datamatters24/research-document-archive huggingface dataset:
Subtitle B—General Administrative
Provisions
SEC. 411. GENERAL AUTHORITY.
In carrying out any function transferred by this Act,
the Secretary, or any officer or employee of the Depart-
ment, may exercise any authority available by law with
respect to such function to the official or agency from
which such function is transferred, and the actions of the
Secretary in exercising such authority shall have the same
force and effect as when exercised by such official or agen-
cy.
SEC. 412. DELEGATION.
Except as otherwise provided in this Act, the Sec-
retary may delegate any function to such officers and em-
ployees of the Department as the Secretary may designate,
and may authorize such successive redelegations of such
functions within the Department as may be necessary or
appropriate. No delegation of functions by the Secretary
under this section or under any other provision of this Act
shall relieve the Secretary of responsibility for the admin-
istration of such functions.
SEC. 413. REORGANIZATION.
(a) AUTHORITY OF SECRETARY.—Except as provided
in subsection (b), the Secretary is authorized to allocate
or reallocate functions among the officers of the Depart-
risk in any State (not including risks covered by life
insurance or health insurance), including incurred
but not reported claims.
ƒ(19) UNITED
STATES
INSURER.—The term
‘‘United States insurer’’ means an insurer or rein-
surer licensed by a State insurance regulator.
ƒ(20) UNITED
STATES
REINSURANCE
OBLIGA-
TIONS.—The term ‘‘United States reinsurance obliga-
tions’’ means obligations (not including obligations
for life insurance or health insurance) under any re-
insurance contracts to United States insurers for re-
ported claims, incurred but not reported claims, un-
earned premiums, losses and loss adjustment expense,
and aggregate reserves.
ƒSEC. 168. RELATION TO STATE LAWS.
ƒThis title may not be construed to preempt the law
of any State, except to the extent that such laws are incon-
sistent with the provisions of this title, and then only to
the extent of such inconsistency. The Secretary is authorized
to determine whether such inconsistencies exist. The Sec-
retary may not determine that any State law is inconsist-
ent with any provision of this title if the law imposes re-
quirements that are in addition to the requirements under
this title and such requirements do not conflict with the
requirements under this title.
‘‘PROHIBITION OF SALE OR ISSUANCE OF DUPLICATE
POLICIES
‘‘SEC. 2135. (a) IN GENERAL.—A person may not
sell or issue a long-term care insurance policy—
‘‘(1) knowing that the policy provides for cov-
erage that, when combined with coverage provided in
a service-benefit long-term care insurance policy (as
defined in subsection (b)) in effect for the benefit of
the same individual, would result in greater than
100 percent reimbursement for covered services (un-
less the policy is intended to replace such other pol-
icy), or
‘‘(2) for the benefit of an individual unless the
individual (or a representative of the individual) pro-
vides a written statement to the effect that the cov-
erage—
‘‘(A) does not duplicate other coverage in
effect under a service-benefit long-term care in-
surance policy, or
‘‘(B) will replace another service-benefit
long-term care insurance policy.
‘‘(b) SERVICE-BENEFIT LONG-TERM CARE INSUR-
ANCE POLICY DEFINED.—In subsection (a), the term
‘service-benefit long-term care insurance policy’ means a
long-term care insurance policy which provides benefits
100
subject to the same or equivalent requirements as
provided under section 210(b).
ƒ(3) DURATION.—A waiver pursuant to para-
graph (1) may remain in effect only during the pe-
riod for which the State law or other requirement re-
quired under paragraph (2) remains in effect.
ƒ(b) MULTIPLE-STATE MSA’S.—In the case of any
designated MSA that contains area within (1) any State
for which a waiver has been made pursuant to subsection
(a), and (2) any State for which such a waiver has not
been made, the provisions of this title requiring submission
of information to the Secretary regarding such MSA shall
be considered to apply only to the portion of such MSA that
is located within the State for which such a waiver has not
been made.
