I

106TH CONGRESS

1ST SESSION H. R. 631

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

programs under titles II and XVI of the Social Security Act, and for

other purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 9, 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, and for other purposes.

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.

TITLE I—FRAUD PREVENTION AND RELATED PROVISIONS
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Sec. 101. Primary liability of representative payees for overpayments to deceased recipients.

Sec. 102. Requirement to provide State prisoner information to Federal and

federally assisted benefit programs.

Sec. 103. Recovery of overpayments of SSI benefits from lump sum SSI benefit

payments.

Sec. 104. Rules relating to collection of overpayments from individuals convicted of crimes.

Sec. 105. Additional debt collection practices.

Sec. 106. Treatment of assets held in trust under the SSI program.

Sec. 107. Disposal of resources for less than fair market value under the SSI

program.

Sec. 108. Loss of benefits as penalty for fraud.

Sec. 109. Exclusion of attorneys and physicians convicted of violations from

participation in social security disability programs.

Sec. 110. Annual reviews by State disability determination services of professionals conducting consultative examinations.

Sec. 111. Computer matches with medicare and medicaid institutionalization

data.

Sec. 112. Access to information held by financial institutions.

Sec. 113. State data exchanges.

Sec. 114. Study on possible measures to improve fraud prevention and administrative processing.

Sec. 115. Annual report on amounts necessary to combat fraud.

TITLE II—BENEFITS FOR PHILIPPINO VETERANS OF WORLD

WAR II

Sec. 201. Provision of reduced SSI benefit to certain individuals who provided

service to the Armed Forces of the United States in the Philippines during World War II after they move back to the Philippines.

1 TITLE I—FRAUD PREVENTION

2 AND RELATED PROVISIONS

3 SEC. 101. PRIMARY LIABILITY OF REPRESENTATIVE PAY4 EES FOR OVERPAYMENTS TO DECEASED RE5 CIPIENTS.

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

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

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

9 payment is made to a representative payee on behalf of

10 an individual who has died, the representative payee shall

11 be primarily liable for the repayment of the overpayment,
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1 and the Commissioner of Social Security shall establish

2 an overpayment control record under the social security

3 account number of the representative payee.’’.

4 (b) AMENDMENT TO TITLE XVI.—Section

5 1631(b)(2) of such Act (42 U.S.C. 1383(b)(2)) is amend6 ed by adding at the end the following new sentence: ‘‘If

7 the payment is made to a representative payee on behalf

8 of an individual who has died, the representative payee

9 shall be primarily liable for the repayment of the overpay10 ment, and the Commissioner of Social Security shall es11 tablish an overpayment control record under the social se12 curity account number of the representative payee.’’.

13 SEC. 102. REQUIREMENT TO PROVIDE STATE PRISONER IN14 FORMATION TO FEDERAL AND FEDERALLY

15 ASSISTED BENEFIT PROGRAMS.

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

17 Act (42 U.S.C. 1382(e)(1)(I)(ii)(II)) is amended by strik18 ing ‘‘is authorized to’’ and inserting ‘‘shall’’.

19 SEC. 103. RECOVERY OF OVERPAYMENTS OF SSI BENEFITS

20 FROM LUMP SUM SSI BENEFIT PAYMENTS.

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

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

23 amended—

24 (1) by inserting ‘‘monthly’’ before ‘‘benefit pay25 ments’’; and
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1 (2) by inserting ‘‘and in the case of an individ2 ual or eligible spouse to whom a lump sum is pay3 able under this title (including under section

4 1616(a) of this Act or under an agreement entered

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

6 shall, as at least one means of recovering such over7 payment, make the adjustment or recovery from the

8 lump sum payment in an amount equal to not less

9 than the lesser of the amount of the overpayment or

10 50 percent of the lump sum payment,’’ before ‘‘un11 less fraud’’.

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

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

14 of this Act and shall apply to amounts incorrectly paid

15 which remain outstanding on or after such date.

16 SEC. 104. RULES RELATING TO COLLECTION OF OVERPAY17 MENTS FROM INDIVIDUALS CONVICTED OF

18 CRIMES.

19 (a) WAIVERS INAPPLICABLE TO OVERPAYMENTS BY

20 REASON OF PAYMENT IN MONTHS IN WHICH BENE21 FICIARY IS A PRISONER OR A FUGITIVE.—

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

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

24 amended—

25 (A) by inserting ‘‘(1)’’ after ‘‘(b)’’; and
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1 (B) by adding at the end the following:

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

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

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

5 (2) AMENDMENT TO TITLE XVI.—Section

6 1631(b)(1)(B)(i) of such Act (42 U.S.C.

