I

106TH CONGRESS

1ST SESSION H. R. 545

To combat fraud in, and to improve the administration of, the disability

programs under titles II and XVI of the Social Security Act.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 3, 1999

Mrs. JOHNSON of Connecticut (for herself and Mr. CARDIN) introduced the

following bill; which was referred to the Committee on Ways and Means

A BILL

To combat fraud in, and to improve the administration of,

the disability programs under titles II and XVI of the

Social Security Act.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘SSI Fraud Prevention Act of 1999’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Primary liability of representative payees for overpayments to deceased

recipients.

Sec. 3. Requirement to provide State prisoner information to Federal and federally assisted benefit programs.
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Sec. 4. Recovery of overpayments of SSI benefits from lump sum SSI benefit

payments.

Sec. 5. Rules relating to collection of overpayments from individuals convicted

of crimes.

Sec. 6. Additional debt collection practices.

Sec. 7. Treatment of assets held in trust under the SSI program.

Sec. 8. Disposal of resources for less than fair market value under the SSI program.

Sec. 9. Loss of benefits as penalty for fraud.

Sec. 10. Exclusion of attorneys and physicians convicted of violations from participation in social security disability programs.

Sec. 11. Annual reviews by State disability determination services of professionals conducting consultative examinations.

Sec. 12. Computer matches with medicare and medicaid institutionalization

data.

Sec. 13. Access to information held by financial institutions.

Sec. 14. State data exchanges.

Sec. 15. Study on possible measures to improve fraud prevention and administrative processing.

Sec. 16. Annual report on amounts necessary to combat fraud.

1 SEC. 2. PRIMARY LIABILITY OF REPRESENTATIVE PAYEES

2 FOR OVERPAYMENTS TO DECEASED RECIPI3 ENTS.

4 (a) AMENDMENT TO TITLE II.—Section 204(a)(2) of

5 the Social Security Act (42 U.S.C. 404(a)(2)) is amended

6 by adding at the end the following new sentence: ‘‘If the

7 payment is made to a representative payee on behalf of

8 an individual who has died, the representative payee shall

9 be primarily liable for the repayment of the overpayment,

10 and the Commissioner of Social Security shall establish

11 an overpayment control record under the social security

12 account number of the representative payee.’’.

13 (b) AMENDMENT TO TITLE XVI.—Section

14 1631(b)(2) of such Act (42 U.S.C. 1383(b)(2)) is amend15 ed by adding at the end the following new sentence: ‘‘If

16 the payment is made to a representative payee on behalf
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1 of an individual who has died, the representative payee

2 shall be primarily liable for the repayment of the overpay3 ment, and the Commissioner of Social Security shall es4 tablish an overpayment control record under the social se5 curity account number of the representative payee.’’.

6 SEC. 3. REQUIREMENT TO PROVIDE STATE PRISONER IN7 FORMATION TO FEDERAL AND FEDERALLY

8 ASSISTED BENEFIT PROGRAMS.

9 Section 1611(e)(1)(I)(ii)(II) of the Social Security

10 Act (42 U.S.C. 1382(e)(1)(I)(ii)(II)) is amended by strik11 ing ‘‘is authorized to’’ and inserting ‘‘shall’’.

12 SEC. 4. RECOVERY OF OVERPAYMENTS OF SSI BENEFITS

13 FROM LUMP SUM SSI BENEFIT PAYMENTS.

14 (a) IN GENERAL.—Section 1631(b)(1)(B)(ii) of the

15 Social Security Act (42 U.S.C. 1383(b)(1)(B)(ii)) is

16 amended—

17 (1) by inserting ‘‘monthly’’ before ‘‘benefit pay18 ments’’; and

19 (2) by inserting ‘‘and in the case of an individ20 ual or eligible spouse to whom a lump sum is pay21 able under this title (including under section

22 1616(a) of this Act or under an agreement entered

23 into under section 212(a) of Public Law 93–66)

24 shall, as at least one means of recovering such over25 payment, make the adjustment or recovery from the
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1 lump sum payment in an amount equal to not less

2 than the lesser of the amount of the overpayment or

3 50 percent of the lump sum payment,’’ before ‘‘un4 less fraud’’.

5 (b) EFFECTIVE DATE.—The amendments made by

6 this section shall take effect on the date of the enactment

7 of this Act and shall apply to amounts incorrectly paid

8 which remain outstanding on or after such date.

9 SEC. 5. RULES RELATING TO COLLECTION OF OVERPAY10 MENTS FROM INDIVIDUALS CONVICTED OF

11 CRIMES.

12 (a) WAIVERS INAPPLICABLE TO OVERPAYMENTS BY

13 REASON OF PAYMENT IN MONTHS IN WHICH BENE14 FICIARY IS A PRISONER OR A FUGITIVE.—

15 (1) AMENDMENT TO TITLE II.—Section 204(b)

16 of the Social Security Act (42 U.S.C. 404(b)) is

17 amended—

18 (A) by inserting ‘‘(1)’’ after ‘‘(b)’’; and

19 (B) by adding at the end the following:

20 ‘‘(2) Paragraph (1) shall not apply with respect to

21 any payment to any person made during a month in which

22 such benefit was not payable under section 202(x).’’.

23 (2) AMENDMENT TO TITLE XVI.—Section

24 1631(b)(1)(B)(i) of such Act (42 U.S.C.

