectly owns1 controls1 or holds with power to vote1 including through coordination with other persons1 #aj percent or more of the outstanding voting interests of a corporation2 or 7,,ii7 that operates the business or substantially all of the property of a corporation under a lease or an operating or management agreement2 7ii7 a corporation1 other than a target firm1 that has #aj percent or more of its outstanding voting interests directly or indirectly owned1 controlled1 or held with power to vote by a person that directly or indirectly owns1 controls1 or holds with power to vote1 including through coordination with other persons1 #aj percent or more of the outstanding voting interests of another corporation2 or 7iii7 a person that otherwise has the ability to direct the actions of a corporation2 and 7,b7 does not include a person that-- 7i7 7,i7 is a limited partner with respect to a controlling private fund that is a partnership2 7,,ii7 does not participate in the direction of the management or policy of a corporation2 and 7,,iii7 is not an insider with respect to the controlling private fund described in subclause 7,i72 7ii7 is a pension fund or employee welfare benefit plan1 if neither the fund nor plan 7as applicable71 nor any beneficiary or affiliate of the benefit or plan1 is an insider with respect to a controlling private fund2 or 7iii7 holds the voting interests of a corporation solely-- 7,i7 in a fiduciary or agency capacity without sole discretionary power to vote the securities2 or 7,,ii7 to secure a debt1 if the person has not-- 7aa7 exercised the power to vote2 or 7bb7 exercised any other governance rights with respect to the corporation4 7#d7 ,controlling private fund ,the term controlling private fund means a private fund that1 directly or through an affiliate1 becomes a control person with respect to a target firm through the change in control transaction with respect to the target firm4 7#e7 ,corporation ,the term corporation means-- 7,a7 a joint-stock company2 7,b7 a company or partnership association organized under a law that makes only the capital subscribed or callable up to a specified amount responsible for the debts of the association1 including a limited partnership and a limited liability company2 7,c7 a trust2 and 7,d7 an association having a power or privilege that a private corporation1 but not an individual or a partnership1 possesses4 7#f7 ,covered compensation ,the term covered compensation means-- 7,a7 salary2 7,b7 any bonus2 7,c7 any compensation that is granted1 earned1 or vested based wholly or in part upon the attainment of any financial reporting measure or other performance metric2 7,d7 equity-based compensation2 7,e7 time- or service-based awards2 7,f7 awards based on nonfinancial metrics2 7,g7 any monitoring fees1 management fees1 advisory fees1 accelerated monitoring fees1 transaction fees1 or fees for services not rendered2 7,h7 any profits realized from the buying or selling of securities or assets1 including any real property2 7,i7 any severance pay2 7,j7 any golden parachute benefit2 or 7,k7 any other transaction similar to a transaction described in subparagraph 7,h7 or 7,i74 7#g7 ,covered party ,the term covered party means-- 7,a7 any current or former director1 officer1 or control person of1 or agent for1 a private equity firm or target firm2 7,b7 any current or former shareholder or joint venture partner that participates in the conduct of the affairs of a target firm2 or 7,c7 any private fund4 7#h7 ,employee welfare benefit plan ,the term employee welfare benefit plan has the meaning given the term in section #c of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb74 7#i7 ,insider ,the term insider means any-- 7,a7 director of a corporation2 7,b7 officer of a corporation2 7,c7 managing agent of a corporation2 7,d7 control person with respect to a corporation2 7,e7 affiliate of a corporation2 7,f7 general partner of a corporation that is a partnership2 7,g7 consultant or contractor retained by a corporation2 7,h7 affiliate1 relative1 or agent of a person described in any of subparagraphs 7,a7 through 7,f72 or 7,i7 affiliate1 relative1 or agent of a person described in subparagraph 7,h74 7#aj7 ,interest coverage ,the term interest coverage means the revenue of the target firm less the expenses of the target firm1 excluding tax and interest1 during the most recent fiscal year of the target firm4 7#aa7 ,pension fund ,the term pension fund has the meaning given the term pension plan in section #c of the ,employee ,retirement ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb74 7#ab7 ,private fund ,the term private fund means a corporation that-- 7,a7 would be considered an investment company under section #c of the ,investment ,company ,act of #aidj 7#ae ,u4,s4,c4 #hj;a-#c7 but for the application of paragraph 7#a7 or 7#g7 of subsection 7c7 of that section2 7,b7 is not a venture capital fund1 as defined in section #bge4bjc7l7-#a of title #ag1 ,code of ,federal ,regulations1 as in effect on the date of enactment of this ,act2 and 7,c7 is not an institution selected under section #ajg of the ,community ,development ,banking and ,financial ,institutions ,act of #aiid 7#ab ,u4,s4,c4 #dgjf74 7#ac7 ,relative ,the term relative means an individual related by affinity or consanguinity within the third degree as determined by the common law1 or individual in a step or adoptive relationship within such third degree4 7#ad7 ,security ,the term security has