7 1383(b)(1)(B)(i)) is amended by inserting ‘‘unless

8 (I) section 1611(e)(1) prohibits payment to the per9 son of a benefit under this title for the month by

10 reason of confinement of a type described in clause

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

12 1611(e)(5) prohibits payment to the person of a

13 benefit under this title for the month,’’ after ‘‘ad14 ministration of this title’’.

15 (b) 10-YEAR PERIOD OF INELIGIBILITY FOR PER16 SONS FAILING TO NOTIFY COMMISSIONER OF OVERPAY17 MENTS IN MONTHS IN WHICH BENEFICIARY IS A PRIS18 ONER OR A FUGITIVE OR FAILING TO COMPLY WITH RE19 PAYMENT SCHEDULE FOR SUCH OVERPAYMENTS.—

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

21 of such Act (42 U.S.C. 402(x)) is amended by add22 ing at the end the following:

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

24 monthly insurance benefits under this section based on the

25 person’s disability or to disability insurance benefits under
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1 section 223 otherwise payable during the 10-year period

2 that begins on the date the person—

3 ‘‘(i) knowingly fails to timely notify the Com4 missioner of Social Security, in connection with any

5 application for benefits under this title, of any prior

6 receipt by such person of any benefit under this title

7 or title XVI in any month in which such benefit was

8 not payable under the preceding provisions of this

9 subsection, or

10 ‘‘(ii) knowingly fails to comply with any sched11 ule imposed by the Commissioner which is for repay12 ment of overpayments comprised of payments de13 scribed in subparagraph (A) and which is in compli14 ance with section 204.

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

16 addition to any other relevant factors, take into account

17 any mental or linguistic limitations of a person (including

18 any lack of facility with the English language) in deter19 mining whether the person has knowingly failed to comply

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

21 (A).’’.

22 (2) AMENDMENT TO TITLE XVI.—Section

23 1611(e)(1) of such Act (42 U.S.C. 1382(e)(1)) is

24 amended by adding at the end the following:
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1 ‘‘(J)(i) A person shall not be considered an eligible

2 individual or eligible spouse for purposes of benefits under

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

4 that begins on the date the person—

5 ‘‘(I) knowingly fails to timely notify the Com6 missioner of Social Security, in an application for

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

8 person of a benefit under this title or title II in a

9 month in which payment to the person of a benefit

10 under this title was prohibited by—

11 ‘‘(aa) the preceding provisions of this para12 graph by reason of confinement of a type de13 scribed in clause (i) or (ii) of section

14 202(x)(1)(A); or

15 ‘‘(bb) section 1611(e)(5); or

16 ‘‘(II) knowingly fails to comply with any sched17 ule imposed by the Commissioner which is for repay18 ment of overpayments comprised of payments de19 scribed in clause (i) of this subparagraph and which

20 is in compliance with section 1631(b).

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

22 addition to any other relevant factors, take into account

23 any mental or linguistic limitations of a person (including

24 any lack of facility with the English language) in deter-
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1 mining whether the person has knowingly failed to comply

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

3 (c) CONTINUED COLLECTION EFFORTS AGAINST

4 PRISONERS.—

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

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

7 amended further by adding at the end the following

8 new paragraph:

9 ‘‘(3) The Commissioner shall not refrain from recov10 ering overpayments from resources currently available to

11 any overpaid person or to such person’s estate solely be12 cause such individual is confined as described in clause

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

14 (2) AMENDMENT TO TITLE XVI.—Section

15 1631(b)(1)(A) of such Act (42 U.S.C.

16 1383(b)(1)(A)) is amended by adding after and

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

18 ‘‘The Commissioner shall not refrain from recovering over19 payments from resources currently available to any indi20 vidual solely because the individual is confined as de21 scribed in clause (i) or (ii) of section 202(x)(1)(A).’’.

22 SEC. 105. ADDITIONAL DEBT COLLECTION PRACTICES.

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

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

2 207’’.

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

4 this section shall apply to debt outstanding on or after

5 the date of the enactment of this Act.