25 1383(b)(1)(B)(i)) is amended by inserting ‘‘unless
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1 (I) section 1611(e)(1) prohibits payment to the per2 son of a benefit under this title for the month by

3 reason of confinement of a type described in clause

4 (i) or (ii) of section 202(x)(1)(A), or (II) section

5 1611(e)(5) prohibits payment to the person of a

6 benefit under this title for the month,’’ after ‘‘ad7 ministration of this title’’.

8 (b) 10-YEAR PERIOD OF INELIGIBILITY FOR PER9 SONS FAILING TO NOTIFY COMMISSIONER OF OVERPAY10 MENTS IN MONTHS IN WHICH BENEFICIARY IS A PRIS11 ONER OR A FUGITIVE OR FAILING TO COMPLY WITH RE12 PAYMENT SCHEDULE FOR SUCH OVERPAYMENTS.—

13 (1) AMENDMENT TO TITLE II.—Section 202(x)

14 of such Act (42 U.S.C. 402(x)) is amended by add15 ing at the end the following:

16 ‘‘(4)(A) No person shall be considered entitled to

17 monthly insurance benefits under this section based on the

18 person’s disability or to disability insurance benefits under

19 section 223 otherwise payable during the 10-year period

20 that begins on the date the person—

21 ‘‘(i) knowingly fails to timely notify the Com22 missioner of Social Security, in connection with any

23 application for benefits under this title, of any prior

24 receipt by such person of any benefit under this title

25 or title XVI in any month in which such benefit was
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1 not payable under the preceding provisions of this

2 subsection, or

3 ‘‘(ii) knowingly fails to comply with any sched4 ule imposed by the Commissioner which is for repay5 ment of overpayments comprised of payments de6 scribed in subparagraph (A) and which is in compli7 ance with section 204.

8 ‘‘(B) The Commissioner of Social Security shall, in

9 addition to any other relevant factors, take into account

10 any mental or linguistic limitations of a person (including

11 any lack of facility with the English language) in deter12 mining whether the person has knowingly failed to comply

13 with a requirement of clause (i) or (ii) of subparagraph

14 (A).’’.

15 (2) AMENDMENT TO TITLE XVI.—Section

16 1611(e)(1) of such Act (42 U.S.C. 1382(e)(1)) is

17 amended by adding at the end the following:

18 ‘‘(J)(i) A person shall not be considered an eligible

19 individual or eligible spouse for purposes of benefits under

20 this title by reason of disability, during the 10-year period

21 that begins on the date the person—

22 ‘‘(I) knowingly fails to timely notify the Com23 missioner of Social Security, in an application for

24 benefits under this title, of any prior receipt by the

25 person of a benefit under this title or title II in a
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1 month in which payment to the person of a benefit

2 under this title was prohibited by—

3 ‘‘(aa) the preceding provisions of this para4 graph by reason of confinement of a type de5 scribed in clause (i) or (ii) of section

6 202(x)(1)(A); or

7 ‘‘(bb) section 1611(e)(5); or

8 ‘‘(II) knowingly fails to comply with any sched9 ule imposed by the Commissioner which is for repay10 ment of overpayments comprised of payments de11 scribed in clause (i) of this subparagraph and which

12 is in compliance with section 1631(b).

13 ‘‘(ii) The Commissioner of Social Security shall, in

14 addition to any other relevant factors, take into account

15 any mental or linguistic limitations of a person (including

16 any lack of facility with the English language) in deter17 mining whether the person has knowingly failed to comply

18 with a requirement of subclause (I) or (II) of clause (i).’’.

19 (c) CONTINUED COLLECTION EFFORTS AGAINST

20 PRISONERS.—

21 (1) AMENDMENT TO TITLE II.—Section 204(b)

22 of such Act (as amended by subsection (a)(1)) is

23 amended further by adding at the end the following

24 new paragraph:
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1 ‘‘(3) The Commissioner shall not refrain from recov2 ering overpayments from resources currently available to

3 any overpaid person or to such person’s estate solely be4 cause such individual is confined as described in clause

5 (i) or (ii) of section 202(x)(1)(A).’’.

6 (2) AMENDMENT TO TITLE XVI.—Section

7 1631(b)(1)(A) of such Act (42 U.S.C.

8 1383(b)(1)(A)) is amended by adding after and

9 below clause (ii) the following flush left sentence:

10 ‘‘The Commissioner shall not refrain from recovering over11 payments from resources currently available to any indi12 vidual solely because the individual is confined as de13 scribed in clause (i) or (ii) of section 202(x)(1)(A).’’.

14 SEC. 6. ADDITIONAL DEBT COLLECTION PRACTICES.

15 (a) IN GENERAL.—Section 1631(d)(1) of the Social

16 Security Act (42 U.S.C. 1383(d)(1)) is amended by strik17 ing ‘‘section 207’’ and inserting ‘‘sections 204(f) and

18 207’’.

19 (b) EFFECTIVE DATE.—The amendment made by

20 this section shall apply to debt outstanding on or after

21 the date of the enactment of this Act.
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1 SEC. 7. TREATMENT OF ASSETS HELD IN TRUST UNDER

2 THE SSI PROGRAM.

3 (a) TREATMENT AS RESOURCE.—Section 1613 of the

4 Social Security Act (42 U.S.C. 1382b) is amended by add5 ing at the end the following:

6 ‘‘Trusts

7 ‘‘(e)(1) In determining the resources of an individual,

8 paragraph (3) shall apply to a trust (other than a trust

9 described in paragraph (5)) established by the individual.

