I

103D CONGRESS

2D SESSION H. R. 4419

To modify the supplemental security income program under title XVI of

the Social Security Act.

IN THE HOUSE OF REPRESENTATIVES

MAY 12, 1994

Mr. SANTORUM (for himself, Mr. ARCHER, Mr. GINGRICH, Mr. THOMAS of

California, Mr. SHAW, Mr. CAMP, Mr. HERGER, Mr. MCCRERY, Mrs.

JOHNSON of Connecticut, Mr. CASTLE, Mr. GEKAS, Mr. SMITH of Michigan, and Mr. ISTOOK) introduced the following bill; which was referred

jointly to the Committees on Ways and Means and Energy and Commerce

A BILL

To modify the supplemental security income program under

title 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,
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1 TITLE I—RESTRICTIONS FOR

2 ALIENS

3 SEC. 101. CERTAIN ALIENS INELIGIBLE FOR SUPPLE4 MENTAL SECURITY INCOME BENEFITS.

5 (a) IN GENERAL.—Section 1614(a) of the Social Se6 curity Act (42 U.S.C. 1382c(a)) is amended by adding at

7 the end the following:

8 ‘‘(5)(A) An alien otherwise eligible for benefits under

9 this title who has qualified for entry pursuant to section

10 207 of the Immigration and Nationality Act shall not be

11 eligible for such benefits after the 6-year period that be12 gins with the date the alien arrives in the United States.

13 ‘‘(B) Subparagraph (A) shall not apply to an alien

14 who—

15 ‘‘(i) has been lawfully admitted to the United

16 States for permanent residence;

17 ‘‘(ii) has attained 75 years of age; and

18 ‘‘(iii) has resided in the United States for at

19 least 5 years.

20 ‘‘(C) Subparagraph (A) shall not apply to an alien

21 who, on the date of the enactment of this paragraph, is

22 residing in the United States and eligible for benefits

23 under this title, until 1 year after such date of enact24 ment.’’.
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1 (b) NOTIFICATION OF AFFECTED ALIENS.—The So2 cial Security Administration shall, directly or through the

3 States, notify each alien receiving supplemental security

4 income benefits under title XVI of the Social Security Act

5 whose eligibility for such benefits is or will be terminated

6 by reason of the amendment made by subsection (a).

7 SEC. 102. STATE AFDC AGENCIES REQUIRED TO PROVIDE

8 INFORMATION ON ILLEGAL ALIENS TO THE

9 IMMIGRATION AND NATURALIZATION SERV10 ICE.

11 Section 402(a) of the Social Security Act (42 U.S.C.

12 602(a)) is amended—

13 (1) by striking ‘‘and’’ at the end of paragraph

14 (44);

15 (2) by striking the period at the end of para16 graph (45) and inserting ‘‘; and’’; and

17 (3) by inserting after paragraph (45) the fol18 lowing:

19 ‘‘(46) require the State agency to provide to the

20 Immigration and Naturalization Service the name,

21 address, and other identifying information that the

22 agency has with respect to any individual unlawfully

23 in the United States any of whose children is a citi24 zen of the United States.’’.
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1 TITLE II—RESTRICTIONS FOR

2 DRUG ADDICTS AND ALCO3 HOLICS

4 SEC. 201. TIME-LIMITED BENEFITS.

5 (a) IN GENERAL.—Section 1614(a) of the Social Se6 curity Act (42 U.S.C. 1382c(a)) is amended by adding at

7 the end the following:

8 ‘‘(5)(A) The Secretary shall identify all recipients of

9 benefits under this title by reason of disability whose dis10 ability is a result of addiction to illegal drugs.

11 ‘‘(B) The Secretary shall periodically, on a random

12 basis, test each recipient identified under subparagraph

13 (A) (including any recipient who had become temporarily

14 ineligible for benefits by reason of subparagraph (C)) to

15 determine whether the recipient is using illegal drugs.

16 ‘‘(C)(i) Notwithstanding any other provision of this

17 title, any individual who is determined under subpara18 graph (B) to be using illegal drugs, or who refuses to sub19 mit to testing as provided for under subparagraph (B),

20 shall not be eligible for benefits under this title during the

21 period described in clause (ii).

22 ‘‘(ii) The period described in this clause begins with

23 the date of the determination referred to in clause (i) and

24 ends with the passage by the individual of 2 tests adminis25 tered by the Secretary (and paid for by the individual)
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1 to determine whether the individual is using illegal drugs,

2 which tests occur—

3 ‘‘(I) at least 2 months apart; and

4 ‘‘(II) after the 1-year period that begins with

5 the date of the determination.

6 ‘‘(6)(A) The Secretary shall identify all recipients of

7 benefits under this title by reason of disability whose dis8 ability is a result of addiction to alcohol.

9 ‘‘(B) The Secretary shall periodically, on a random

10 basis, test each recipient identified under subparagraph

11 (A) (including any recipient who had become temporarily

12 ineligible for benefits by reason of subparagraph (C)) to

13 determine whether the recipient is using alcohol.

14 ‘‘(C)(i) Notwithstanding any other provision of this

15 title, any individual who is determined under subpara16 graph (B) to be using alcohol, or who refuses to submit

17 to testing as provided for under subparagraph (B), shall

18 not be eligible for benefits under this title during the pe19 riod described in clause (ii).