the meaning given the term in section #b7;a7 of the ,securities ,act of #aicc 7#ae ,u4,s4,c4 #gg;b7a774 7#ae7 ,target firm ,the term target firm means a health care corporation that is acquired in a change in control transaction4 7#af7 ,triggering event ,the term triggering event means-- 7,a7 any time at which a target firm is behind on salary payments greater than #be percent of the total workforce of the target firm for a period of more than #ij days2 7,b7 closure of the target firm2 7,c7 if the target firm is behind on rent payments for a period of more than #ij days2 7,d7 if the target firm defaults on a loan for a period of more than #ij days2 or 7,e7 the entry of an order for relief under title #aa on behalf of the target firm or the commencement of any other insolvency proceeding4 7#ag7 ,unjust enrichment ,the term unjust enrichment means the acquisition of covered compensation by a covered party from the target firm during the #aj-year period preceding or succeeding a triggering event if any of the following aggravating circumstances are established3 7,a7 ,the covered compensation was obtained through a dividend recapitalization1 a sale-leaseback of real estate or equipment1 or a related person transaction1 as set forth in section #bbi4djd of title #ag1 ,code of ,federal ,regulations4 7,b7 ,the covered party has been implicated in any white-collar crime1 as defined in section #ija of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajbea71 committed in the course of the current or former employment of the covered party4 7,c7 ,the covered party has charged the target firm accelerated monitoring fees or fees for services not rendered4 7,d7 ,at the time of the issuance of the covered compensation1 or as the result of the issuance of the covered compensation1 the target firm had an interest coverage in excess of #ajj percent4 4 7b7 ,technical and conforming amendment ,the table of sections for chapter #ca of title #ah1 ,united ,states ,code1 is amended by adding at the end the following3 #fga4 ,unjust enrichment clawback and criminal penalty4#fgb4 ,criminal penalty4#fgc4 ,civil penalty4#fgd4 ,clawback4 4 #c4 ,prohibiting payments from ,federal health care programs to entities that sell assets to or use assets as collateral for a loan with a real estate investment trust ,section #aabh7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g7;a77 is amended by adding at the end the following new paragraph3 7#e7 ,selling assets to or using assets as collateral for a loan with a real estate investment trust 7,a7 ,in general ,any individual or entity that1 on or after the date of enactment of this paragraph1 sells any assets to1 or newly pledges any assets as collateral for a loan with1 a real estate investment trust 7as defined in section #hef7;a7 of the ,internal ,revenue ,code of #aihf74 7,b7 ,clarification ,subparagraph 7,a7 shall not apply in the case where an individual or entity agreed to pledge an asset as collateral for a loan with a real estate investment trust prior to the date of enactment of this paragraph1 including with respect to any future agreement between the individual or entity and the real estate investment trust regarding that same asset4 4 #d4 ,repeal of special rule for taxable ,,reit subsidiaries with interests in certain health care property 7a7 ,in general ,section #hef7;d77#h77;,b7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 by striking or a qualified health care property 7as defined in subsection 7e77#f77;,d77i771 and 7#b7 by striking qualified health care property or4 7b7 ,conforming amendments ,section #hef7;d77#i7 of such ,code is amended-- 7#a7 in subparagraph 7,a7-- 7,a7 by striking or a qualified health care property 7as defined in subsection 7e77#f77;,d77i771 7,b7 by striking or qualified health care property1 and 7,c7 by striking or qualified health care properties1 and 7#b7 in subparagraph 7,b7-- 7,a7 by striking or qualified health care property 7as so defined71 and 7,b7 by striking or qualified health care property each place it appears in clauses 7i71 7ii71 and 7iii77,,ii74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #e4 ,elimination of qualified ,,reit dividends from qualified business income 7a7 ,in general ,paragraph 7#a7 of section #aii;,a7b7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7#a7 ,in general ,the term combined qualified business income amount means1 with respect to any taxable year1 an amount equal to the sum of the amounts determined under paragraph 7#b7 for each qualified trade or business carried on by the taxpayer4 4 7b7 ,conforming amendments 7#a7 ,section #aii;,a7c77#a7 of such ,code is amended by striking the last sentence4 7#b7 ,section #aii;,a7e7 of such ,code is amended by striking paragraph 7#c7 and by redesignating paragraph 7#d7 as paragraph 7#c74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #f4 ,mandatory reporting with respect to certain health-related ownership information ,part ,a of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is amended by adding at the end the following new section3 #aaej;,d4 ,mandatory reporting with respect to certain health-related ownership information 7a7 ,mandatory reporting with respect certain health-,related ownership information 7#a7 ,reporting ,not later than ,january #a1 #bjbg 7or in the case of a specified entity formed after ,january #a1 #bjbg1 within #fj days of becoming a specified entity71 and each year thereafter1 each specified entity 7as defined in