10 ‘‘(2)(A) For purposes of this subsection, an individual

11 shall be considered to have established a trust if any assets

12 of the individual (or of the individual’s spouse) are trans13 ferred to the trust other than by will.

14 ‘‘(B) In the case of an irrevocable trust to which are

15 transferred the assets of an individual (or of the individ16 ual’s spouse) and the assets of any other person, this sub17 section shall apply to the portion of the trust attributable

18 to the assets of the individual (or of the individual’s

19 spouse).

20 ‘‘(C) This subsection shall apply to a trust without

21 regard to—

22 ‘‘(i) the purposes for which the trust is estab23 lished;

24 ‘‘(ii) whether the trustees have or exercise any

25 discretion under the trust;
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1 ‘‘(iii) any restrictions on when or whether dis2 tributions may be made from the trust; or

3 ‘‘(iv) any restrictions on the use of distributions

4 from the trust.

5 ‘‘(3)(A) In the case of a revocable trust established

6 by an individual, the corpus of the trust shall be consid7 ered a resource available to the individual.

8 ‘‘(B) In the case of an irrevocable trust established

9 by an individual, if there are any circumstances under

10 which payment from the trust could be made to or for

11 the benefit of the individual or the individual’s spouse, the

12 portion of the corpus from which payment to or for the

13 benefit of the individual or the individual’s spouse could

14 be made shall be considered a resource available to the

15 individual.

16 ‘‘(4) The Commissioner of Social Security may waive

17 the application of this subsection with respect to an indi18 vidual if the Commissioner determines that such applica19 tion would work an undue hardship on the individual.

20 ‘‘(5) This subsection shall not apply to a trust de21 scribed in subparagraph (A) or (C) of section 1917(d)(4).

22 ‘‘(6) For purposes of this subsection—

23 ‘‘(A) the term ‘trust’ includes any legal instru24 ment or device that is similar to a trust;
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1 ‘‘(B) the term ‘corpus’ means, with respect to

2 a trust, all property and other interests held by the

3 trust, including accumulated earnings and any other

4 addition to the trust after its establishment (except

5 that such term does not include any such earnings

6 or addition in the month in which the earnings or

7 addition is credited or otherwise transferred to the

8 trust); and

9 ‘‘(C) the term ‘asset’ includes any income or re10 source of the individual or of the individual’s spouse,

11 including—

12 ‘‘(i) any income excluded by section

13 1612(b);

14 ‘‘(ii) any resource otherwise excluded by

15 this section; and

16 ‘‘(iii) any other payment or property to

17 which the individual or the individual’s spouse

18 is entitled but does not receive or have access

19 to because of action by—

20 ‘‘(I) the individual or spouse;

21 ‘‘(II) a person or entity (including a

22 court) with legal authority to act in place

23 of, or on behalf of, the individual or

24 spouse; or
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1 ‘‘(III) a person or entity (including a

2 court) acting at the direction of, or on the

3 request of, the individual or spouse.’’.

4 (b) TREATMENT AS INCOME.—Section 1612(a)(2) of

5 such Act (42 U.S.C. 1382a(a)(2)) is amended—

6 (1) by striking ‘‘and’’ at the end of subpara7 graph (E);

8 (2) by striking the period at the end of sub9 paragraph (F) and inserting ‘‘; and’’; and

10 (3) by adding at the end the following:

11 ‘‘(G) any earnings of, and additions to, the cor12 pus of a trust established by an individual (within

13 the meaning of section 1613(e)), of which the indi14 vidual is a beneficiary, to which section 1613(e) ap15 plies, and, in the case of an irrevocable trust, with

16 respect to which circumstances exist under which a

17 payment from the earnings or additions could be

18 made to or for the benefit of the individual.’’.

19 (c) EFFECTIVE DATE.—The amendments made by

20 this section shall take effect on January 1, 2000, and shall

21 apply to trusts established on or after such date.

22 SEC. 8. DISPOSAL OF RESOURCES FOR LESS THAN FAIR

23 MARKET VALUE UNDER THE SSI PROGRAM.

24 (a) IN GENERAL.—Section 1613(c) of the Social Se25 curity Act (42 U.S.C. 1382b(c)) is amended—
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1 (1) in the caption, by striking ‘‘Notification of

2 Medicaid Policy Restricting Eligibility of Institu3 tionalized Individuals for Benefits Based on’’;

4 (2) in paragraph (1)—

5 (A) in subparagraph (A)—

6 (i) by inserting ‘‘paragraph (1) and’’

7 after ‘‘provisions of’’;

8 (ii) by striking ‘‘title XIX’’ the first

9 place it appears and inserting ‘‘this title

10 and title XIX, respectively,’’;

11 (iii) by striking ‘‘subparagraph (B)’’

12 and inserting ‘‘clause (ii)’’;

13 (iv) by striking ‘‘paragraph (2)’’ and

14 inserting ‘‘subparagraph (B)’’;

15 (B) in subparagraph (B)—

16 (i) by striking ‘‘by the State agency’’;

17 and

18 (ii) by striking ‘‘section 1917(c)’’ and

19 all that follows and inserting ‘‘paragraph

20 (1) or section 1917(c).’’; and

21 (C) by redesignating subparagraphs (A)

22 and (B) as clauses (i) and (ii), respectively;

23 (3) in paragraph (2)—

24 (A) by striking ‘‘(2)’’ and inserting ‘‘(B)’’;

25 and
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1 (B) by striking ‘‘paragraph (1)(B)’’ and

2 inserting ‘‘subparagraph (A)(ii)’’;

3 (4) by striking ‘‘(c)(1)’’ and inserting ‘‘(2)(A)’’;

4 and

5 (5) by inserting before paragraph (2) (as redes6 ignated by paragraph (4) of this subsection) the fol7 lowing:

8 ‘‘(c)(1)(A)(i) If an individual or the spouse of an indi9 vidual disposes of resources for less than fair market value

10 on or after the look-back date described in clause (ii)(I),

11 the individual is ineligible for benefits under this title for

12 months during the period beginning on the date described

13 in clause (iii) and equal to the number of months cal14 culated as provided in clause (iv).