20 ‘‘(ii) The period described in this clause begins with

21 the date of the determination referred to in clause (i) and

22 ends with the passage by the individual of 2 tests adminis23 tered by the Secretary (and paid for by the individual)

24 to determine whether the individual is using alcohol, which

25 tests occur—
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1 ‘‘(I) at least 2 months apart; and

2 ‘‘(II) after the 6-month period that begins with

3 the date of the determination.’’.

4 (b) PRESERVATION OF ELIGIBILITY FOR MEDICAID

5 BENEFITS.—Section 1634 of the Social Security Act (42

6 U.S.C. 1383c) is amended by adding at the end the

7 following:

8 ‘‘(e) For purposes of title XIX, an individual is

9 deemed to be receiving benefits under this title if the indi10 vidual is ineligible for such benefits solely by reason of

11 paragraph (5) or (6) of section 1614(a).’’.

12 SEC. 202. RESTRICTIONS ON PAYMENT OF BENEFITS BASED

13 ON DISABILITY TO SUBSTANCE ABUSERS.

14 (a) REQUIRED PAYMENT OF BENEFITS TO REP15 RESENTATIVE PAYEES.—

16 (1) IN GENERAL.—Section 1631(a)(2)(A) of the

17 Social Security Act (42 U.S.C. 1383(a)(2)(A)) is

18 amended—

19 (A) in clause (ii), by adding at the end the

20 following: ‘‘In the case of an individual entitled

21 to benefits under this title by reason of disabil22 ity, if alcoholism or drug addiction is a contrib23 uting factor material to the Secretary’s deter24 mination that the individual is disabled, the

25 payment of such benefits to a representative
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1 payee shall be deemed to serve the interest of

2 such individual under this title.’’; and

3 (B) in clause (iii), by striking ‘‘to the indi4 vidual or eligible spouse or to an alternative

5 representative payee of the individual or eligible

6 spouse’’ and inserting ‘‘to an alternative rep7 resentative payee of the individual or eligible

8 spouse or, if the interest of the individual under

9 this title would be served thereby, to the indi10 vidual or eligible spouse’’.

11 (2) CONFORMING AMENDMENT.—Section

12 1631(a)(2)(B)(viii)(II) of such Act (42 U.S.C.

13 1383(a)(2)(B)(viii)(II)) is amended by striking ‘‘15

14 years’’ and all that follows and inserting ‘‘of 15

15 years, or (if alcoholism or drug addition is a contrib16 uting factor material to the Secretary’s determina17 tion that the individual is disabled) is entitled to

18 benefits under this title by reason of disability.’’.

19 (3) EFFECTIVE DATE.—The amendments made

20 by this subsection shall apply with respect to bene21 fits for months beginning after 180 days after the

22 date of the enactment of this Act.

23 (b) INCREASED RELIANCE ON PROFESSIONAL REP24 RESENTATIVE PAYEES.—
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1 (1) PREFERENCE REQUIRED FOR ORGANIZA2 TIONAL REPRESENTATIVE PAYEES.—Section

3 1631(a)(2)(B) of such Act (42 U.S.C.

4 1383(a)(2)(B)) is amended—

5 (A) by redesignating clauses (vii) through

6 (xii) as clauses (viii) through (xiii), respectively;

7 (B) by inserting after clause (vi) the

8 following:

9 ‘‘(vii) In the case of an individual entitled to benefits

10 under this title by reason of disability, if alcoholism or

11 drug addiction is a contributing factor material to the Sec12 retary’s determination that the individual is disabled,

13 when selecting such individual’s representative payee,

14 preference shall be given to a—

15 ‘‘(I) community-based nonprofit social service

16 agency licensed or bonded by the State;

17 ‘‘(II) State or local government agency whose

18 mission is to carry out income maintenance, social

19 service, or health care-related activities; or

20 ‘‘(III) State or local government agency with

21 fiduciary responsibilities,

22 (or a designee of such an agency if the Secretary deems

23 it appropriate), unless the Secretary determines that selec24 tion of such an agency would not be appropriate.’’;
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1 (C) in clause (viii) (as so redesignated), by

2 striking ‘‘clause (viii)’’ and inserting ‘‘clause

3 (ix)’’;

4 (D) in clause (ix) (as so redesignated), by

5 striking ‘‘(vii)’’ and inserting ‘‘(viii)’’;

6 (E) in clause (xiii) (as so redesignated)—

7 (i) by striking ‘‘(xi)’’ and inserting

8 ‘‘(xii)’’; and

9 (ii) by striking ‘‘(x)’’ and inserting

10 ‘‘(xi)’’.