subsection 7e77#h77 shall submit to the ,secretary1 in a form and manner specified by the ,secretary1 a report containing the following information1 subject to paragraph 7#c77;,b73 7,a7 ,data on mergers1 acquisitions1 changes in ownership1 changes in control1 transactions to form new affiliations1 changes in partnerships1 joint ventures1 and_/or management services agreements1 to which such specified entity is a party for the previous #a-year period1 including-- 7i7 the primary reason the reporting entity completed the acquisition2 and 7ii7 a description of how the acquirer obtained control of the acquiree1 and the percentage of ownership acquired 7i4e41 voting equity interests74 7,b7 ,as applicable1 the name1 address1 tax or health plan identification numbers 7including1 without limitation1 the tax identification number1 ,national ,association of ,insurance ,commissioners identification number1 ,state insurance identification number1 ,medicare provider number1 and the standard unique health identifier 7as described in section #aagc7;b777 of all health care providers within the specified entity that furnish items or services4 7,c7 ,the business structure of any controlling entity1 including the business type and the tax identification number of such entity1 other affiliates under common control1 subsidiaries1 and management services entities of such specified entity1 as of the date of the submission of such report4 7,d7 ,information regarding-- 7i7 the debt-to-earnings ratio of the specified entity2 7ii7 the amount of debt incurred-- 7,i7 by each hospital or separate entity within the health system2 and 7,,ii7 by the entire specified entity2 7iii7 real estate leases and purchases for property used1 or intended to be used1 to furnish or otherwise support the provision of health care services1 including expenditures on rents and maintenance1 property taxes paid1 and the name of the company leased from2 7iv7 details of other companies' revenue sharing arrangement2 7v7 fees charged or dividends paid to investors2 7vi7 in the case of a non-profit hospital1 a subsidiary of a non-profit hospital1 or a #eja7;c77#c7 entity that shares common ownership with a non-profit hospital1 capital gains investments 7disaggregated by the type of investment7 and any taxes paid on such gains from such investments2 and 7vii7 information with respect to any controlling entity of such specified entity4 7,e7 ,the value of quality payments received for performance under any value-based or other performance-based program such as the shared savings program under section #ahii4 7,f7 ,any other information with respect to ownership or control of a specified entity1 as determined by the ,secretary4 7,g7 ,any changes to the health care providers within the specified entity that furnish items or services during the previous #a-year period1 identified by the ,national ,provider identifier described in section #aagc7;b74 7,h7 ,the domicile and business registration information for any controlling entity or subsidiary of such controlling entity that is domiciled outside of the ,united ,states4 7#b7 ,avoiding duplicate reporting ,if a specified entity is owned or controlled by an entity described in subparagraph 7,g7 of subsection 7e77#h71 only the entity described in such subparagraph 7,g7 shall be required to submit reports under this subsection with respect to such entity and any specified entity owned or controlled by the entity4 7#c7 ,availability of information and public reporting 7,a7 ,in general ,not later than ,january #a1 #bjbh1 and annually thereafter1 subject to subparagraph 7,b71 the ,secretary shall post on a publicly available website of the ,department of ,health and ,human ,services the information reported under this subsection with respect to the previous #a-year period for which the information was collected4 7,b7 ,requirement ,in making information reported under this subsection publicly available under subparagraph 7,a71 the ,secretary shall do so in a manner that does not disclose the social security number of any individual provider of services or supplier4 7b7 ,audits ,the ,secretary shall conduct an annual audit consisting of a random sample of specified entities to verify compliance with the requirements of this section and the accuracy of information submitted pursuant to this section4 7c7 ,penalty for failure ,to report ,if a specified entity fails to provide a complete report under subsection 7a71 or submits a report containing false information1 such entity shall be subject to a civil monetary penalty of not more than #e1jjj1jjj for each such report not provided or containing false information4 ,such penalty shall be imposed and collected in the same manner as civil money penalties under subsection 7a7 of section #aabh;,a are imposed and collected under that section4 7d7 ,inapplicability of paperwork reduction act ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to collections of information made under this section4 7e7 ,definitions ,in this section3 7#a7 ,control ,the term control means the direct or indirect power through ownership1 contractual agreement1 or otherwise-- 7,a7 to vote more than #e percent of any class of voting securities of a specified entity2 or 7,b7 to direct the actions of the specified entity4 7#b7 ,controlling entity 7,a7 ,in general ,the term controlling entity means1 with respect to any specified entity1 a parent company or other entity that owns or controls the specified