15 ‘‘(ii)(I) The look-back date described in this sub16 clause is a date that is 36 months before the date de17 scribed in subclause (II).

18 ‘‘(II) The date described in this subclause is the date

19 on which the individual applies for benefits under this title

20 or, if later, the date on which the individual (or the spouse

21 of the individual) disposes of resources for less than fair

22 market value.

23 ‘‘(iii) The date described in this clause is the first

24 day of the first month that follows the month in which

25 resources were disposed of for less than fair market value
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1 and that does not occur in any other period of ineligibility

2 under this paragraph.

3 ‘‘(iv) The number of months calculated under this

4 clause shall be equal to—

5 ‘‘(I) the total, cumulative uncompensated value

6 of all resources so disposed of by the individual (or

7 the spouse of the individual) on or after the look8 back date described in clause (ii)(I); divided by

9 ‘‘(II) the amount of the maximum monthly ben10 efit payable under section 1611(b) for the month in

11 which occurs the date described in clause (ii)(II),

12 rounded up, in the case of any fraction, to the next whole

13 number.

14 ‘‘(B)(i) Notwithstanding subparagraph (A), this sub15 section shall not apply to a transfer of a resource to a

16 trust if the portion of the trust attributable to the resource

17 is considered a resource available to the individual pursu18 ant to subsection (e)(3) (or would be so considered but

19 for the application of subsection (e)(4)).

20 ‘‘(ii) In the case of a trust established by an individ21 ual or an individual’s spouse (within the meaning of sub22 section (e)), if from such portion of the trust, if any, that

23 is considered a resource available to the individual pursu24 ant to subsection (e)(3) (or would be so considered but
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1 for the application of subsection (e)(4)) or the residue of

2 the portion on the termination of the trust—

3 ‘‘(I) there is made a payment other than to or

4 for the benefit of the individual; or

5 ‘‘(II) no payment could under any circumstance

6 be made to the individual,

7 then, for purposes of this subsection, the payment de8 scribed in clause (I) or the foreclosure of payment de9 scribed in clause (II) shall be considered a transfer of re10 sources by the individual or the individual’s spouse as of

11 the date of the payment or foreclosure, as the case may

12 be.

13 ‘‘(C) An individual shall not be ineligible for benefits

14 under this title by reason of the application of this para15 graph to a disposal of resources by the individual or the

16 spouse of the individual, to the extent that—

17 ‘‘(i) the resources are a home and title to the

18 home was transferred to—

19 ‘‘(I) the spouse of the transferor;

20 ‘‘(II) a child of the transferor who has not

21 attained 21 years of age, or is blind or disabled;

22 ‘‘(III) a sibling of the transferor who has

23 an equity interest in such home and who was

24 residing in the transferor’s home for a period of

25 at least 1 year immediately before the date the
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1 transferor becomes an institutionalized individ2 ual; or

3 ‘‘(IV) a son or daughter of the transferor

4 (other than a child described in subclause (II))

5 who was residing in the transferor’s home for

6 a period of at least 2 years immediately before

7 the date the transferor becomes an institu8 tionalized individual, and who provided care to

9 the transferor which permitted the transferor to

10 reside at home rather than in such an institu11 tion or facility;

12 ‘‘(ii) the resources—

13 ‘‘(I) were transferred to the transferor’s

14 spouse or to another for the sole benefit of the

15 transferor’s spouse;

16 ‘‘(II) were transferred from the transfer17 or’s spouse to another for the sole benefit of the

18 transferor’s spouse;

19 ‘‘(III) were transferred to, or to a trust

20 (including a trust described in section

21 1917(d)(4)) established solely for the benefit of,

22 the transferor’s child who is blind or disabled;

23 or

24 ‘‘(IV) were transferred to a trust (includ25 ing a trust described in section 1917(d)(4)) es-
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1 tablished solely for the benefit of an individual

2 who has not attained 65 years of age and who

3 is disabled;

4 ‘‘(iii) a satisfactory showing is made to the Sec5 retary (in accordance with regulations promulgated

6 by the Secretary) that—

7 ‘‘(I) the individual who disposed of the re8 sources intended to dispose of the resources ei9 ther at fair market value, or for other valuable

10 consideration;

11 ‘‘(II) the resources were transferred exclu12 sively for a purpose other than to qualify for

13 benefits under this title; or

14 ‘‘(III) all resources transferred for less

15 than fair market value have been returned to

16 the transferor; or

17 ‘‘(iv) the Secretary determines, under proce18 dures established by the Secretary, that the denial of

19 eligibility would work an undue hardship as deter20 mined on the basis of criteria established by the Sec21 retary;

22 ‘‘(D) For purposes of this subsection, in the case of

23 a resource held by an individual in common with another

24 person or persons in a joint tenancy, tenancy in common,

25 or similar arrangement, the resource (or the affected por-
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1 tion of such resource) shall be considered to be disposed

2 of by the individual when any action is taken, either by

3 the individual or by any other person, that reduces or

4 eliminates the individual’s ownership or control of such re5 source.