6 SEC. 106. TREATMENT OF ASSETS HELD IN TRUST UNDER

7 THE SSI PROGRAM.

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

9 Social Security Act (42 U.S.C. 1382b) is amended by add10 ing at the end the following:

11 ‘‘Trusts

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

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

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

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

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

17 of the individual (or of the individual’s spouse) are trans18 ferred to the trust other than by will.

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

20 transferred the assets of an individual (or of the individ21 ual’s spouse) and the assets of any other person, this sub22 section shall apply to the portion of the trust attributable

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

24 spouse).
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1 ‘‘(C) This subsection shall apply to a trust without

2 regard to—

3 ‘‘(i) the purposes for which the trust is estab4 lished;

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

6 discretion under the trust;

7 ‘‘(iii) any restrictions on when or whether dis8 tributions may be made from the trust; or

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

10 from the trust.

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

12 by an individual, the corpus of the trust shall be consid13 ered a resource available to the individual.

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

15 by an individual, if there are any circumstances under

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

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

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

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

20 be made shall be considered a resource available to the

21 individual.

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

23 the application of this subsection with respect to an indi24 vidual if the Commissioner determines that such applica25 tion would work an undue hardship on the individual.
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1 ‘‘(5) This subsection shall not apply to a trust de2 scribed in subparagraph (A) or (C) of section 1917(d)(4).

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

4 ‘‘(A) the term ‘trust’ includes any legal instru5 ment or device that is similar to a trust;

6 ‘‘(B) the term ‘corpus’ means, with respect to

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

8 trust, including accumulated earnings and any other

9 addition to the trust after its establishment (except

10 that such term does not include any such earnings

11 or addition in the month in which the earnings or

12 addition is credited or otherwise transferred to the

13 trust); and

14 ‘‘(C) the term ‘asset’ includes any income or re15 source of the individual or of the individual’s spouse,

16 including—

17 ‘‘(i) any income excluded by section

18 1612(b);

19 ‘‘(ii) any resource otherwise excluded by

20 this section; and

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

22 which the individual or the individual’s spouse

23 is entitled but does not receive or have access

24 to because of action by—

25 ‘‘(I) the individual or spouse;
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1 ‘‘(II) a person or entity (including a

2 court) with legal authority to act in place

3 of, or on behalf of, the individual or

4 spouse; or

5 ‘‘(III) a person or entity (including a

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

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

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

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

10 (1) by striking ‘‘and’’ at the end of subpara11 graph (E);

12 (2) by striking the period at the end of sub13 paragraph (F) and inserting ‘‘; and’’; and

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

15 ‘‘(G) any earnings of, and additions to, the cor16 pus of a trust established by an individual (within

17 the meaning of section 1613(e)), of which the indi18 vidual is a beneficiary, to which section 1613(e) ap19 plies, and, in the case of an irrevocable trust, with

20 respect to which circumstances exist under which a

21 payment from the earnings or additions could be

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

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

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

25 apply to trusts established on or after such date.
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1 SEC. 107. DISPOSAL OF RESOURCES FOR LESS THAN FAIR

2 MARKET VALUE UNDER THE SSI PROGRAM.

3 (a) IN GENERAL.—Section 1613(c) of the Social Se4 curity Act (42 U.S.C. 1382b(c)) is amended—

5 (1) in the caption, by striking ‘‘Notification of

6 Medicaid Policy Restricting Eligibility of Institu7 tionalized Individuals for Benefits Based on’’;

8 (2) in paragraph (1)—

9 (A) in subparagraph (A)—

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

11 after ‘‘provisions of’’;

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

13 place it appears and inserting ‘‘this title

14 and title XIX, respectively,’’;

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

16 and inserting ‘‘clause (ii)’’;

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

18 inserting ‘‘subparagraph (B)’’;

19 (B) in subparagraph (B)—

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

21 and

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

23 all that follows and inserting ‘‘paragraph

24 (1) or section 1917(c).’’; and

25 (C) by redesignating subparagraphs (A)

26 and (B) as clauses (i) and (ii), respectively;
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1 (3) in paragraph (2)—

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

3 and

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

5 inserting ‘‘subparagraph (A)(ii)’’;

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

7 and

8 (5) by inserting before paragraph (2) (as redes9 ignated by paragraph (4) of this subsection) the fol10 lowing:

11 ‘‘(c)(1)(A)(i) If an individual or the spouse of an indi12 vidual disposes of resources for less than fair market value

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

14 the individual is ineligible for benefits under this title for

15 months during the period beginning on the date described

16 in clause (iii) and equal to the number of months cal17 culated as provided in clause (iv).