11 (2) AVAILABILITY OF PUBLIC AGENCIES AND

12 OTHER QUALIFIED ORGANIZATIONS TO SERVE AS

13 REPRESENTATIVE PAYEES.—Section 1631(a)(2)(D)

14 of such Act (42 U.S.C. 1383(a)(2)(D)) is amend15 ed—

16 (A) in clause (i)—

17 (i) by striking ‘‘exceed the lesser

18 of—’’ and inserting ‘‘exceed—’’; and

19 (ii) by striking subclauses (I) and (II)

20 and inserting the following:

21 ‘‘(I) in any case in which an individual is enti22 tled to benefits under this title by reason of disabil23 ity and alcoholism or drug addiction is a contribut24 ing factor material to the Secretary’s determination
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1 that the individual is disabled, 10 percent of the

2 monthly benefit involved, or

3 ‘‘(II) in any other case, the lesser of—

4 ‘‘(aa) 10 percent of the monthly benefit

5 involved, or

6 ‘‘(bb) $25.00 per month.’’;

7 (B) in clause (ii)—

8 (i) by inserting ‘‘State or local govern9 ment agency whose mission is to carry out

10 income maintenance, social service, or

11 health care-related activities, any State or

12 local government agency with fiduciary re13 sponsibilities, or any’’ after ‘‘means any’’;

14 (ii) by inserting a comma after ‘‘serv15 ice agency’’;

16 (iii) by adding ‘‘and’’ at the end of

17 subclause (I); and

18 (iv) in subclause (II)—

19 (I) by adding ‘‘and’’ at the end

20 of item (aa);

21 (II) by striking ‘‘; and’’ at the

22 end of item (bb) and inserting a pe23 riod; and

24 (III) by striking item (cc); and
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1 (C) by striking clause (iv), effective July 1,

2 1994.

3 (c) NONPAYMENT OR TERMINATION OF BENEFITS.—

4 (1) IN GENERAL.—Section 1611(e)(3) of such

5 Act (42 U.S.C. 1382(e)(3)), is amended by redesig6 nating subparagraph (B) as subparagraph (C) and

7 by inserting after subparagraph (A) the following:

8 ‘‘(B)(i) Notwithstanding any other provision of this

9 title, in the case of any individual entitled to benefits

10 under this title solely by reason of disability, if alcoholism

11 or drug addiction is a contributing factor material to the

12 Secretary’s determination that such individual is disabled

13 and such individual is determined by the Secretary not

14 to be in compliance with the requirements of this subpara15 graph for a month, such benefits shall be suspended for

16 a period commencing with such month and ending with

17 the month preceding the first month, after the determina18 tion of noncompliance, in which such individual dem19 onstrates that he or she has reestablished and maintained

20 compliance with such requirements for the applicable pe21 riod specified in clause (iii).

22 ‘‘(ii)(I) An individual described in clause (i) is in com23 pliance with the requirements of this subparagraph for a

24 month if the individual in such month undergoes any med25 ical or psychological treatment that may be appropriate,
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1 for the individual’s condition diagnosed as substance

2 abuse or alcohol abuse and for the stage of the individual’s

3 rehabilitation, at an institution or facility approved for

4 purposes of this subparagraph by the Secretary, and com5 plies in such month with the terms, conditions, and re6 quirements of such treatment and with requirements im7 posed by the Secretary under subparagraph (C).

8 ‘‘(II) An individual described in clause (i) shall not

9 be determined to be not in compliance with the require10 ments of this subparagraph for a month if access by such

11 individual to such treatment is not reasonably available

12 for the month, as determined under regulations of the

13 Secretary.

14 ‘‘(iii) The applicable period specified in this clause

15 is—

16 ‘‘(I) 2 consecutive months, in the case of a 1st

17 determination that an individual is not in compliance

18 with the requirements of this subparagraph;

19 ‘‘(II) 3 consecutive months, in the case of the

20 2nd such determination with respect to the individ21 ual; or

22 ‘‘(III) 6 consecutive months, in the case of the

23 3rd or subsequent such determination with respect

24 to the individual.
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1 ‘‘(iv) An individual shall not be an eligible individual

2 for purposes of this title for the 12-month period that be3 gins with the end of any period of 12 consecutive months

4 for which the benefits of the individual under this title

5 have been suspended by reason of this subparagraph.

6 ‘‘(v) In the case of any individual entitled to benefits

7 under this title by reason of disability, if alcoholism or

8 drug addiction is a contributing factor material to the Sec9 retary’s determination that such individual is disabled,

10 such individual may not be entitled to such benefits by

11 reason of disability (or any past-due benefits under such

12 entitlement) for any month after the 36-month period be13 ginning with such individual’s first month of such entitle14 ment, notwithstanding section 1619(a).

15 ‘‘(vi)(I) The Secretary shall not, in a month, pay to

16 an individual described in clause (i) benefits under this

17 title the payment of which is past due, in an amount that

18 exceeds the amount of benefits under this title which are

19 payable to the individual for the month and the payment

20 of which is not past due.