ƒ(c) AUTHORITY FOR SECRETARY TO OBTAIN INFOR-
MATION DIRECTLY FROM INSURERS.—If the State for
which a waiver has been made pursuant to subsection (a)
does not submit to the Secretary the information required
under subsection (a)(2)(A) or submits information that is
not complete, the Secretary shall require the insurers
transacting business within the State to submit such infor-
mation directly to the Secretary.
come tax under section 501 of the Internal Revenue
Code of 1986 if—
(i) the renumeration for such services does
not exceed $150; or
(ii) such service is in connection with the
collection of dues or premiums for a fraternal
beneficiary society, order, or association, and is
performed away from the home office or is rit-
ualistic service in connection with any such so-
ciety, order, or association; or
(iii) such service is performed by a student
who is enrolled and is regularly attending class-
es at a school, college, or university;
(H) service performed in the employ of a for-
eign government (including service as a consular or
other officer or employee or a nondiplomatic rep-
resentative);
(I) service performed in the employ of an in-
strumentality wholly owned by a foreign government,
if—
(i) the service is of a character similar to
that performed in foreign countries by employ-
ees of the United States Government or of an
instrumentality thereof; and
surers with any risk-based capital standards estab-
lished under section 106.
ƒ(2) CONSIDERATION
OF
ESTABLISHED
AC-
COUNTING PRINCIPLES.—In establishing the account-
ing standards, the Secretary shall take into consider-
ation (A) generally accepted accounting principles,
(B) United States statutory accounting principles,
(C) the results of the study under section 163 and the
recommendations of the Comptroller General con-
tained in the report under such section, and (D) the
specific characteristics of the insurance business and
reinsurers.
ƒSEC. 106. AUTHORITY TO ESTABLISH RISK-BASED CAPITAL
STANDARDS.
ƒ(a) AUTHORITY.—The Secretary may, by regulation,
establish risk-based capital standards under this section re-
quiring a foreign direct insurer to have a net worth appro-
priate to the underwriting, financial, investment, and other
risk assumed by the insurer (as provided under subsection
(b)(1)), and may require, for certification as a certified for-
eign direct insurer, that a foreign direct insurer comply
with such standards.
ƒ(b) CONTENT.—
ƒ(1) IN
GENERAL.—Any risk-based capital
standards established under this section shall require
a foreign direct insurer to maintain an amount of
capital that is sufficient, as determined by the Sec-
retary, for the foreign insurer to maintain minimum
capital amounts taking into account the nature and
type of risks underwritten by the insurer, the pre-
mium volume of risks underwritten by the insurer,
the composition, quality, duration, and liquidity of
the insurer’s investment portfolio, and the adequacy
of the capital reserves of the insurer, and such other
risks as the Secretary considers appropriate.
ƒ(2) CAPITAL LEVELS.—Any risk-based capital
standards established under this section may include
various capital levels designed to identify the serious-
ness of any capital inadequacies of a foreign insurer.
ƒ(3) ENFORCEMENT.—The Secretary may pro-
vide that if the amount of capital maintained by a
foreign insurer does not meet or exceed the amount re-
quired to be maintained under the various risk-based
capital standards, the Secretary may take actions
under subtitle C to enforce such requirements and
may take other actions as the Secretary considers ap-
propriate to facilitate compliance with such require-
ments.
ƒSubtitle B—Certification of
Foreign Reinsurers
ƒSEC. 121. REQUIREMENT FOR CLAIMING CREDIT FOR RE-
INSURANCE.
ƒNo United States insurer may claim reinsurance ob-
tained from a foreign reinsurer after the date provided in
section 169(c) as an asset or deduction from liability for
purposes of any financial statement (including financial
statements required under this title) unless the foreign rein-
surer is certified under this subtitle by the Secretary as a
certified foreign reinsurer.
ƒSEC. 122. APPLICATION.
ƒThe Secretary shall provide for a foreign reinsurer
to apply, in the form and manner determined by the Sec-
retary, for certification under this subtitle as a certified for-
eign reinsurer.
ƒSEC. 123. CERTIFICATION PROCEDURE.
ƒ(a) IN GENERAL.—The Secretary may certify a for-
eign reinsurer as a certified foreign reinsurer for purposes
of this title only if—
ƒ(1) the foreign reinsurer submits an applica-
tion under section 122 containing such information
as the Secretary may require to determine whether the
foreign insurer complies with the standards estab-
TITLE I—ALL-PAYER FRAUD AND
ABUSE PROGRAM
SEC. 101. ALL-PAYER FRAUD AND ABUSE CONTROL PRO-
GRAM
(a) ESTABLISHMENT OF PROGRAM.—
(1) ESTABLISHMENT.—Not later than January
1, 1995, the Secretary shall establish in the Office
of the Inspector General of the Department of
Health and Human Services a program—
(A) to coordinate Federal, State, and local
law enforcement programs to control fraud and
abuse with respect to the delivery of and pay-
ment for health care in the United States,
(B) to conduct investigations, audits, eval-
uations, and inspections relating to the delivery
of and payment for health care in the United
States, and
(C) to facilitate the enforcement of the
provisions of sections 1128, 1128A, and 1128B
of the Social Security Act and other statutes
applicable to health care fraud and abuse.