18 ‘‘(ii)(I) The look-back date described in this sub19 clause is a date that is 36 months before the date de20 scribed in subclause (II).

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

22 on which the individual applies for benefits under this title

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

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

25 market value.
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1 ‘‘(iii) The date described in this clause is the first

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

3 resources were disposed of for less than fair market value

4 and that does not occur in any other period of ineligibility

5 under this paragraph.

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

7 clause shall be equal to—

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

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

10 the spouse of the individual) on or after the look11 back date described in clause (ii)(I); divided by

12 ‘‘(II) the amount of the maximum monthly ben13 efit payable under section 1611(b) for the month in

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

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

16 number.

17 ‘‘(B)(i) Notwithstanding subparagraph (A), this sub18 section shall not apply to a transfer of a resource to a

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

20 is considered a resource available to the individual pursu21 ant to subsection (e)(3) (or would be so considered but

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

23 ‘‘(ii) In the case of a trust established by an individ24 ual or an individual’s spouse (within the meaning of sub25 section (e)), if from such portion of the trust, if any, that
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1 is considered a resource available to the individual pursu2 ant to subsection (e)(3) (or would be so considered but

3 for the application of subsection (e)(4)) or the residue of

4 the portion on the termination of the trust—

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

6 for the benefit of the individual; or

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

8 be made to the individual,

9 then, for purposes of this subsection, the payment de10 scribed in clause (I) or the foreclosure of payment de11 scribed in clause (II) shall be considered a transfer of re12 sources by the individual or the individual’s spouse as of

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

14 be.

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

16 under this title by reason of the application of this para17 graph to a disposal of resources by the individual or the

18 spouse of the individual, to the extent that—

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

20 home was transferred to—

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

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

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

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

25 an equity interest in such home and who was
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1 residing in the transferor’s home for a period of

2 at least 1 year immediately before the date the

3 transferor becomes an institutionalized individ4 ual; or

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

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

7 who was residing in the transferor’s home for

8 a period of at least 2 years immediately before

9 the date the transferor becomes an institu10 tionalized individual, and who provided care to

11 the transferor which permitted the transferor to

12 reside at home rather than in such an institu13 tion or facility;

14 ‘‘(ii) the resources—

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

16 spouse or to another for the sole benefit of the

17 transferor’s spouse;

18 ‘‘(II) were transferred from the transfer19 or’s spouse to another for the sole benefit of the

20 transferor’s spouse;

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

22 (including a trust described in section

23 1917(d)(4)) established solely for the benefit of,

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

25 or
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1 ‘‘(IV) were transferred to a trust (includ2 ing a trust described in section 1917(d)(4)) es3 tablished solely for the benefit of an individual

4 who has not attained 65 years of age and who

5 is disabled;

6 ‘‘(iii) a satisfactory showing is made to the

7 Commissioner of Social Security (in accordance with

8 regulations promulgated by the Commissioner)

9 that—

10 ‘‘(I) the individual who disposed of the re11 sources intended to dispose of the resources ei12 ther at fair market value, or for other valuable

13 consideration;

14 ‘‘(II) the resources were transferred exclu15 sively for a purpose other than to qualify for

16 benefits under this title; or

17 ‘‘(III) all resources transferred for less

18 than fair market value have been returned to

19 the transferor; or

20 ‘‘(iv) the Commissioner determines, under pro21 cedures established by the Commissioner, that the

22 denial of eligibility would work an undue hardship as

23 determined on the basis of criteria established by the

24 Commissioner;
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1 ‘‘(D) For purposes of this subsection, in the case of

2 a resource held by an individual in common with another

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

4 or similar arrangement, the resource (or the affected por5 tion of such resource) shall be considered to be disposed

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

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

8 eliminates the individual’s ownership or control of such re9 source.

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

11 individual that results in a period of ineligibility for the

12 individual under this subsection, the Commissioner shall

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

14 the individual and the individual’s spouse if the spouse be15 comes eligible for benefits under this title.

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

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

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

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

20 of Public Law 93–66;

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

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

23 and

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

25 such term in subsection (e)(5)(A) of this section.’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 this section shall be effective with respect to disposals

3 made on or after the date of enactment of this Act.