21 ‘‘(II) As used in subclause (I) of this clause, the term

22 ‘benefits under this title’ includes supplementary pay23 ments of the type described in section 1616(a) and pay24 ments pursuant to an agreement entered into under sec25 tion 212(a) of Public Law 93–66.’’.
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1 (2) REFERRAL, MONITORING, AND TREAT2 MENT.—Section 1611(e)(3)(C) of such Act (42

3 U.S.C. 1382(e)(3)(C)), as so designated by the

4 amendment made by paragraph (1) of this sub5 section, is amended—

6 (A) by adding at the end the following:

7 ‘‘Each such annual report shall include the

8 number and percentage of such individuals who

9 did not receive regular drug testing during the

10 year covered by the report.’’;

11 (B) by inserting ‘‘(i)’’ after ‘‘(C)’’; and

12 (C) by adding after and below the end

13 following:

14 ‘‘(ii) The Secretary, in consultation with drug and al15 cohol treatment professionals, shall issue regulations—

16 ‘‘(I) defining appropriate treatment for alcohol17 ics and drug addicts who are subject to required

18 medical or psychological treatment under this sub19 paragraph; and

20 ‘‘(II) establishing guidelines to be used to re21 view and evaluate their compliance, including meas22 ures of the progress of participants in such pro23 grams.

24 ‘‘(iii)(I) For purposes of carrying out the require25 ments of clauses (i) and (ii), the Secretary shall establish
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1 in each State a referral and monitoring agency for the

2 State.

3 ‘‘(II) Each referral and monitoring agency for a State

4 shall—

5 ‘‘(aa) identify appropriate placements, for indi6 viduals residing in the State who are entitled to ben7 efits under this title by reason of disability and with

8 respect to whom alcoholism or drug addiction is a

9 contributing factor material to the Secretary’s deter10 mination that they are disabled, where they may ob11 tain treatment described in subparagraph (B)(ii)(I);

12 ‘‘(bb) refer such individuals to such placements

13 for such treatment; and

14 ‘‘(cc) monitor compliance with the requirements

15 of subparagraph (B) by individuals who are referred

16 by the agency to such placements, and promptly re17 port to the Secretary any failure to comply with

18 such requirements.’’.

19 (3) PRESERVATION OF MEDICAID BENEFITS.—

20 Section 1634 of such Act (42 U.S.C. 13283c) is

21 amended by adding at the end the following:

22 ‘‘(e) Each person to whom benefits under this title

23 by reason of disability are not payable for any month sole24 ly by reason of section 1611(e)(3)(B) shall be treated, for
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1 purposes of title XIX, as receiving benefits under this title

2 for such month.’’.

3 (4) CONFORMING AMENDMENTS.—Section

4 1611(e)(3) of such Act (42 U.S.C. 1382(e)(3)), as

5 amended by paragraphs (1) and (2) of this sub6 section, is amended—

7 (A) in subparagraph (A), by striking ‘‘(B)’’

8 and inserting ‘‘(C)’’; and

9 (B) in subparagraph (C), by inserting ‘‘or

10 (B)’’ after ‘‘(A)’’.

11 (5) EFFECTIVE DATE.—

12 (A) IN GENERAL.—Except as provided in

13 subparagraphs (B) and (C), the amendments

14 made by this subsection shall apply with respect

15 to benefits for months beginning after 180 days

16 after the date of the enactment of this Act.

17 (B) TIME LIMITATION ON BENEFITS.—

18 Section 1611(e)(3)(B)(v) of the Social Security

19 Act (as added by the amendment made by para20 graph (1) of this subsection) shall apply with

21 respect to benefits for months ending after 180

22 days after the date of the enactment of this

23 Act, and, for purposes of such section, in the

24 case of any individual entitled to benefits by

25 reason of disability for the first month ending
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1 after 180 days after the date of the enactment

2 of this Act, such month shall be treated as such

3 individual’s first month of entitlement to such

4 benefits.

5 (C) ESTABLISHMENT OF REFERRAL

6 AND MONITORING AGENCIES.—Section

7 1611(e)(3)(C)(iii) of the Social Security Act (as

8 added by the amendment made by paragraph

9 (2)(C) of this subsection) shall take effect 180

10 days after the date of the enactment of this

11 Act.

12 (d) IRRELEVANCE OF LEGALITY OF SUBSTANTIAL

13 GAINFUL ACTIVITY.—

14 (1) IN GENERAL.—Section 1614(a)(3)(D) of

15 such Act (42 U.S.C. 1382c(a)(3)(D)) is amended by

16 adding at the end the following: ‘‘The Secretary

17 shall make determinations under this title with re18 spect to substantial gainful activity, without regard

19 to the legality of the activity.’’.

20 (2) EFFECTIVE DATE.—The amendment made

21 by paragraph (1) shall take effect on the date of the

22 enactment of this Act.

23 (e) EFFECTIVE DATE.—Except as otherwise provided

24 in this section, the amendments made by this section shall
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1 apply to benefits payable for months beginning 180 or

2 more days after the date of the enactment of this Act.

3 TITLE III—BENEFITS FOR

4 CHILDREN

5 SEC. 301. REPLACEMENT OF CASH BENEFIT WITH MEDICAL

6 VOUCHER.

7 (a) IN GENERAL.—Section 1611(b) of the Social Se8 curity Act (42 U.S.C. 1382(b)) is amended by adding at

9 the end the following:

10 ‘‘(3) Notwithstanding paragraphs (1) and (2), the

11 benefit under this title for a child who has not attained

12 18 years of age shall be vouchers issued pursuant to sub13 section (j).’’.