6 ‘‘(E) In the case of a transfer by the spouse of an

7 individual that results in a period of ineligibility for the

8 individual under this subsection, the Commissioner shall

9 apportion the period (or any portion of the period) among

10 the individual and the individual’s spouse if the spouse be11 comes eligible for benefits under this title.

12 ‘‘(F) For purposes of this paragraph—

13 ‘‘(i) the term ‘benefits under this title’ includes

14 payments of the type described in section 1616(a) of

15 this Act and of the type described in section 212(b)

16 of Public Law 93-66;

17 ‘‘(ii) the term ‘institutionalized individual’ has

18 the meaning given such term in section 1917(e)(3);

19 and

20 ‘‘(iii) the term ‘trust’ has the meaning given

21 such term in subsection (e)(5)(A) of this section.’’.

22 (b) EFFECTIVE DATE.—The amendments made by

23 this section shall be effective with respect to disposals

24 made on or after the date of enactment of this Act.
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1 SEC. 9. LOSS OF BENEFITS AS PENALTY FOR FRAUD.

2 (a) IN GENERAL.—Part A of title XI of the Social

3 Security Act (42 U.S.C. 1301 et seq.) is amended by in4 serting after section 1129 the following:

5 ‘‘SEC. 1129A. LOSS OF BENEFITS AS PENALTY FOR FRAUD.

6 ‘‘(a) IN GENERAL.—Any person who makes, or

7 causes to be made, a statement or representation of a ma8 terial fact for use in determining any initial or continuing

9 right to or the amount of—

10 ‘‘(1) monthly insurance benefits under title II;

11 or

12 ‘‘(2) benefits or payments under title XVI,

13 that the person knows or should know is false or mislead14 ing or knows or should know omits a material fact or

15 makes such a statement with knowing disregard for the

16 truth shall be subject to, in addition to any other penalties

17 that may be prescribed by law, a penalty described in sub18 section (b) which shall be imposed by the Commissioner

19 of Social Security.

20 ‘‘(b) PENALTY.—The penalty described in this sub21 section is—

22 ‘‘(1) nonpayment of benefits under title II that

23 would otherwise be payable to the person; and

24 ‘‘(2) ineligibility for cash benefits under title

25 XVI,
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1 for each month that begins during the applicable period

2 described in subsection (c).

3 ‘‘(c) DURATION OF PENALTY.—The applicable period

4 begins with the date the Commissioner makes a deter5 mination that the person has engaged in conduct described

6 in subsection (a), and the duration of the period shall be—

7 ‘‘(1) 6 consecutive months, in the case of the

8 first such determination with respect to the person;

9 ‘‘(2) 12 consecutive months, in the case of a

10 second such determination with respect to the per11 son;

12 ‘‘(3) 24 consecutive months, in the case of a

13 third or subsequent such determination with respect

14 to the person.

15 ‘‘(d) EFFECT ON OTHER ASSISTANCE.—A person

16 subject to a period of nonpayment of benefits under title

17 II or ineligibility for title XVI benefits by reason of this

18 section nevertheless shall be considered to be receiving

19 such benefits for purposes of—

20 ‘‘(1) determination of the eligibility of the per21 son for benefits under titles XVIII and XIX; and

22 ‘‘(2) determination of the eligibility or amount

23 of benefits payable under title II or XVI to another

24 person.
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1 ‘‘(e) DEFINITION.—In this section, the term ‘benefits

2 under title XVI’ includes State supplementary payments

3 made by the Commissioner pursuant to an agreement

4 under section 1616(a) of this Act or section 212(b) of

5 Public Law 93–66.

6 ‘‘(f) CONSULTATIONS.—The Commissioner of Social

7 Security shall consult with the Inspector General of the

8 Social Security Administration before initiating an action

9 under this section.’’.

10 (b) CONFORMING AMENDMENT PRECLUDING DE11 LAYED RETIREMENT CREDIT FOR ANY MONTH TO WHICH

12 A NONPAYMENT OF BENEFITS PENALTY APPLIES.—Sec13 tion 202(w)(2)(B) of such Act (42 U.S.C. 402(w)(2)(B))

14 is amended—

15 (1) by striking ‘‘and’’ at the end of clause (i);

16 (2) by striking the period at the end of clause

17 (ii) and inserting ‘‘, and’’; and

18 (3) by adding at the end the following:

19 ‘‘(iii) such individual was not subject to a

20 penalty imposed under section 1129A.’’.

21 (c) ELIMINATION OF REDUNDANT PROVISION.—Sec22 tion 1611(e) of such Act (42 U.S.C. 1382(e)) is

23 amended—

24 (1) by striking paragraph (4);
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1 (2) in paragraph (6)(A)(i), by striking ‘‘(5)’’

2 and inserting ‘‘(4)’’; and

3 (3) by redesignating paragraphs (5) and (6) as

4 paragraphs (4) and (5), respectively.

5 (d) REGULATIONS.—Within 6 months after the date

6 of the enactment of this Act, the Commissioner of Social

7 Security shall develop regulations that prescribe the ad8 ministrative process for making determinations under sec9 tion 1129A of the Social Security Act.

10 SEC. 10. EXCLUSION OF ATTORNEYS AND PHYSICIANS CON11 VICTED OF VIOLATIONS FROM PARTICIPA12 TION IN SOCIAL SECURITY DISABILITY PRO13 GRAMS.