4 SEC. 108. LOSS OF BENEFITS AS PENALTY FOR FRAUD.

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

6 Security Act (42 U.S.C. 1301 et seq.) is amended by in7 serting after section 1129 the following:

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

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

10 causes to be made, a statement or representation of a ma11 terial fact for use in determining any initial or continuing

12 right to or the amount of—

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

14 or

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

16 that the person knows or should know is false or mislead17 ing or knows or should know omits a material fact or

18 makes such a statement with knowing disregard for the

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

20 that may be prescribed by law, a penalty described in sub21 section (b) which shall be imposed by the Commissioner

22 of Social Security.

23 ‘‘(b) PENALTY.—The penalty described in this sub24 section is—
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1 ‘‘(1) nonpayment of benefits under title II that

2 would otherwise be payable to the person; and

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

4 XVI,

5 for each month that begins during the applicable period

6 described in subsection (c).

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

8 begins with the date the Commissioner makes a deter9 mination that the person has engaged in conduct described

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

11 ‘‘(1) 6 consecutive months, in the case of the

12 first such determination with respect to the person;

13 ‘‘(2) 12 consecutive months, in the case of a

14 second such determination with respect to the per15 son; and

16 ‘‘(3) 24 consecutive months, in the case of a

17 third or subsequent such determination with respect

18 to the person.

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

20 subject to a period of nonpayment of benefits under title

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

22 section nevertheless shall be considered to be receiving

23 such benefits for purposes of—

24 ‘‘(1) determination of the eligibility of the per25 son for benefits under titles XVIII and XIX; and
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1 ‘‘(2) determination of the eligibility or amount

2 of benefits payable under title II or XVI to another

3 person.

4 ‘‘(e) DEFINITION.—In this section, the term ‘benefits

5 under title XVI’ includes State supplementary payments

6 made by the Commissioner pursuant to an agreement

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

8 Public Law 93–66.

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

10 Security shall consult with the Inspector General of the

11 Social Security Administration before initiating an action

12 under this section.’’.

13 (b) CONFORMING AMENDMENT PRECLUDING DE14 LAYED RETIREMENT CREDIT FOR ANY MONTH TO WHICH

15 A NONPAYMENT OF BENEFITS PENALTY APPLIES.—Sec16 tion 202(w)(2)(B) of such Act (42 U.S.C. 402(w)(2)(B))

17 is amended—

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

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

20 (ii) and inserting ‘‘, and’’; and

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

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

23 penalty imposed under section 1129A.’’.
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1 (c) ELIMINATION OF REDUNDANT PROVISION.—Sec2 tion 1611(e) of such Act (42 U.S.C. 1382(e)) is

3 amended—

4 (1) by striking paragraph (4);

5 (2) in paragraph (6)(A)(i), by striking ‘‘(5)’’

6 and inserting ‘‘(4)’’; and

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

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

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

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

11 Security shall develop regulations that prescribe the ad12 ministrative process for making determinations under sec13 tion 1129A of the Social Security Act.

14 SEC. 109. EXCLUSION OF ATTORNEYS AND PHYSICIANS

15 CONVICTED OF VIOLATIONS FROM PARTICI16 PATION IN SOCIAL SECURITY DISABILITY

17 PROGRAMS.

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

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

20 adding at the end the following:

21 ‘‘EXCLUSION OF ATTORNEYS AND PHYSICIANS CON22 VICTED OF VIOLATIONS FROM PARTICIPATION IN SO23 CIAL SECURITY DISABILITY PROGRAMS

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

25 of Social Security shall exclude from participation in the
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1 social security disability programs any attorney or

2 physician—

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

4 208 or 1632 of this Act,

5 ‘‘(2) who is convicted of any violation under

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

7 application for or continuing entitlement to benefits

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

9 or continuing eligibility for benefits under title XVI

10 of this Act, or

11 ‘‘(3) who becomes subject to a penalty or as12 sessment under section 1129(a)(1)(A) of this Act.

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

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

15 effective at such time, for such period, and upon such rea16 sonable notice to the public and to the individual excluded

17 as may be specified in regulations consistent with para18 graph (2).

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

20 to services furnished to any individual on or after the ef21 fective date of the exclusion. Nothing in this section may

22 be construed to preclude, in determining disability under

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

24 derived from services provided by a physician before the
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1 effective date of the exclusion of the physician under this

2 section.

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

4 of exclusion under paragraph (1), the period of the exclu5 sion.