14 (b) ISSUANCE OF VOUCHERS FOR TREATMENT OF

15 DISABLING CONDITIONS OF CHILDREN ELIGIBLE FOR

16 SSI BENEFITS.—Section 1611 of such Act (42 U.S.C.

17 1382(b)) is amended by adding at the end the following:

18 ‘‘(j)(1) The Secretary of Health and Human Services

19 shall issue to each child eligible for benefits under this

20 title who has not attained 18 years of age a voucher which

21 may be used to cover the cost of any item—

22 ‘‘(A) that is associated with treating the blind23 ness or disability of the child;

24 ‘‘(B) for which a medical expense deduction

25 may be claimed under section 213 of the Internal
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1 Revenue Code of 1986 by the child or any taxpayer

2 who may claim the child as a dependent; and

3 ‘‘(C) the cost of which is not covered by the

4 program of medical assistance approved under title

5 XIX of the State in which the child resides.

6 ‘‘(2) The face dollar amount of the voucher issued

7 with respect to a child shall not exceed the amount of the

8 cash benefit to which the child would (but for section

9 1611(b)(3)) have been entitled under this title.

10 ‘‘(3) The Secretary shall pay to each provider of

11 health care goods or services that is licensed by a State,

12 or by a professional health care organization approved by

13 the Secretary, that submits to the Secretary a voucher is14 sued under this subsection an amount equal to the face

15 dollar amount of the voucher.’’.

16 SEC. 302. DISABILITY REVIEW REQUIRED FOR SSI RECIPI17 ENTS WHO ARE 18 YEARS OF AGE.

18 (a) IN GENERAL.—Section 1614(a)(3)(G) of the So19 cial Security Act (42 U.S.C. 1382c(a)(3)(G)) is amend20 ed—

21 (1) by inserting ‘‘(i)’’ after ‘‘(G)’’; and

22 (2) by adding after and below the end the

23 following:

24 ‘‘(ii)(I) During the 1-year period that begins on the

25 date a recipient of benefits under this title by reason of
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1 disability attains 18 years of age, the applicable State

2 agency or the Secretary (as may be appropriate) shall re3 determine the eligibility of the recipient for such benefits

4 by reason of disability, by applying the criteria used in

5 determining eligibility for such benefits of applicants who

6 have attained 18 years of age.

7 ‘‘(II) A review under subclause (I) of this clause shall

8 be considered a substitute for a review required under

9 clause (i).’’.

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

11 subsection (a) shall apply to individuals who attain 18

12 years of age in or after the 9th month after the month

13 in which this Act is enacted.

14 TITLE IV—FRAUD

15 SEC. 401. EXPANSION OF THE AUTHORITY OF THE SOCIAL

16 SECURITY ADMINISTRATION TO PREVENT,

17 DETECT, AND TERMINATE FRAUDULENT

18 CLAIMS FOR SSI BENEFITS.

19 (a) PREVENTION OF FRAUD IN THE SSI PROGRAM

20 BY TRANSLATORS OF FOREIGN LANGUAGES.—

21 (1) IN GENERAL.—Section 1631(e) of the So22 cial Security Act (42 U.S.C. 1383(e)) is amended by

23 inserting after paragraph (3) the following:

24 ‘‘(4) A translation into English by a third party of

25 a statement made in a foreign language by an applicant
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1 for or recipient of benefits under this title shall not be

2 regarded as reliable unless the third party, under penalty

3 of perjury—

4 ‘‘(A) certifies that the translation is accurate;

5 and

6 ‘‘(B) discloses the nature and scope of the rela7 tionship between the third party and the applicant

8 or recipient, as the case may be.’’.

9 (2) EFFECTIVE DATE.—The amendment made

10 by paragraph (1) shall take effect on October 1,

11 1994.

12 (b) CIVIL MONETARY PENALTIES, ASSESSMENTS,

13 AND EXCLUSIONS FOR TITLE XVI.—

14 (1) IN GENERAL.—Title XI of such Act (42

15 U.S.C. 1301–1320b–14) is amended by inserting

16 after section 1128B the following:

17 ‘‘SEC. 1129. CIVIL MONETARY PENALTIES AND ASSESS18 MENTS FOR TITLE XVI.

19 ‘‘(a) Any person (including an organization, agency,

20 or other entity) who makes, or causes to be made, a state21 ment or representation of a material fact for use in deter22 mining any initial or continuing right to benefits or pay23 ments under title XVI that the person knows or should

24 know is false or misleading or knows or should know omits

25 a material fact shall be subject to, in addition to any other
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1 penalties that may be prescribed by law, a civil money pen2 alty of not more than $5,000 for each such statement or

3 representation. Such person also shall be subject to an as4 sessment, in lieu of damages sustained by the United

5 States because of such statement or representation, of not

6 more than twice the amount of benefits or payments paid

7 as a result of such a statement or representation. In addi8 tion, the Secretary may make a determination in the same

9 proceeding to exclude the person from participation in the

10 programs under title XVIII and to direct the appropriate

11 State agency to exclude the person from participation in

12 any State health care program.

13 ‘‘(b)(1) The Secretary may initiate a proceeding to

14 determine whether to impose a civil money penalty, assess15 ment, or exclusion under subsection (a) only as authorized

16 by the Attorney General pursuant to procedures agreed

17 upon by the Secretary and the Attorney General. The Sec18 retary may not initiate an action under this section with

19 respect to any violation described in subsection (a) later

20 than 6 years after the date the violation was committed.