(2) COORDINATION WITH LAW ENFORCEMENT
AGENCIES.—In carrying out the program established
under paragraph (1), the Secretary shall consult
with, and arrange for the sharing of data and re-
135
ƒ(i) the characteristics of rural areas
that should be included in the group of des-
ignated rural areas under such section;
ƒ(ii) the number of rural areas having
each particular characteristic that should be
included in the group; and
ƒ(iii) the characteristics of rural areas,
and number of rural areas having each such
characteristic, that should be removed from
the group of designated rural areas in effect
at the time of the report.
ƒ(K) 
Any 
other 
information 
or 
rec-
ommendations relating to the requirements or
implementation of this title that the Comptroller
General considers appropriate.
ƒ(4) CONSULTATION.—In preparing each report
under this subsection, the Comptroller General shall
consult with Federal agencies having appropriate ex-
pertise, the National Association of Insurance Com-
missioners, State insurance regulators, statistical
agents, representatives of small businesses, representa-
tives of insurance agents (including minority insur-
ance agents) and property and casualty insurers, and
community, consumer, and civil rights organizations.
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘National Health Care Anti-Fraud and Abuse Act of
1993’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Section 1. Short title; table of contents.
TITLE I—ALL-PAYER FRAUD AND ABUSE PROGRAM
Sec. 101. All-payer fraud and abuse control program
Sec. 102. Application of Federal health anti-fraud and abuse sanctions to all
fraud and abuse against any health benefit plan.
Sec. 103. Public reporting of fraudulent actions.
TITLE II—REVISIONS TO CURRENT SANCTIONS FOR FRAUD AND
ABUSE
Sec. 201. Mandatory exclusion from participation in medicare and State health
care programs.
Sec. 202. Establishment of minimum period of exclusion for certain individuals
and entities subject to permissive exclusion from medicare and
State health care programs.
Sec. 203. Permissive exclusion of individuals with ownership or control interest
in sanctioned entities.
Sec. 204. Civil monetary penalties.
Sec. 205. Actions subject to criminal penalties.
Sec. 206. Sanctions against practitioners and persons for failure to follow cor-
rective action plan of peer review organization.
Sec. 207. Restrictions on certain durable medical equipment marketing and
sales activities.
Sec. 208. Intermediate sanctions for medicare health maintenance organiza-
tions.
Sec. 209. Effective date.
TITLE III—ADMINISTRATIVE AND MISCELLANEOUS PROVISIONS
Sec. 301. Requirements for uniform claims and electronic claims data set.
Sec. 302. Quarterly publication of adverse actions taken.
Sec. 303. Study of electronic reporting of ownership information.
I
103D CONGRESS
1ST SESSION
H. R. 1255
To amend title XI of the Social Security Act to extend the penalties for
fraud and abuse assessed against providers under the medicare program
and State health care programs to providers under all health care plans,
and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 9, 1993
Mr. STARK (for himself, Mr. LEVIN, Mr. MCDERMOTT, and Mr. CARDIN) in-
troduced the following bill; which was referred jointly to the Committees
on Ways and Means and Energy and Commerce
APRIL 28, 1993
Additional sponsors: Mr. OWENS, and Mr. MILLER of California
A BILL
To amend title XI of the Social Security Act to extend
the penalties for fraud and abuse assessed against pro-
viders under the medicare program and State health
care programs to providers under all health care plans,
and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
lished under section 124, together with an application
fee in the amount determined under section 164(a);
ƒ(2) the Secretary determines that the foreign
insurer complies with the requirements under section
124; and
ƒ(3) the Secretary determines that the foreign
insurer has complied with the requirements under sec-
tion 125.
ƒ(b) REQUIREMENTS FOR FOREIGN REINSURERS NOT
SEEKING CERTIFICATION.—The Secretary may reduce or
waive the requirements under sections 124 and 125 as the
Secretary determines appropriate, with respect to any for-
eign reinsurer that submits to the Secretary, before the date
provided in section 169(c), written notice that the foreign
reinsurer does not intend to apply for certification under
this subtitle and will comply with any requirements pursu-
ant to this subsection. In making any such determinations,
the Secretary shall consider the United States reinsurance
obligations of the foreign reinsurer, the adequacy of insur-
ance regulation in the country of domicile of the foreign
reinsurer, and the needs and protections of United States
policyholders, creditors, and the general public.