6 ‘‘(B) Subject to subparagraph (C), in the case of an

7 exclusion under subsection (a), the minimum period of ex8 clusion shall be five years, except that the Commissioner

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

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

11 Commissioner’s decision whether to waive the exclusion

12 shall not be reviewable.

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

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

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

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

17 convicted—

18 ‘‘(i) on one previous occasion of one or more of19 fenses for which an exclusion may be effected under

20 such subsection, the period of the exclusion shall be

21 not less than 10 years, or

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

23 more offenses for which an exclusion may be effected

24 under such subsection, the period of the exclusion

25 shall be permanent.
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1 ‘‘(c) NOTICE TO STATE AGENCIES.—The Commis2 sioner shall promptly notify each appropriate State agency

3 employed for the purpose of making disability determina4 tions under section 221 or 1633(a)—

5 ‘‘(1) of the fact and circumstances of each ex6 clusion effected against an individual under this sec7 tion, and

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

9 (b)(3)) for which the State agency is directed to ex10 clude the individual from participation in the activi11 ties of the State agency in the course of its employ12 ment.

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

14 Commissioner shall—

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

16 local agency or authority having responsibility for

17 the licensing or certification of an individual ex18 cluded from participation under this section of the

19 fact and circumstances of the exclusion,

20 ‘‘(2) request that appropriate investigations be

21 made and sanctions invoked in accordance with ap22 plicable State law and policy, and

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

24 authority keep the Commissioner and the Inspector

25 General of the Social Security Administration fully
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1 and currently informed with respect to any actions

2 taken in response to the request.

3 ‘‘(e) APPLICATION FOR TERMINATION OF EXCLU4 SION.—(1) An individual excluded from participation

5 under this section may apply to the Commissioner, in the

6 manner specified by the Commissioner in regulations and

7 at the end of the minimum period of exclusion provided

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

9 Commissioner may provide, for termination of the exclu10 sion effected under this section.

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

12 if the Commissioner determines, on the basis of the con13 duct of the applicant which occurred after the date of the

14 notice of exclusion or which was unknown to the Commis15 sioner at the time of the exclusion, that—

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

17 a continuation of the exclusion, and

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

19 types of actions which formed the basis for the origi20 nal exclusion have not recurred and will not recur.

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

22 State agency employed for the purpose of making disabil23 ity determinations under section 221 or 1633(a) of the

24 fact and circumstances of each termination of exclusion

25 made under this subsection.
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1 ‘‘(f) AVAILABILITY OF RECORDS OF EXCLUDED AT2 TORNEYS AND PHYSICIANS.—Nothing in this section shall

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

4 applicant or beneficiary under title II or XVI, any State

5 agency acting under section 221 or 1633(a), or the Com6 missioner of Social Security to records maintained by any

7 attorney or physician in connection with services provided

8 to the applicant or beneficiary prior to the exclusion of

9 such attorney or physician under this section.

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

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

12 social security disability program shall inform the Com13 missioner, in such form and manner as the Commissioner

14 shall prescribe by regulation, whether such attorney or

15 physician has been convicted of a violation described in

16 subsection (a).

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

18 ‘‘(1) EXCLUDE.—The term ‘exclude’ from par19 ticipation means—

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

21 prohibit from engaging in representation of an

22 applicant for, or recipient of, benefits as a rep23 resentative payee under section 205(j) or

24 1631(a)(2)(A)(ii) or otherwise as a representa-
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1 tive in any hearing or other proceeding relating

2 to entitlement to benefits, and

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

4 prohibit from providing items or services to an

5 applicant for, or recipient of, benefits for the

6 purpose of assisting such applicant or recipient

7 in demonstrating disability.

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

9 The term ‘social security disability program’ means

10 the program providing for monthly disability insur11 ance benefits under section 223 or monthly benefits

12 based on the disability of the recipient under section

13 202 and the program providing for supplemental se14 curity income to individuals based on disability

15 under title XVI.

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

17 to have been ‘convicted’ of a violation—

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

19 been entered against the individual by a Fed20 eral, State, or local court, except if the judg21 ment of conviction has been set aside or ex22 punged;

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

24 guilt against the individual by a Federal, State,

25 or local court;
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1 ‘‘(C) when a plea of guilty or nolo

2 contendere by the individual has been accepted

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

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

5 participation in a first offender, deferred adju6 dication, or other arrangement or program

7 where judgment of conviction has been with8 held.’’.