14 (a) IN GENERAL.—Part A of title XI of the Social

15 Security Act (42 U.S.C. 1301–1320b–17) is amended by

16 adding at the end the following:

17 ‘‘EXCLUSION OF ATTORNEYS AND PHYSICIANS CON18 VICTED OF VIOLATIONS FROM PARTICIPATION IN SO19 CIAL SECURITY DISABILITY PROGRAMS

20 ‘‘SEC. 1148. (a) IN GENERAL.—The Commissioner

21 of Social Security shall exclude from participation in the

22 social security disability programs any attorney or

23 physician—

24 ‘‘(1) who is convicted of a violation of section

25 208 or 1632 of this Act,
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1 ‘‘(2) who is convicted of any violation under

2 title 18, United States Code, relating to an initial

3 application for or continuing entitlement to benefits

4 under title II of this Act, or an initial application for

5 or continuing eligibility for benefits under title XVI

6 of this Act, or

7 ‘‘(3) who becomes subject to a penalty or as8 sessment under section 1129(a)(1)(A) of this Act.

9 ‘‘(b) NOTICE, EFFECTIVE DATE, AND PERIOD OF

10 EXCLUSION.—(1) An exclusion under this section shall be

11 effective at such time, for such period, and upon such rea12 sonable notice to the public and to the individual excluded

13 as may be specified in regulations consistent with para14 graph (2).

15 ‘‘(2) Such an exclusion shall be effective with respect

16 to services furnished to any individual on or after the ef17 fective date of the exclusion. Nothing in this section may

18 be construed to preclude, in determining disability under

19 title II or title XVI, consideration of any medical evidence

20 derived from services provided by a physician before the

21 effective date of the exclusion of the physician under this

22 section.

23 ‘‘(3)(A) The Commissioner shall specify, in the notice

24 of exclusion under paragraph (1), the period of the exclu25 sion.
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1 ‘‘(B) Subject to subparagraph (C), in the case of an

2 exclusion under subsection (a), the minimum period of ex3 clusion shall be five years, except that the Commissioner

4 may waive the exclusion in the case of an individual who

5 is the sole source of essential services in a community. The

6 Commissioner’s decision whether to waive the exclusion

7 shall not be reviewable.

8 ‘‘(C) In the case of an exclusion of an individual

9 under subsection (a) based on a conviction occurring on

10 or after the date of the enactment of this section, if the

11 individual has (before, on, or after such date) been

12 convicted—

13 ‘‘(i) on one previous occasion of one or more of14 fenses for which an exclusion may be effected under

15 such subsection, the period of the exclusion shall be

16 not less than 10 years, or

17 ‘‘(ii) on 2 or more previous occasions of one or

18 more offenses for which an exclusion may be effected

19 under such subsection, the period of the exclusion

20 shall be permanent.

21 ‘‘(c) NOTICE TO STATE AGENCIES.—The Commis22 sioner shall promptly notify each appropriate State agency

23 employed for the purpose of making disability determina24 tions under section 221 or 1633(a)—
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1 ‘‘(1) of the fact and circumstances of each ex2 clusion effected against an individual under this sec3 tion, and

4 ‘‘(2) of the period (described in subsection

5 (b)(3)) for which the State agency is directed to ex6 clude the individual from participation in the activi7 ties of the State agency in the course of its employ8 ment.

9 ‘‘(d) NOTICE TO STATE LICENSING AGENCIES.—The

10 Commissioner shall—

11 ‘‘(1) promptly notify the appropriate State or

12 local agency or authority having responsibility for

13 the licensing or certification of an individual ex14 cluded from participation under this section of the

15 fact and circumstances of the exclusion,

16 ‘‘(2) request that appropriate investigations be

17 made and sanctions invoked in accordance with ap18 plicable State law and policy, and

19 ‘‘(3) request that the State or local agency or

20 authority keep the Commissioner and the Inspector

21 General of the Social Security Administration fully

22 and currently informed with respect to any actions

23 taken in response to the request.

24 ‘‘(e) APPLICATION FOR TERMINATION OF EXCLU25 SION.—(1) An individual excluded from participation
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1 under this section may apply to the Commissioner, in the

2 manner specified by the Commissioner in regulations and

3 at the end of the minimum period of exclusion provided

4 under subsection (b)(3) and at such other times as the

5 Commissioner may provide, for termination of the exclu6 sion effected under this section.

7 ‘‘(2) The Commissioner may terminate the exclusion

8 if the Commissioner determines, on the basis of the con9 duct of the applicant which occurred after the date of the

10 notice of exclusion or which was unknown to the Commis11 sioner at the time of the exclusion, that—

12 ‘‘(A) there is no basis under subsection (a) for

13 a continuation of the exclusion, and

14 ‘‘(B) there are reasonable assurances that the

15 types of actions which formed the basis for the origi16 nal exclusion have not recurred and will not recur.

17 ‘‘(3) The Commissioner shall promptly notify each

18 State agency employed for the purpose of making disabil19 ity determinations under section 221 or 1633(a) of the

20 fact and circumstances of each termination of exclusion

21 made under this subsection.

22 ‘‘(f) AVAILABILITY OF RECORDS OF EXCLUDED AT23 TORNEYS AND PHYSICIANS.—Nothing in this section shall

24 be construed to have the effect of limiting access by any

25 applicant or beneficiary under title II or XVI, any State
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1 agency acting under section 221 or 1633(a), or the Com2 missioner of Social Security to records maintained by any

3 attorney or physician in connection with services provided

4 to the applicant or beneficiary prior to the exclusion of

5 such attorney or physician under this section.