21 The Secretary may initiate an action under this section

22 by serving notice of the action in any manner authorized

23 by Rule 4 of the Federal Rules of Civil Procedure.

24 ‘‘(2) The Secretary shall not make a determination

25 adverse to any person under this section until the person
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1 has been given written notice and an opportunity for the

2 determination to be made on the record after a hearing

3 at which the person is entitled to be represented by coun4 sel, to present witnesses, and to cross-examine witnesses

5 against the person.

6 ‘‘(3) In a proceeding under this section which—

7 ‘‘(A) is against a person who has been convicted

8 (whether upon a verdict after trial or upon a plea of

9 guilty or nolo contendere) of a Federal crime charg10 ing fraud or false statements; and

11 ‘‘(B) involves the same transaction as in the

12 criminal action,

13 the person is estopped from denying the essential elements

14 of the criminal offense.

15 ‘‘(4) The official conducting a hearing under this sec16 tion may sanction a person, including any party or attor17 ney, for failing to comply with an order or procedure, fail18 ing to defend an action, or other misconduct as would

19 interfere with the speedy, orderly, or fair conduct of the

20 hearing. Such sanction shall reasonably relate to the sever21 ity and nature of the failure or misconduct. Such sanction

22 may include—

23 ‘‘(A) in the case of refusal to provide or permit

24 discovery, drawing negative factual inference or
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1 treating such refusal as an admission by deeming

2 the matter, or certain facts, to be established;

3 ‘‘(B) prohibiting a party from introducing cer4 tain evidence or otherwise supporting a particular

5 claim or defense;

6 ‘‘(C) striking pleadings, in whole or in part;

7 ‘‘(D) staying the proceedings;

8 ‘‘(E) dismissal of the action;

9 ‘‘(F) entering a default judgment;

10 ‘‘(G) ordering the party or attorney to pay at11 torneys’ fees and other costs caused by the failure

12 or misconduct; and

13 ‘‘(H) refusing to consider any motion or other

14 action which is not filed in a timely manner.

15 ‘‘(c) In determining the amount or scope of any pen16 alty, assessment, or exclusion imposed pursuant to this

17 section, the Secretary shall take into account—

18 ‘‘(1) the nature of the statements and represen19 tations referred to in subsection (a) and the cir20 cumstances under which they occurred;

21 ‘‘(2) the degree of culpability, history of prior

22 offenses, and financial condition of the person com23 mitting the offense; and

24 ‘‘(3) such other matters as justice may require.
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1 ‘‘(d)(1) Any person adversely affected by a deter2 mination of the Secretary under this section may obtain

3 a review of such determination in the United States Court

4 of Appeals for the circuit in which the person resides, or

5 in which the statement or representation referred to in

6 subsection (a) was made, by filing in such court (within

7 60 days following the date the person is notified of the

8 Secretary’s determination) a written petition requesting

9 that the determination be modified or set aside. A copy

10 of the petition shall be forthwith transmitted by the clerk

11 of the court to the Secretary, and thereupon the Secretary

12 shall file in the court the record in the proceeding as pro13 vided in section 2112 of title 28, United States Code.

14 Upon such filing, the court shall have jurisdiction of the

15 proceeding and of the question determined therein, and

16 shall have the power to make and enter upon the plead17 ings, testimony, and proceedings set forth in such record

18 a decree affirming, modifying, remanding for further con19 sideration, or setting aside, in whole or in part, the deter20 mination of the Secretary and enforcing the same to the

21 extent that such order is affirmed or modified. No objec22 tion that has not been urged before the Secretary shall

23 be considered by the court, unless the failure or neglect

24 to urge such objection shall be excused because of extraor25 dinary circumstances.
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1 ‘‘(2) The findings of the Secretary with respect to

2 questions of fact, if supported by substantial evidence on

3 the record considered as a whole, shall be conclusive in

4 the review described in paragraph (1). If any party shall

5 apply to the court for leave to adduce additional evidence

6 and shall show to the satisfaction of the court that such

7 additional evidence is material and that there were reason8 able grounds for the failure to adduce such evidence in

9 the hearing before the Secretary, the court may order such

10 additional evidence to be taken before the Secretary and

11 to be made a part of the record. The Secretary may modify

12 its findings as to the facts, or make new findings, by rea13 son of additional evidence so taken and filed, and the Sec14 retary shall file with the court such modified or new find15 ings, which findings with respect to questions of fact, if

16 supported by substantial evidence on the record considered

17 as a whole shall be conclusive, and his recommendations,

18 if any, for the modification or setting aside of his original

19 order.