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

10 this section shall apply with respect to violations and con11 victions occurring on or after the date of the enactment

12 of this Act.

13 SEC. 110. ANNUAL REVIEWS BY STATE DISABILITY DETER14 MINATION SERVICES OF PROFESSIONALS

15 CONDUCTING CONSULTATIVE EXAMINA16 TIONS.

17 (a) IN GENERAL.—Section 221(j) of the Social Secu18 rity Act (42 U.S.C. 421(j)) is amended—

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

20 (3), as subparagraphs (A), (B), and (C), respec21 tively;

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

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

24 paragraph:
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1 ‘‘(2) The Commissioner shall provide for annual eval2 uations by State disability determination services of the

3 performance of professionals to whom cases are referred

4 for purposes of disability determinations by such services.

5 Such evaluations shall include a thorough analysis of the

6 completeness of the examinations performed through such

7 referrals and the extent to which any patterns of abuse

8 have arisen in the referral processes. The Commissioner

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

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

11 disability determination service to have occurred is

12 promptly referred by such service to the Inspector General

13 of the Social Security Administration.’’.

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

15 required pursuant to the amendments made by this section

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

17 SEC. 111. COMPUTER MATCHES WITH MEDICARE AND MED18 ICAID INSTITUTIONALIZATION DATA.

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

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

21 by adding at the end the following:

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

23 the Commissioner of Social Security shall conduct periodic

24 computer matches with data maintained by the Secretary

25 of Health and Human Services under title XVIII or XIX.
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1 The Secretary shall furnish to the Commissioner, in such

2 form and manner and under such terms as the Commis3 sioner and the Secretary shall mutually agree, such infor4 mation as the Commissioner may request for this purpose.

5 Information obtained pursuant to such a match may be

6 substituted for the physician’s certification otherwise re7 quired under subparagraph (G)(i).’’.

8 (b) CONFORMING AMENDMENT.—Section

9 1611(e)(1)(G) of such Act (42 U.S.C. 1382(e)(1)(G)) is

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

11 ‘‘subparagraph (H) or (K)’’.

12 SEC. 112. ACCESS TO INFORMATION HELD BY FINANCIAL

13 INSTITUTIONS.

14 (a) IN GENERAL.—Section 1631(e)(1)(B) of the So15 cial Security Act (42 U.S.C. 1383(e)(1)(B)) is amended—

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

17 The’’; and

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

19 clause:

20 ‘‘(ii)(I) The Commissioner of Social Security may re21 quire each applicant for, or recipient of, benefits under

22 this title to provide authorization by the applicant or recip23 ient (or by any other person whose income or resources

24 are material to the determination of the eligibility of the

25 applicant or recipient for such benefits) for the Commis-
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1 sioner to obtain (subject to the cost reimbursement re2 quirements of section 1115(a) of the Right to Financial

3 Privacy Act) from any financial institution (within the

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

5 record (within the meaning of section 1101(2) of such

6 Act) held by the institution with respect to the applicant

7 or recipient (or any such other person) whenever the Com8 missioner determines the record is needed in connection

9 with a determination with respect to such eligibility or the

10 amount of such benefits.

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

12 Right to Financial Privacy Act, an authorization provided

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

14 income or resources are material to the determination of

15 the eligibility of the applicant or recipient) pursuant to

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

17 earliest of—

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

19 on the applicant’s application for eligibility for bene20 fits under this title;

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

22 for benefits under this title; or

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

24 recipient (or such other person referred to in sub-
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1 clause (I)) of the authorization, in a written notifica2 tion to the Commissioner.

3 ‘‘(III)(aa) An authorization obtained by the Commis4 sioner of Social Security pursuant to this clause shall be

5 considered to meet the requirements of the Right to Fi6 nancial Privacy Act for purposes of section 1103(a) of

7 such Act, and need not be furnished to the financial insti8 tution, notwithstanding section 1104(a) of such Act.

9 ‘‘(bb) The certification requirements of section

10 1103(b) of the Right to Financial Privacy Act shall not

11 apply to requests by the Commissioner of Social Security

12 pursuant to an authorization provided under this clause.

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

14 authorization provided under this clause is deemed to meet

15 the requirements of section 1104(a)(3) of the Right to Fi16 nancial Privacy Act and the flush language of section

17 1102 of such Act.

