I 

115TH CONGRESS 

2D SESSION H. R. 5757 

To amend title XI of the Social Security Act to expand the permissive 

exclusion from Federal health programs to include certain individuals 

with prior interest in sanctioned entities and entities affiliated with 

sanctioned entities, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 10, 2018 

Ms. FRANKEL of Florida (for herself and Mr. KEATING) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XI of the Social Security Act to expand 

the permissive exclusion from Federal health programs 

to include certain individuals with prior interest in sanctioned entities and entities affiliated with sanctioned entities, 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. 

4 This Act may be cited as the ‘‘Fighting Medicare 

5 Fraud Act of 2018’’. 


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1 SEC. 2. PERMISSIVE EXCLUSION FROM FEDERAL HEALTH 

2 PROGRAMS EXPANDED TO CERTAIN INDIVID3 UALS WITH PRIOR INTEREST IN SANCTIONED 

4 ENTITIES AND ENTITIES AFFILIATED WITH 

5 SANCTIONED ENTITIES. 

6 Paragraph (15) of section 1128(b) of the Social Secu7 rity Act (42 U.S.C. 1320a–7(b)) is amended to read as 

8 follows: 

9 ‘‘(15) INDIVIDUALS AND ENTITIES AFFILIATED

10 WITH A SANCTIONED ENTITY.—(A) Any of the fol11 lowing: 

12 ‘‘(i) Any individual who— 

13 ‘‘(I) is a person with an ownership or 

14 control interest in a sanctioned entity or 

15 an affiliated entity of such sanctioned enti16 ty (or was a person with such an owner17 ship or control interest at the time of any 

18 of the conduct that formed a basis for the 

19 conviction or exclusion described in sub20 paragraph (B)); and 

21 ‘‘(II) knows or should have known (as 

22 defined in section 1128A(i)(7)) (or knew or 

23 should have known) of such conduct. 

24 ‘‘(ii) Any individual who is an officer or 

25 managing employee (as defined in section 

26 1126(b)) of a sanctioned entity or affiliated enVerDate Sep 11 2014 18:37 May 24, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5757.IH H5757

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1 tity of such sanctioned entity (or was such an 

2 officer or managing employee at the time of any 

3 of the conduct that formed a basis for the con4 viction or exclusion described in subparagraph 

5 (B)). 

6 ‘‘(iii) Any affiliated entity of a sanctioned 

7 entity. 

8 ‘‘(B) For purposes of this paragraph, the term 

9 ‘sanctioned entity’ means an entity— 

10 ‘‘(i) that has been convicted of any offense 

11 described in subsection (a) of this section or in 

12 paragraph (1), (2), or (3) of this subsection; or 

13 ‘‘(ii) that has been excluded from partici14 pation under a program under title XVIII or 

15 under a State health care program. 

16 ‘‘(C) For purposes of subparagraph (A), the 

17 term ‘affiliated entity’ means, with respect to a 

18 sanctioned entity, an entity that is (or was at the 

19 time of any of the conduct that formed the basis for 

20 the conviction or exclusion described in subpara21 graph (B)) affiliated with such sanctioned entity, 

22 and includes an entity— 

23 ‘‘(i) that is a person with an ownership or 

24 control interest in such sanctioned entity (or 

25 was such a person with respect to such sancVerDate Sep 11 2014 18:37 May 24, 2018 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5757.IH H5757

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1 tioned entity at the time of any conduct that 

2 formed the basis for the conviction described in 

3 subparagraph (B)); 

4 ‘‘(ii) with respect to which a sanctioned en5 tity is a person with an ownership or control in6 terest in such entity (or was such a person with 

7 respect to such entity at the time of any con8 duct that formed the basis for the conviction 

9 described in subparagraph (B)); 

10 ‘‘(iii) with respect to which a person with 

11 an ownership or control interest in such entity 

12 also has such an interest in such sanctioned en13 tity; and 

14 ‘‘(iv) with respect to which a person who is 

15 an officer or managing employee (as defined in 

16 section 1126(b)) of such entity also is such an 

17 officer or managing employee of such sanc18 tioned entity. 

19 ‘‘(D) For purposes of this paragraph, the term 

20 ‘person with an ownership or control interest’ has 

21 the meaning given such term in section 

22 1124(a)(3).’’. 


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1 SEC. 3. REPORTS ON INCIDENCES OF FRAUD AND ABUSE 

2 UNDER MEDICARE PARTS C AND D. 

3 (a) IN GENERAL.—Section 1857(d) of the Social Se4 curity Act (42 U.S.C. 1395w–27(d)) is amended by adding 

5 at the end the following new paragraph: 

6 ‘‘(7) REPORT ON INCIDENCES OF FRAUD AND

7 ABUSE.— 

8 ‘‘(A) IN GENERAL.—A contract under this 

9 section with an MA organization offering an 

10 MA plan shall provide that such MA organiza11 tion report to the Secretary (or to any person 

12 or organization designated by the Secretary for 

13 such purpose) any instances of fraud or abuse 

14 related to the payment or delivery of health 

15 benefits under such contract not later than 60 

16 days after such organization identifies such in17 stance. 

18 ‘‘(B) GUIDANCE.—Not later than 90 days 

19 after the date of the enactment of this para20 graph, the Secretary, in consultation with the 

21 Inspector General of the Department of Health 

22 and Human Services and the Attorney General, 

23 shall issue to MA organizations (and PDP 

24 sponsors) guidance for defining the terms 

25 ‘fraud’ and ‘abuse’ for purposes of subpara26 graph (A).’’. 


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1 (b) CONFORMING AMENDMENT TO PART D.—Section 

2 1860D–12(b)(3)(C) of the Social Security Act (42 U.S.C. 

3 1395w–112(b)(3)(C)) is amended by inserting before the 

4 period at the end the following: ‘‘, except in applying para5 graph (7) of such section any reference to an MA organi6 zation, with respect to an MA plan, shall be deemed a ref7 erence to a PDP sponsor or MA organization, with respect 

8 to a prescription drug plan or MA–PD plan’’. 

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

10 subsections (a) and (b) shall apply with respect to plan 

11 years beginning on or after the date of the enactment of 

12 this Act. 

Æ 


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