entity through ownership1 contractual agreement1 or otherwise4 7,b7 ,inclusion of ,r,e,i,ts ,such term includes1 with respect to a specified entity1 a real estate investment trust 7as defined in section #hef of the ,internal ,revenue ,code of #aihf7 that owns property where the specified entity furnishes health care items or services4 7#c7 ,health plan ,the term health plan has the meaning given such term in section #aabh;,c7c74 7#d7 ,health system ,the term health system means a group of health care organizations 7such as physician practices1 hospitals1 skilled nursing facilities7 that are jointly owned or managed4 7#e7 ,hospital ,the term hospital has the meaning given such term in section #ahfa7;e74 7#f7 ,independent freestanding emergency department ,the term independent freestanding emergency department has the meaning given such term in section #bgii;,a-#a7;a77#c77;,d7 of the ,public ,health ,service ,act4 7#g7 ,private fund ,the term private fund means a corporation that-- 7,a7 would be considered an investment company under section #c of the ,investment ,company ,act of #aidj 7#ae ,u4,s4,c4 #hj;a-#c7 but for the application of paragraph 7#a7 or 7#g7 of subsection 7c7 of such section #c2 7,b7 is not a venture capital fund1 as defined in section #bge4bjc7l7-#a of title #ag1 ,code of ,federal ,regulations1 as in effect on the date of enactment of this section2 and 7,c7 is not an institution selected under section #ajg of the ,community ,development ,banking and ,financial ,institutions ,act of #aiid 7#ab ,u4,s4,c4 #dgjf74 7#h7 ,specified entity ,the term specified entity means-- 7,a7 a hospital or health system2 7,b7 a physician-owned physician practice 7other than a practice described in subparagraph 7,c77 that is enrolled in the ,medicare program under title ,,xviii under section #ahff7;j72 7,c7 a physician practice owned1 controlled1 under common control1 or under management agreement by a hospital1 health system1 a health plan1 a private fund1 a venture capital fund1 a public or private corporation1 or any subsidiaries or entities under common control thereof2 7,d7 an ambulatory surgical center meeting the standards specified under section #ahcb7;a77#b77;,f77i72 7,e7 an independent freestanding emergency department2 7,f7 a behavioral health treatment facility1 a hospice program 7as defined in section #ahfa7;dd77#b771 a home health agency1 a provider of services or renal dialysis facility that furnishes renal dialysis services1 or an assisted living facility2 7,g7 any entity that owns or controls #a or more specified entities2 and 7,h7 any other entity specified by the ,secretary that furnishes health care items and services4 7#i7 ,venture capital fund ,the term venture capital fund has the meaning given such term in section #bge4bjc7l7-#a of title #ag1 ,code of ,federal ,regulations4 4 #g4 ,report on moral injury in health care 7a7 ,in general ,not later than #c years after the date of enactment of this ,act1 the ,inspector ,general of the ,department of ,health and ,human ,services shall-- 7#a7 conduct a study that evaluates profit-driven practices1 including cost-cutting practices and revenue-enhancing practices1 in health care delivery2 and 7#b7 submit to ,congress a report describing the results of such study4 7b7 ,inclusions ,the study conducted under subsection 7a77#a7 shall include-- 7#a7 an evaluation of profit-driven and revenue-maximization practices in health care delivery1 including-- 7,a7 overbilling or up-coding2 7,b7 inflated patient severity or patient risk scores2 7,c7 executive and provider compensation designed to increase revenue or profits1 such as bonuses based on productivity1 relative value units1 or service volume2 7,d7 reductions in staff and substitution of patient care staff with technology2 7,e7 changes in the mix of services provided in order to maximize revenue2 7,f7 efforts by private health insurers that are designed to restrict1 delay1 deny1 or discourage health care access services1 such as prior authorization or utilization review mechanisms2 and 7,g7 efforts by private health insurers1 private equity firms1 and other corporate entities to evade ,state corporate practice of medicine laws2 7#b7 an evaluation of the impact of such practices on-- 7,a7 the quality1 safety1 and outcomes of patient care2 7,b7 the well-being of personnel providing health care services2 7,c7 the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 7,d7 the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq472 7,e7 health care furnished under the laws administered by the ,secretary of ,veterans ,affairs2 7,f7 the health insurance program carried out under chapter #hi of title #e1 ,united ,states ,code2 7,g7 qualified health plans offered through ,american ,health ,benefit ,exchanges established under section #acaa or #acba of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca1 #ahjda72 and 7,h7 group health plans and group and individual health insurance coverage1 including managed care plans2 7#c7 an estimate of the financial returns accruing to parties that benefit from such practices1 including investors and other entities2 and 7#d7 an evaluation of the adequacy of ,federal policies designed to prevent and penalize health care fraud and abuse1 given health care consolidation and integration1 including the transparency of health care entities' financial practices1 the enforcement resources of ,federal agencies1 and the adequacy of financial and other penalties as deterrents4