I 
119TH CONGRESS 
1ST SESSION H. R. 5433 
To prohibit health insurance issuers and certain health care providers under 
Medicare from being under common ownership, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 17, 2025 
Ms. HOYLE of Oregon (for herself, Mr. RYAN, Ms. JAYAPAL, and Ms. OCASIO- 
CORTEZ) introduced the following bill; which was referred to the Com-
mittee on the Judiciary, and in addition to the Committees on Energy 
and Commerce, and Ways and Means, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To prohibit health insurance issuers and certain health care 
providers under Medicare from being under common 
ownership, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patients Over Profit 
Act’’ or the ‘‘POP Act’’. 
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SEC. 2. PROHIBITION ON COMMON OWNERSHIP OF HEALTH 
INSURANCE ISSUERS AND CERTAIN HEALTH 
CARE PROVIDERS UNDER MEDICARE. 
(a) IN GENERAL.—It shall be unlawful for any per-
son to both— 
(1) directly or indirectly own, operate, or con-
trol the whole or any part of an applicable provider 
or a management services organization that has a 
management services agreement with an applicable 
provider; and 
(2) directly or indirectly own, operate, or con-
trol the whole or any part of a health insurance 
issuer. 
(b) DIVESTMENT.—Any person in violation of sub-
section (a) shall divest either the applicable provider (or, 
if applicable, the management services organization) or 
the health insurance issuer of such person— 
(1) in the case of an applicable provider, man-
agement services organization, or health insurance 
issuer acquired on or before the date of enactment 
of this Act, not later than 2 years after such date 
of enactment; or 
(2) in the case of an applicable provider, man-
agement services organization, or health insurance 
issuer acquired after the date of enactment of this 
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Act, not later than 1 year after the date of acquisi-
tion. 
(c) CIVIL ACTIONS.— 
(1) IN GENERAL.—When the Inspector General 
of the Department of Health and Human Services, 
the Assistant Attorney General in charge of the 
Antitrust Division of the Department of Justice, the 
Federal Trade Commission, or an attorney general 
of a State has reason to believe that a person is in 
violation of subsection (a) or (b), such Inspector 
General, Assistant Attorney General, Federal Trade 
Commission, or attorney general of a State may 
bring a civil action in an applicable district court of 
the United States for the relief described in para-
graph (2). 
(2) INJUNCTIVE AND EQUITABLE RELIEF.—In 
any action described in paragraph (1), the applicable 
court, on a finding that a person is in violation of 
subsection (a) or (b), shall issue an order requiring 
such person— 
(A) to cease and desist from such violation, 
and divest either the applicable provider (or, if 
applicable, the management services organiza-
tion) or the health insurance issuer of such per-
son; and 
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(B) to disgorge any revenue received from 
the provision of health care services during the 
period of such violation. 
(3) DEPOSIT AND DISTRIBUTION.—Any revenue 
disgorged pursuant to an action under this sub-
section for a violation of subsection (a) or (b) shall 
be deposited into a fund created by the Federal 
Trade Commission and distributed by the Federal 
Trade Commission to be put to use in the interest 
of serving the health care needs of the harmed com-
munity. Receipt of any funds under this paragraph 
shall not alter or diminish the rights of an individual 
to bring an action or recover any amount as other-
wise authorized by law. 
(d) FTC REVIEW.— 
(1) REPORTING REQUIRED.—Any divestment of 
an applicable provider, management services organi-
zation, or health insurance issuer required under 
subsection (b) shall be reported to the Federal 
Trade Commission and the Assistant Attorney Gen-
eral in charge of the Antitrust Division of the De-
partment of Justice under section 7A of the Clayton 
Act (15 U.S.C. 18a) without respect to the thresh-
olds under subsection (a)(2) of that section. 
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(2) TOLLING OF DIVESTMENT PERIOD DURING 
REVIEW.—The divestment period under subsection 
(b) shall be tolled during the pendency of any wait-
ing period required under section 7A of the Clayton 
Act (15 U.S.C. 18a). 
(3) REVIEW
OF
EFFECT
OF
DIVESTITURE.— 
With respect to each divestiture undertaken pursu-
ant to subsection (b), in addition to any applicable 
review under section 7A of the Clayton Act (15 
U.S.C. 18a), the Federal Trade Commission and the 
Assistant Attorney General in charge of the Anti-
trust Division of the Department of Justice shall re-
view the effect on competition, financial viability, 
and the public interest— 
(A) of the divestiture; and 
(B) of the subsequent acquisition of the 
applicable provider (or, if applicable, the man-
agement services organization) or the health in-
surance issuer of such person by the acquiring 
person. 
(e) RULEMAKING AUTHORITY.—The Federal Trade 
Commission shall promulgate rules to carry out this sec-
tion. Such rules shall not diminish any obligation under 
this section. 
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(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to limit the authority of the Fed-
eral Trade Commission, the Inspector General of the De-
partment of Justice, the Department of Health and 
Human Services, or the attorney general of a State under 
any other provision of law. 