20 ‘‘(3) Upon the filing of the record with the Sec21 retary’s original or modified order, the jurisdiction of the

22 court shall be exclusive and its judgment and decree shall

23 be final, except that the same shall be subject to review

24 by the Supreme Court of the United States, as provided

25 in section 1254 of title 28, United States Code.
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1 ‘‘(e)(1) Civil money penalties and assessments im2 posed under this section may be compromised by the Sec3 retary and may be recovered—

4 ‘‘(A) in a civil action in the name of the United

5 States brought in United States district court for

6 the district where the statement or representation

7 referred to in subsection (a) was made, or where the

8 person resides, as determined by the Secretary;

9 ‘‘(B) by means of reduction in tax refunds to

10 which the person is entitled, based on notice to the

11 Secretary of the Treasury as permitted under sec12 tion 3720A of title 31, United States Code;

13 ‘‘(C) by decrease of any payment under title

14 XVI to which the person is entitled, notwithstanding

15 section 207 of this Act, as made applicable to this

16 title by reason of section 1631(d)(1);

17 ‘‘(D) by authorities provided under the Debt

18 Collection Act of 1982, as amended, to the extent

19 applicable to debts arising under the Social Security

20 Act;

21 ‘‘(E) by deduction of the amount of such pen22 alty or assessment, when finally determined, or the

23 amount agreed upon in compromise, from any sum

24 then or later owing by the United States to the per-
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1 son against whom the penalty or assessment has

2 been assessed; or

3 ‘‘(F) by any combination of the foregoing.

4 ‘‘(f) A determination by the Secretary to impose a

5 penalty, assessment, or exclusion under this section shall

6 be final upon the expiration of the 60-day period referred

7 to in subsection (d). Matters that were raised or that could

8 have been raised in a hearing before the Secretary or in

9 an appeal pursuant to subsection (d) may not be raised

10 as a defense to a civil action by the United States to collect

11 a penalty and assessment imposed under this section.

12 ‘‘(g) Whenever the Secretary’s determination to im13 pose a penalty, assessment, or exclusion under this section

14 with respect to a medical provider or physician becomes

15 final, the provisions of section 1128A(h) shall apply.

16 ‘‘(h) Whenever the Secretary has reason to believe

17 that any person has engaged, is engaging, or is about to

18 engage in any activity which makes the person subject to

19 a civil monetary penalty under this section, the Secretary

20 may bring an action in an appropriate district court of

21 the United States (or, if applicable, a United States court

22 of any territory) to enjoin such activity, or to enjoin the

23 person from concealing, removing, encumbering, or dispos24 ing of assets which may be required in order to pay a civil
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1 monetary penalty and assessment if any such penalty were

2 to be imposed or to seek other appropriate relief.

3 ‘‘(i)(1) The provisions of subsections (d) and (e) of

4 section 205 shall apply with respect to this section to the

5 same extent as they are applicable with respect to title

6 II. The Secretary may delegate the authority granted by

7 section 205(d) (as made applicable to this section) to the

8 Inspector General of the Department of Health and

9 Human Services for purposes of any investigation under

10 this section.

11 ‘‘(2) The Secretary may delegate authority granted

12 under this section to the Inspector General of the Social

13 Security Administration.

14 ‘‘(j) For purposes of this section, the term ‘State

15 agency’ shall have the same meaning as in section

16 1128A(i)(1).

17 ‘‘(k) A principal is liable for penalties, assessments,

18 and exclusions under this section for the actions of the

19 principal’s agent acting within the scope of the agency.’’.

20 (2) CONFORMING AMENDMENTS.—Section 1128

21 of such Act (42 U.S.C. 1320a–7) is amended—

22 (A) in subsection (b)(7), by striking ‘‘or

23 section 1128B’’ and inserting ‘‘, section 1128B,

24 or section 1129’’;
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1 (B) in subsection (b)(8)(B)(ii), by insert2 ing ‘‘and section 1129’’ after ‘‘section 1128A’’;

3 (C) in subsection (c)(1), by striking ‘‘or

4 under section 1128A’’ and inserting ‘‘, section

5 1128A, or section 1129’’;

6 (D) in subsection (c)(3)(A), by inserting

7 ‘‘or section 1129’’ after ‘‘section 1128A’’;

8 (E) in subsection (d)(1), by striking ‘‘and

9 section 1128A’’ and inserting ‘‘, section 1128A,

10 and section 1129’’;

11 (F) in subsection (d)(2)(A), by striking ‘‘or

12 section 1128A’’ and inserting ‘‘, section 1128A,

13 or section 1129’’;

14 (G) in subsection (e)(1), by striking ‘‘or

15 section 1128A’’ and inserting ‘‘, section 1128A,

16 or section 1129’’;

17 (H) in subsection (f)(3), by inserting ‘‘,

18 1129,’’ after ‘‘sections 1128A’’;

19 (I) in subsection (g)(1), by striking ‘‘or

20 section 1128A’’ each place such term appears

21 and inserting ‘‘, section 1128A, or section

22 1129’’;

23 (J) in subsection (g)(2)(A), by inserting

24 ‘‘and section 1129(a)’’ after ‘‘section

25 1128A(a)’’; and
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1 (K) in subsection (h), by striking ‘‘1128A

2 and 1128B’’ and inserting ‘‘1128A, 1128B, and

3 1129’’.

4 (c) SSI FRAUD CONSIDERED A FELONY.—

5 (1) IN GENERAL.—Section 1632(a) of such Act

6 (42 U.S.C. 1383a(a)) is amended by striking ‘‘shall’’

7 the 1st place such term appears and all that follows

8 and inserting ‘‘shall be fined under title 18, United

9 States Code, imprisoned not more than 5 years, or

10 both.’’.