6 ‘‘(g) REPORTING REQUIREMENT.—Any attorney or

7 physician participating in, or seeking to participate in, a

8 social security disability program shall inform the Com9 missioner, in such form and manner as the Commissioner

10 shall prescribe by regulation, whether such attorney or

11 physician has been convicted of a violation described in

12 subsection (a).

13 ‘‘(h) DEFINITIONS.—For purposes of this section.—

14 ‘‘(1) EXCLUDE.—The term ‘exclude’ from par15 ticipation means—

16 ‘‘(A) in connection with an attorney, to

17 prohibit from engaging in representation of an

18 applicant for, or recipient of, benefits as a rep19 resentative payee under section 205(j) or

20 1631(a)(2)(A)(ii) or otherwise as a representa21 tive in any hearing or other proceeding relating

22 to entitlement to benefits, and

23 ‘‘(B) in connection with a physician, to

24 prohibit from providing items or services to an

25 applicant for, or recipient of, benefits for the
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1 purpose of assisting such applicant or recipient

2 in demonstrating disability.

3 ‘‘(2) SOCIAL SECURITY DISABILITY PROGRAM.—

4 The term ‘social security disability program’ means

5 the program providing for monthly disability insur6 ance benefits under section 223 or monthly benefits

7 based on the disability of the recipient under section

8 202 and the program providing for supplemental se9 curity income to individuals based on disability

10 under title XVI.

11 ‘‘(3) CONVICTED.—An individual is considered

12 to have been ‘convicted’ of a violation—

13 ‘‘(A) when a judgment of conviction has

14 been entered against the individual by a Fed15 eral, State, or local court, except if the judge16 ment of conviction has been set aside or ex17 punged;

18 ‘‘(B) when there has been a finding of

19 guilt against the individual by a Federal, State,

20 or local court;

21 ‘‘(C) when a plea of guilty or nolo

22 contendere by the individual has been accepted

23 by a Federal, State, or local court; or

24 ‘‘(D) when the individual has entered into

25 participation in a first offender, deferred adju-
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1 dication, or other arrangement or program

2 where judgment of conviction has been with3 held.’’.

4 (b) EFFECTIVE DATE.—The amendment made by

5 this section shall apply with respect to violations and con6 victions occurring on or after the date of the enactment

7 of this Act.

8 SEC. 11. ANNUAL REVIEWS BY STATE DISABILITY DETER9 MINATION SERVICES OF PROFESSIONALS

10 CONDUCTING CONSULTATIVE EXAMINA11 TIONS.

12 (a) IN GENERAL.—Section 221(j) of the Social Secu13 rity Act (42 U.S.C. 421(j)) is amended—

14 (1) by redesignating paragraphs (1), (2), and

15 (3), as subparagraphs (A), (B), and (C), respec16 tively;

17 (2) by inserting ‘‘(1)’’ after ‘‘(j)’’; and

18 (3) by adding at the end the following new

19 paragraph:

20 ‘‘(2) The Commissioner shall provide for annual eval21 uations by State disability determination services of the

22 performance of professionals to whom cases are referred

23 for purposes of disability determinations by such services.

24 Such evaluations shall include a thorough analysis of the

25 completeness of the examinations performed through such
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1 referrals and the extent to which any patterns of abuse

2 have arisen in the referral processes. The Commissioner

3 shall ensure that any such pattern of abuse which, in the

4 course of any such evaluation, is determined by any State

5 disability determination service to have occurred is

6 promptly referred by such service to the Inspector General

7 of the Social Security Administration.’’.

8 (b) EFFECTIVE DATE.—The first annual evaluations

9 required pursuant to the amendments made by this section

10 shall be filed not later than December 31, 1999.

11 SEC. 12. COMPUTER MATCHES WITH MEDICARE AND MED12 ICAID INSTITUTIONALIZATION DATA.

13 (a) IN GENERAL.—Section 1611(e)(1) of the Social

14 Security Act (42 U.S.C. 1382(e)(1)) is further amended

15 by adding at the end the following:

16 ‘‘(K) For the purpose of carrying out this paragraph,

17 the Commissioner of Social Security shall conduct periodic

18 computer matches with data maintained by the Secretary

19 of Health and Human Services under title XVIII or XIX.

20 The Secretary shall furnish to the Commissioner, in such

21 form and manner and under such terms as the Commis22 sioner and the Secretary shall mutually agree, such infor23 mation as the Commissioner may request for this purpose.

24 Information obtained pursuant to such a match may be
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1 substituted for the physician’s certification otherwise re2 quired under subparagraph (G)(i).’’.

3 (b) CONFORMING AMENDMENT.—Section

4 1611(e)(1)(G) of such Act (42 U.S.C. 1382(e)(1)(G)) is

5 amended by striking ‘‘subparagraph (H)’’ and inserting

6 ‘‘subparagraph (H) or (K)’’.