(g) ENFORCEMENT UNDER MEDICARE ADVANTAGE 
AND MEDICARE PART D.— 
(1) MEDICARE ADVANTAGE.—Section 1857 of 
the Social Security Act (42 U.S.C. 1395w–27) is 
amended by adding at the end the following new 
subsection: 
‘‘(j) PROHIBITION ON COMMON OWNERSHIP OF MA 
ORGANIZATIONS AND APPLICABLE PROVIDERS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2026, the Secretary may not 
contract with, or provide payment under this part 
to, a Medicare Advantage organization with respect 
to offering an MA plan or MA–PD plan under this 
part if the organization— 
‘‘(A) directly or indirectly owns, operates, 
or controls the whole or any part of an applica-
ble provider or a management services organiza-
tion that has a management services agreement 
with an applicable provider; or 
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‘‘(B) is directly or indirectly owned, oper-
ated, or controlled in whole or part by a person 
who also directly or indirectly owns, operates, 
or controls the whole or any part of an applica-
ble provider or a management services organiza-
tion that has a management services agreement 
with an applicable provider. 
‘‘(2) CERTIFICATION.—Each Medicare Advan-
tage organization shall furnish to the Secretary (in 
a form and manner, and at a time, specified by the 
Secretary) a certification of compliance with this 
subsection, as well as such information as the Sec-
retary determines necessary to carry out this sub-
section. 
‘‘(3) FALSE CLAIMS SUBMITTED BY ENTITIES 
IN VIOLATION OF PROHIBITION ON COMMON OWNER-
SHIP.—Any claim for payment from an entity in vio-
lation of paragraph (1) constitutes a false or fraudu-
lent claim for purposes of subchapter III of title 31, 
United States Code. 
‘‘(4) DEFINITIONS.—In this subsection: 
‘‘(A) APPLICABLE PROVIDER.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the term ‘applicable provider’ means 
any entity that receives payment for fur-
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nishing services covered under part B or 
under a Medicare Advantage plan under 
part C. 
‘‘(ii) EXCLUSIONS.—Such term does 
not include— 
‘‘(I) a hospital (as defined in sec-
tion 1861(e)), a critical access hos-
pital 
(as 
defined 
in 
section 
1861(mm)(1)), or a rural emergency 
hospital 
(as 
defined 
in 
section 
1861(kkk)(2)); 
‘‘(II) a supplier of durable med-
ical equipment, prosthetics, orthotics, 
or supplies; or 
‘‘(III) a pharmacy. 
‘‘(B) MANAGEMENT
SERVICES
AGREE-
MENT.—The term ‘management services agree-
ment’ means a contract between a management 
services organization and an applicable provider 
for management or administrative services re-
lating to, supporting, or facilitating the provi-
sion of health care services. 
‘‘(C) MANAGEMENT SERVICES ORGANIZA-
TION.—The term ‘management services organi-
zation’ means any organization or entity that 
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contracts with an applicable provider to perform 
management or administrative services relating 
to, supporting, or facilitating the provision of 
health care services.’’. 
(2) MEDICARE
PART
D.—Section 1860D– 
12(b)(3) of the Social Security Act (42 U.S.C. 
1395w–112(b)(3)) is amended by adding at the end 
the following new subparagraph: 
‘‘(G) PROHIBITION
ON
COMMON
OWNER-
SHIP.—Section 1857(j).’’. 
(h) DEFINITIONS.—In this section: 
(1) APPLICABLE PROVIDER.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘‘applicable provider’’ 
means any entity that receives payment for fur-
nishing services covered under part B of title 
XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.) or under a Medicare Advantage 
plan under part C of such title (42 U.S.C. 
1395w–21 et seq.). 
(B) EXCLUSIONS.—Such term does not in-
clude— 
(i) a hospital (as defined in section 
1861(e) of the Social Security Act (42 
U.S.C. 1395x(e))), a critical access hos-
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pital (as defined in section 1861(mm)(1) of 
such Act (42 U.S.C. 1395x(mm)(1))), or a 
rural emergency hospital (as defined in 
section 1861(kkk)(2)); 
(ii) a supplier of durable medical 
equipment, prosthetics, orthotics, and sup-
plies; or 
(iii) a pharmacy. 
(2) HEALTH
INSURANCE
ISSUER.—The term 
‘‘health insurance issuer’’ has the meaning given 
that term in section 2791 of the Public Health Serv-
ice Act (42 U.S.C. 300gg–91). 
(3) MANAGEMENT
SERVICES
AGREEMENT.— 
The term ‘‘management services agreement’’ means 
a contract between a management services organiza-
tion and an applicable provider for management or 
administrative services relating to, supporting, or fa-
cilitating the provision of health care services. 
(4) MANAGEMENT SERVICES ORGANIZATION.— 
The term ‘‘management services organization’’ 
means any organization or entity that contracts with 
an applicable provider to perform management or 
administrative services relating to, supporting, or fa-
cilitating the provision of health care services. 
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