II

105TH CONGRESS

2D SESSION S. 2007

To amend the false claims provisions of chapter 37 of title 31, United

States Code.

IN THE SENATE OF THE UNITED STATES

APRIL 29, 1998

Mr. COCHRAN (for himself and Mr. HOLLINGS) introduced the following bill;

which was read twice and referred to the Committee on the Judiciary

A BILL

To amend the false claims provisions of chapter 37 of title

31, United States Code.

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.

4 This Act may be cited as the ‘‘Health Care Claims

5 Guidance Act’’.
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1 SEC. 2. RULES FOR ACTIONS UNDER FALSE CLAIMS PROVI2 SIONS BASED ON CLAIMS SUBMITTED UNDER

3 CERTAIN HEALTH CARE PROGRAMS.

4 (a) IN GENERAL.—Subchapter III of chapter 37 of

5 title 31, United States Code, is amended by adding at the

6 end the following:

7 ‘‘§ 3734. Rules for certain actions based on health

8 care claims

9 ‘‘(a) IN GENERAL.—In the case of any action that

10 is brought under this subchapter based on a claim submit11 ted with respect to a federally funded health care program,

12 the preceding provisions of this subchapter shall apply

13 only to the extent that such provisions are consistent with

14 the provisions of this section.

15 ‘‘(b) ACTIONS IF AMOUNT OF DAMAGES ARE MATE16 RIAL AMOUNT.—Notwithstanding the preceding sections

17 of this subchapter, no action may be brought under this

18 subchapter based on a claim that is submitted under a

19 federally funded health care program unless the amount

20 of damages alleged to have been sustained by the United

21 States Government with respect to such claim is a mate22 rial amount.

23 ‘‘(c) ACTIONS FOR CLAIMS SUBMITTED IN RELIANCE

24 ON OFFICIAL GUIDANCE.—Notwithstanding the preceding

25 sections of this subchapter, no action may be brought

26 under this subchapter based on a claim submitted—
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1 ‘‘(1) in reliance on (and correctly using) erro2 neous information supplied by a Federal agency (or

3 an agent thereof) about matters of fact at issue; or

4 ‘‘(2) in reliance on (and correctly applying)

5 written statements of Federal policy which affects

6 such claim provided by a Federal agency (or an

7 agent thereof).

8 ‘‘(d) ACTION FOR CLAIMS SUBMITTED BY PERSONS

9 IN SUBSTANTIAL COMPLIANCE WITH MODEL COMPLI10 ANCE PLAN.—Notwithstanding the preceding sections of

11 this subchapter, no action may be brought under this sub12 chapter based on a claim submitted by a person that is

13 in substantial compliance with a model compliance plan

14 issued by the Secretary of Health and Human Services

15 (in consultation with the Secretary of Defense).

16 ‘‘(e) STANDARD OF PROOF.—In any action brought

17 under this subchapter with respect to a claim submitted

18 to a federally funded health care program, section 3731(c)

19 shall be applied by substituting ‘clear and convincing evi20 dence’ for ‘a preponderance of the evidence’.

21 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec22 tion shall be construed as limiting the authority of the

23 Government of the United States to recoup or otherwise

24 recover damages with respect to a claim submitted to a
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1 federally funded health care program under provisions of

2 law other than this subchapter.

3 ‘‘(g) DEFINITIONS; RELATED RULES.—For purposes

4 of this section—

5 ‘‘(1) the term ‘claim’ means a claim (as defined

6 in section 3729(c)) made with respect to a federally

7 funded health care program;

8 ‘‘(2) the term ‘damages’ means the amount of

9 any overpayment made by the United States Govern10 ment with respect to a claim;

11 ‘‘(3) the term ‘federally funded health care pro12 gram’ means a program that provides health bene13 fits, whether directly, through the purchase of insur14 ance, or otherwise, that is established under—

15 ‘‘(A) title XVIII, XIX, or XXI of the So16 cial Security Act, or

17 ‘‘(B) title 10, United States Code;

18 ‘‘(4) the amount of damages alleged to have

19 been sustained by the United States Government

20 with respect to a claim submitted by (or on behalf

21 of) a person shall be treated as a ‘material amount’

22 only if such amount exceeds a proportion (specified

23 in regulations promulgated by the Secretary of

24 Health and Human Services in consultation with the

25 Secretary of Defense) of the total of the amounts for
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1 which claims were submitted by (or on behalf of)

2 such person—

3 ‘‘(A) to the same federally funded health

4 care program, and

5 ‘‘(B) for the same calendar year,

6 as the claim upon which an action under this sub7 chapter is based;

8 ‘‘(5) the regulations specifying the proportion

9 referred to in paragraph (4) shall be based on the

10 definition of the term ‘material’ used by the Amer11 ican Institute of Certified Public Accountants as of

12 the date of the enactment of this section; and

13 ‘‘(6) in determining whether an amount of dam14 ages is a ‘material amount’ under paragraph (4),

15 with respect to a person—

16 ‘‘(A) the amount of damages for more than

17 1 claim may be aggregated only if the acts or

18 omissions resulting in such damages were part

19 of a pattern of related acts or omissions by

20 such person, and

21 ‘‘(B) if damages for more than 1 claim are

22 aggregated in accordance with subparagraph

23 (A), the proportion referred to in such para24 graph shall be determined by comparing the

25 amount of such aggregate damages to the total
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1 of the amounts for which claims were submitted

2 by (or on behalf of) such person to the same

3 federally funded health care program for each

4 of the calendar years for which any claim upon

5 which such aggregate damages were based was

6 submitted.’’.

7 (b) TECHNICAL AND CONFORMING AMENDMENT.—

8 The table of sections for chapter 37 of title 31, United

9 States Code, is amended by adding after the item relating

10 to section 3733 the following:

‘‘3734. Rules for certain actions based on health care claims.’’.

11 (c) EFFECTIVE DATE.—The amendment made by

12 subsection (a) shall apply to actions brought under sub13 chapter III of chapter 37 of title 31, United States Code,

14 with respect to claims submitted before, on, and after the

15 date of the enactment of this Act.

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