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

19 provides authorization pursuant to this clause of the dura20 tion and scope of the authorization.

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

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

23 subclause (I)) refuses to provide or revokes any authoriza24 tion for the Commissioner of Social Security to obtain

25 from any financial institution any financial record, the
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1 Commissioner may, on that basis, determine that the ap2 plicant or recipient is ineligible for benefits under this

3 title.’’.

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

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

6 of this Act.

7 SEC. 113. STATE DATA EXCHANGES.

8 Whenever the Commissioner of Social Security re9 quests information from a State for the purpose of

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

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

12 the Social Security Act, the standards of the Commis13 sioner promulgated pursuant to section 1106 of such Act

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

15 disclosure of information are deemed to meet any stand16 ards of the State that would otherwise apply to the disclo17 sure of information by the State to the Commissioner.

18 SEC. 114. STUDY ON POSSIBLE MEASURES TO IMPROVE

19 FRAUD PREVENTION AND ADMINISTRATIVE

20 PROCESSING.

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

22 the enactment of this Act, the Commissioner of Social Se23 curity, in consultation with the Inspector General of the

24 Social Security Administration and the Attorney General,

25 shall conduct a study of possible measures to improve—
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1 (1) prevention of fraud on the part of individ2 uals entitled to disability benefits under section 223

3 of the Social Security Act or benefits under section

4 202 of such Act based on the beneficiary’s disability,

5 individuals eligible for supplemental security income

6 benefits under title XVI of such Act, and applicants

7 for any such benefits; and

8 (2) timely processing of reported income

9 changes by individuals receiving such benefits.

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

11 of the enactment of this Act, the Commissioner shall re12 port in writing to the Committee on Ways and Means of

13 the House of Representatives and the Committee on Fi14 nance of the Senate the results of the Commissioner’s

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

16 recommendations for legislative and administrative

17 changes as the Commissioner considers appropriate.

18 SEC. 115. ANNUAL REPORT ON AMOUNTS NECESSARY TO

19 COMBAT FRAUD.

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

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

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

23 (2) by adding at the end the following new sub24 paragraph:
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1 ‘‘(B) The Commissioner shall include in the annual

2 budget prepared pursuant to subparagraph (A) an

3 itemization of the amount of funds required by the Social

4 Security Administration for the fiscal year covered by the

5 budget to support efforts to combat fraud committed by

6 applicants and beneficiaries.’’.

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

8 this section shall apply with respect to annual budgets pre9 pared for fiscal years after fiscal year 1999.

10 TITLE II—BENEFITS FOR

11 PHILIPPINO VETERANS OF

12 WORLD WAR II

13 SEC. 201. PROVISION OF REDUCED SSI BENEFIT TO CER14 TAIN INDIVIDUALS WHO PROVIDED SERVICE

15 TO THE ARMED FORCES OF THE UNITED

16 STATES IN THE PHILIPPINES DURING WORLD

17 WAR II AFTER THEY MOVE BACK TO THE

18 PHILIPPINES.

19 (a) IN GENERAL.—Notwithstanding sections

20 1611(b), 1611(f)(1), and 1614(a)(1)(B)(i) of the Social

21 Security Act—

22 (1) the eligibility of a qualified individual for

23 benefits under the supplemental security income pro24 gram under title XVI of such Act shall not termi-
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1 nate by reason of a change in the place of residence

2 of the individual to the Philippines; and

3 (2) the benefits payable to the individual under

4 such program shall be reduced by 50 percent for so

5 long as the place of residence of the individual is in

6 the Philippines.

7 (b) QUALIFIED INDIVIDUAL DEFINED.—In sub8 section (a), the term ‘‘qualified individual’’ means an indi9 vidual who—

10 (1) as of the date of the enactment of this Act,

11 is eligible for benefits under the supplemental secu12 rity income program under title XVI of the Social

13 Security Act;

14 (2) as of January 1, 1990, was eligible for such

15 benefits; and

16 (3) before August 15, 1945, served in the orga17 nized military forces of the Government of the Com18 monwealth of the Philippines while such forces were

19 in the service of the Armed Forces of the United

20 States pursuant to the military order of the Presi21 dent dated July 26, 1941, including among such

22 military forces organized guerrilla forces under com23 manders appointed, designated, or subsequently rec24 ognized by the Commander in Chief, Southwest Pa-
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1 cific Area, or other competent military authority in

2 the Army of the United States.

Æ