11 (2) CONFORMING AMENDMENT.—Section

12 1632(b) of such Act (42 U.S.C. 1383a(b)) is amend13 ed to read as follows:

14 ‘‘(b)(1) If a person or entity violates subsection (a)

15 in the person’s or entity’s role as, or in applying to be16 come, a payee under section 1631(a)(2) on behalf of an17 other individual (other than the person’s eligible spouse),

18 and the violation includes a willful misuse of funds by the

19 person or entity, the court may also require that full or

20 partial restitution of funds be made to such other

21 individual.

22 ‘‘(2) Any person or entity convicted of a violation of

23 subsection (a) of this section or of section 208 may not

24 be certified as a payee under section 1631(a)(2).’’.
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1 (d) AUTHORITY TO REDETERMINE ELIGIBILITY IN

2 DISABILITY CASES IF FRAUD IS INVOLVED, AND TO TER3 MINATE BENEFITS IF THERE IS INSUFFICIENT RELIABLE

4 EVIDENCE OF DISABILITY.—

5 (1) IN GENERAL.—Section 1631(e) of such Act

6 (42 U.S.C. 1383(e)) is amended by adding at the

7 end the following:

8 ‘‘(6)(A) The Secretary shall immediately redetermine

9 the eligibility of an individual for benefits under this title

10 by reason of disability, disregarding any unreliable evi11 dence of disability, if there is reason to believe that fraud

12 was involved in the application of the individual for such

13 benefits, unless a United States attorney, or equivalent

14 State prosecutor, with jurisdiction over potential or actual

15 related criminal cases, certifies, in writing, that there is

16 a substantial risk that redetermining such eligibility would

17 jeopardize the criminal prosecution of any person who is

18 a subject of the investigation from which the information

19 is derived.

20 ‘‘(B) If, after redetermining the eligibility of an indi21 vidual for benefits under this title by reason of disability,

22 the Secretary determines that there is insufficient reliable

23 evidence of disability, the Secretary may terminate such

24 eligibility.’’.
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1 (2) EFFECTIVE DATE.—The amendment made

2 by paragraph (1) shall take effect on October 1,

3 1994, and shall apply to eligibility determinations

4 made before, on, or after such date.

5 (e) AVAILABILITY OF RECIPIENT IDENTIFYING IN6 FORMATION FROM THE INSPECTOR GENERAL, DEPART7 MENT OF HEALTH AND HUMAN SERVICES.—

8 (1) IN GENERAL.—Section 1631(e) of such Act

9 (42 U.S.C. 1383(e)), as amended by subsection (d)

10 of this section, is amended by adding at the end the

11 following:

12 ‘‘(7) As soon as the Inspector General, Social Secu13 rity Administration, has reason to believe that fraud was

14 involved in the application of a recipient for benefits under

15 this title, the Inspector General shall make available to

16 the Secretary information identifying the recipient, unless

17 a United States attorney, or equivalent State prosecutor,

18 with jurisdiction over potential or actual related criminal

19 cases, certifies, in writing, that there is a substantial risk

20 that making the information so available or redetermining

21 the eligibility of the recipient for such benefits would jeop22 ardize the criminal prosecution of any person who is a sub23 ject of the investigation from which the information is

24 derived.’’.
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1 (2) EFFECTIVE DATE.—The amendment made

2 by paragraph (1) shall take effect on October 1,

3 1994.

4 (f) AUTHORITY TO USE AVAILABLE PREADMISSION

5 IMMIGRANT AND REFUGEE MEDICAL INFORMATION.—

6 (1) IN GENERAL.—Section 1631(e) of such Act

7 (42 U.S.C. 1383(e)), as amended by the preceding

8 provisions of this Act, is amended by adding at the

9 end the following:

10 ‘‘(8) The Secretary shall request the Immigration and

11 Naturalization Service and the Centers for Diease Control

12 to provide the Secretary with whatever medical informa13 tion either such entity has with respect to any alien who

14 has applied for benefits under this title to the extent that

15 the information is relevant to any determination relating

16 to such eligibility.’’.

17 (2) EFFECTIVE DATE.—The amendment made

18 by paragraph (1) shall take effect on October 1,

19 1994.

20 (g) ANNUAL REPORTS ON REVIEWS OF SSI CASES.—

21 The Secretary shall annually submit to the Committee on

22 Ways and Means of the House of Representatives and the

23 Committee on Finance of the Senate a report on the ex24 tent to which the Secretary has exercised its authority to

25 review supplemental security income cases under title XVI
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1 of the Social Security Act, and the extent to which the

2 cases reviewed were those that involved a high likelihood

3 or probability of fraud.

4 (h) DEVELOPMENT OF PROFILES; PERIODIC TAR5 GETED REDETERMINATIONS.—Part B of title XVI of such

6 Act (42 U.S.C. 1383–1383d) is amended by adding at the

7 end the following:

8 ‘‘SEC. 1636. DEVELOPMENT OF PROFILES; PERIODIC TAR9 GETED REDETERMINATIONS.

10 ‘‘The Social Security Administration shall develop

11 profiles of the kinds of cases that have a high probability

12 of fraud, and shall conduct periodic targeted

13 redeterminations based on such profiles.’’.

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