I 
118TH CONGRESS 
1ST SESSION H. R. 3262 
To amend title XI of the Social Security Act to increase transparency of 
certain health-related ownership information. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 11, 2023 
Ms. SCHAKOWSKY (for herself and Mr. BILIRAKIS) 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 sub-
sequently 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 increase 
transparency of certain health-related ownership information. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. MANDATORY REPORTING WITH RESPECT TO 
CERTAIN HEALTH-RELATED OWNERSHIP IN-
FORMATION. 
Part A of title XI of the Social Security Act (42 
U.S.C. 1301 et seq.) is amended by adding at the end 
the following new section: 
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‘‘SEC. 1150D. MANDATORY REPORTING WITH RESPECT TO 
CERTAIN HEALTH-RELATED OWNERSHIP IN-
FORMATION. 
‘‘(a) MANDATORY REPORTING WITH RESPECT CER-
TAIN HEALTH-RELATED OWNERSHIP INFORMATION.— 
‘‘(1) INITIAL REPORT.—Not later than January 
1, 2025 (or in the case of a specified entity formed 
after January 1, 2025, within 60 days of becoming 
a specified entity), each specified entity (as defined 
in subsection (f)(5)) shall submit to the Secretary, 
in a form and manner specified by the Secretary, a 
report containing the following information: 
‘‘(A) Data on mergers, acquisitions, and 
changes in ownership with respect to such spec-
ified entity for the previous 1-year period. 
‘‘(B) In the case that a specified entity is, 
or includes, a hospital, the additional informa-
tion described in subsection (b). 
‘‘(C) As applicable, the name, address, and 
business structure of the parent company of 
such specified entity (including the tax status of 
such parent company), as of the date of the 
submission of this report. 
‘‘(D) Any other information with respect to 
ownership of a specified entity, as determined 
by the Secretary. 
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‘‘(2) SUBSEQUENT REPORTS.—Not later than 1 
year after submitting the report under paragraph 
(1), and annually thereafter, each specified entity 
shall submit to the Secretary an updated report, in-
cluding— 
‘‘(A)(i) data on mergers, acquisitions, and 
changes in ownership with respect to such enti-
ties for the previous 1-year period; and 
‘‘(ii) any other information with respect to 
ownership of a specified entity, as determined 
by the Secretary; and 
‘‘(B) in the case that a specified entity is, 
or includes, a hospital, the additional informa-
tion described in subsection (b). 
‘‘(b) ADDITIONAL
INFORMATION
SUBMITTED
BY 
CERTAIN SPECIFIED ENTITIES.—For purposes of para-
graphs (1)(B) and (2)(B) of subsection (a), with respect 
to a specified entity that is, or includes, a hospital, the 
information described in this subsection is the following 
information with respect to the previous 1-year period: 
‘‘(1) The business structure of the specified en-
tity, including the business type and the tax status 
of such entity. 
‘‘(2) The average debt-to-earnings ratio of the 
specified entity. 
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‘‘(3) The average amount of debt incurred— 
‘‘(A) by the hospital; and 
‘‘(B) by the entire specified entity. 
‘‘(4) Information with respect to real estate 
leases and purchases for property used, or intended 
to be used, to furnish or otherwise support the provi-
sion of health care services. 
‘‘(5) In the case of a non-profit hospital, a sub-
sidiary of a non-profit hospital, or a 501(c)(3) entity 
that shares common ownership with a non-profit 
hospital, capital gains investments (disaggregated by 
the type of investment) and any taxes paid on such 
gains from such investments. 
‘‘(6) As applicable, information with respect to 
the parent company of such specified entity. 
‘‘(c) PUBLIC REPORTING.—Not later than January 
1, 2027, and annually thereafter, the Secretary shall post 
on a publicly available website of the Department of 
Health and Human Services a report with respect to the 
previous 1-year period, including— 
‘‘(1) the number of specified entities reporting 
for such year, disaggregated by the business struc-
ture of each specified entity; 
‘‘(2) the number of owners of each specified en-
tity; 
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‘‘(3) any change in ownership for each specified 
entity; 
‘‘(4) any change in the tax status of a specified 
entity; 
‘‘(5) an analysis of trends in horizontal and 
vertical consolidation, disaggregated by business 
structure and provider type; and 
‘‘(6) as applicable, the name, address, and busi-
ness structure of the parent company of such speci-
fied entity (including the business type and the tax 
status of such parent company). 
‘‘(d) AUDITS.—The Secretary shall conduct an an-
nual audit consisting of a random sample of specified enti-
ties to verify compliance with the requirements of this sec-
tion and the accuracy of information submitted pursuant 
to this section. 
‘‘(e) PENALTY FOR FAILURE TO REPORT.—If a spec-
ified entity fails to provide a complete report under sub-
section (a), or submits a report containing false informa-
tion, such entity shall be subject to a civil monetary pen-
alty of not more than $5,000,000 for each such report 
not provided or containing false information. Such penalty 
shall be imposed and collected in the same manner as civil 
money penalties under subsection (a) of section 1128A are 
imposed and collected under that section. 
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‘‘(f) INAPPLICABILITY OF PAPERWORK REDUCTION 
ACT.—Chapter 35 of title 44, United States Code, shall 
not apply to collections of information made under this 
section. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) HEALTH PLAN.—The term ‘health plan’ 
has the meaning given such term in section 
1128C(c). 
‘‘(2) HOSPITAL.—The term ‘hospital’ has the 
meaning given such term in section 1861(e). 
‘‘(3) INDEPENDENT
FREESTANDING
EMER-
GENCY DEPARTMENT.—The term ‘independent free-
standing emergency department’ has the meaning 
given such term in section 2799A–1(a)(3)(D) of the 
Public Health Service Act. 
‘‘(4) PRIVATE
EQUITY
COMPANY.—The term 
‘private equity company’ means a publicly traded or 
non-publicly traded company that collects capital in-
vestments from individuals or entities and purchases 
an ownership share of a provider of services (as de-
fined in section 1861(u)). 
‘‘(5) SPECIFIED ENTITY.—The term ‘specified 
entity’ means— 
‘‘(A) a hospital; 
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‘‘(B) a physician-owned physician practice 
with more than 25 physicians for a year; 
‘‘(C) a physician practice owned by a hos-
pital, a health plan, a private equity company, 
or a venture capital firm; 
‘‘(D) an ambulatory surgical center meet-
ing the standards specified under section 
1832(a)(2)(F)(i); or 
‘‘(E) an independent freestanding emer-
gency department. 
‘‘(6) VENTURE CAPITAL FUND.—The term ‘ven-
ture capital fund’ has the meaning given such term 
in section 275.203(l)–1of title 17, Code of Federal 
Regulations.’’. 
Æ 
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