7 SEC. 13. ACCESS TO INFORMATION HELD BY FINANCIAL IN8 STITUTIONS.

9 (a) IN GENERAL.—Section 1631(e)(1)(B) of the So10 cial Security Act (42 U.S.C. 1383(e)(1)(B)) is amended—

11 (1) by striking ‘‘(B) The’’ and inserting ‘‘(B)(i)

12 The’’; and

13 (2) by adding at the end the following new

14 clause:

15 ‘‘(ii)(I) The Commissioner of Social Security may re16 quire each applicant for, or recipient of, benefits under

17 this title to provide authorization by the applicant or recip18 ient (or by any other person whose income or resources

19 are material to the determination of the eligibility of the

20 applicant or recipient for such benefits) for the Commis21 sioner to obtain (subject to the cost reimbursement re22 quirements of section 1115(a) of the Right to Financial

23 Privacy Act) from any financial institution (within the

24 meaning of section 1101(1) of such Act) any financial

25 record (within the meaning of section 1101(2) of such
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1 Act) held by the institution with respect to the applicant

2 or recipient (or any such other person) whenever the Com3 missioner determines the record is needed in connection

4 with a determination with respect to such eligibility or the

5 amount of such benefits.

6 ‘‘(II) Notwithstanding section 1104(a)(1) of the

7 Right to Financial Privacy Act, an authorization provided

8 by an applicant or recipient (or any other person whose

9 income or resources are material to the determination of

10 the eligibility of the applicant or recipient) pursuant to

11 subclause (I) of this clause shall remain effective until the

12 earliest of—

13 ‘‘(aa) the rendering of a final adverse decision

14 on the applicant’s application for eligibility for bene15 fits under this title;

16 ‘‘(bb) the cessation of the recipient’s eligibility

17 for benefits under this title; or

18 ‘‘(cc) the express revocation by the applicant or

19 recipient (or such other person referred to in sub20 clause (I)) of the authorization, in a written notifica21 tion to the Commissioner.

22 ‘‘(III)(aa) An authorization obtained by the Commis23 sioner of Social Security pursuant to this clause shall be

24 considered to meet the requirements of the Right to Fi25 nancial Privacy Act for purposes of section 1103(a) of
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1 such Act, and need not be furnished to the financial insti2 tution, notwithstanding section 1104(a) of such Act.

3 ‘‘(bb) The certification requirements of section

4 1103(b) of the Right to Financial Privacy Act shall not

5 apply to requests by the Commissioner of Social Security

6 pursuant to an authorization provided under this clause.

7 ‘‘(cc) A request by the Commissioner pursuant to an

8 authorization provided under this clause is deemed to meet

9 the requirements of section 1104(a)(3) of the Right to Fi10 nancial Privacy Act and the flush language of section

11 1102 of such Act.

12 ‘‘(IV) The Commissioner shall inform any person who

13 provides authorization pursuant to this clause of the dura14 tion and scope of the authorization.

15 ‘‘(V) If an applicant for, or recipient of, benefits

16 under this title (or any such other person referred to in

17 subclause (I)) refuses to provide or revokes any authoriza18 tion for the Commissioner of Social Security to obtain

19 from any financial institution any financial record, the

20 Commissioner may, on that basis, determine that the ap21 plicant or recipient is ineligible for benefits under this

22 title.’’.

23 (b) EFFECTIVE DATE.—The amendments made by

24 this section shall take effect on the date of the enactment

25 of this Act.
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1 SEC. 14. STATE DATA EXCHANGES.

2 Whenever the Commissioner of Social Security re3 quests information from a State for the purpose of

4 ascertaining an individual’s eligibility for benefits (or the

5 correct amount of such benefits) under title II or XVI of

6 the Social Security Act, the standards of the Commis7 sioner promulgated pursuant to section 1106 of such Act

8 or any other Federal law for the use, safeguarding, and

9 disclosure of information are deemed to meet any stand10 ards of the State that would otherwise apply to the disclo11 sure of information by the State to the Commissioner.

12 SEC. 15. STUDY ON POSSIBLE MEASURES TO IMPROVE

13 FRAUD PREVENTION AND ADMINISTRATIVE

14 PROCESSING.

15 (a) STUDY.—As soon as practicable after the date of

16 the enactment of this Act, the Commissioner of Social Se17 curity, in consultation with the Inspector General of the

18 Social Security Administration and the Attorney General,

19 shall conduct a study of possible measures to improve—

20 (1) prevention of fraud on the part of individ21 uals entitled to disability benefits under section 223

22 of the Social Security Act or benefits under section

23 202 of such Act based on the beneficiary’s disability,

24 individuals eligible for supplemental security income

25 benefits under title XVI of such Act, and applicants

26 for any such benefits; and
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1 (2) timely processing of reported income

2 changes by individuals receiving such benefits.

3 (b) REPORT.—Not later than 1 year after the date

4 of the enactment of this Act, the Commissioner shall re5 port in writing to the Committee on Ways and Means of

6 the House of Representatives and the Committee on Fi7 nance of the Senate the results of the Commissioner’s

8 study under subsection (a). Such report shall contain such

9 recommendations for legislative and administrative

10 changes as the Commissioner considers appropriate.

11 SEC. 16. ANNUAL REPORT ON AMOUNTS NECESSARY TO

12 COMBAT FRAUD.

13 (a) IN GENERAL.—Section 704(b)(1) of the Social

14 Security Act (42 U.S.C. 904(b)(1)) is amended—

15 (1) by inserting ‘‘(A)’’ after ‘‘(b)(1)’’; and

16 (2) by adding at the end the following new sub17 paragraph:

18 ‘‘(B) The Commissioner shall include in the annual

19 budget prepared pursuant to subparagraph (A) an

20 itemization of the amount of funds required by the Social

21 Security Administration for the fiscal year covered by the

22 budget to support efforts to combat fraud committed by

23 applicants and beneficiaries.’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 this section shall apply with respect to annual budgets pre3 pared for fiscal years after fiscal year 1999.

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