ƒSEC. 124. REQUIREMENTS FOR FOREIGN REINSURERS.
ƒ(a) IN GENERAL.—Each foreign reinsurer shall com-
ply with the following requirements:
ƒ(1) MINIMUM
NET
WORTH
AND
RISK-BASED
CAPITAL
STANDARDS.—The foreign reinsurer shall
have a net worth in an amount not less than
$20,000,000 (or an aggregate amount of not less than
$10,000,000,000, in the case of a group of incor-
porated reinsurers under common administration), or
such higher amount as the Secretary may require
based on the amount of business transacted by the for-
eign reinsurer and the value of the insurance ceded to
the foreign reinsurer and shall comply with any risk-
based capital standards established by the Secretary
under section 126. The Secretary shall determine the
net worth of a foreign reinsurer and may adjust the
value of any assets and liabilities of a reinsurer, for
purposes of this paragraph, in accordance with the
accounting standards established by the Secretary
pursuant to section 125(d).
ƒ(2) POLICYHOLDER SECURITY.—The foreign re-
insurer shall secure the interests of United States pol-
icyholders by compliance with at least 1 of the follow-
ing subparagraphs:
ƒ(A) TRUST FUND.—The foreign reinsurer
shall establish and, at all times, maintain at a
qualified financial institution in the United
less than 3 years ending upon the submission of
an application under section 122; or
ƒ(C) be the continuing corporation result-
ing from a merger or consolidation of insurers,
at least one of which has been actively and con-
tinuously engaged in the business of insurance as
a reinsurer for a period of not less than 3 years
ending upon the submission of an application
under section 122.
ƒ(8) OTHER.—The foreign reinsurer shall meet
any other requirements relating to the solvency or ca-
pacity, or safety and soundness of the business prac-
tices of the reinsurer, that are established by the Sec-
retary as the Secretary may determine are reasonably
necessary to protect the interest of United States pol-
icyholders, creditors, and the general public.
ƒ(b) WAIVER.—The Secretary may reduce or waive
any of the requirements under paragraphs (3) through (8)
of subsection (a) with respect to a foreign reinsurer if the
Secretary determines on a case-by-case basis that the for-
eign reinsurer has demonstrated, to the satisfaction of the
Secretary, experience, competence, and capacity to safely
and soundly engage in the business of reinsurance in the
United States.
(ii) automobile medical-payment in-
surance.
(D) TREATMENT
OF
DIRECT
FEDERAL
PROVISION OF SERVICES.—Such term does not
include a Federal program that provides di-
rectly for the provision of health services to
beneficiaries.
(2) HEALTH SERVICE PROVIDER.—In this sec-
tion, the term ‘‘health service provider’’ includes a
provider of services (as defined in section 1861(u) of
the Social Security Act), physician, supplier, and
other person furnishing health care services.
(3) SECRETARY.—In this section, the term
‘‘Secretary’’ means the secretary of health and
human services.
SEC. 302. QUARTERLY PUBLICATION OF ADVERSE ACTIONS
TAKEN.
(a) IN GENERAL.—Part A of title XI of the Social
Security Act (42 U.S.C. 1301 et seq.) is amended by add-
ing at the end the following new section:
‘‘QUARTERLY PUBLICATION OF ADVERSE ACTIONS TAKEN
‘‘SEC. 1144. Not later than 30 days after the end
of each calendar quarter, the Secretary shall publish in
the Federal Register a listing of all final adverse actions
taken during the quarter under this part (including pen-
alties imposed under section 1107, exclusions under sec-
tion 1128, the imposition of civil monetary penalties under
section 1128A, and the imposition of criminal penalties
under section 1128B) and under section 1156.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to calendar quarters beginning
on or after January 1, 1995.
SEC. 303. STUDY OF ELECTRONIC REPORTING OF OWNER-
SHIP INFORMATION.
(a) STUDY.—The Secretary of Health and Human
Services shall conduct a study on the feasibility and desir-
ability of establishing a method by which the information
required to be reported under the all-payer anti-fraud pro-
gram established under section 101 on the ownership of
entities providing health care services may be reported
electronically.
(b) REPORT.—Not later than 1 year after the date
of the enactment of this Act, the Secretary shall submit
a report on the study conducted under subsection (a) to
the Committee on Ways and Means and the Committee
on Energy and Commerce of the House of Representatives
and the Committee on Finance of the Senate.
Æ
HR 1255 SC——2
HR 1255 SC——3
HR 1255 SC——4
not less than the amount equal to the percent-
age of the aggregate amount of the United
States direct written obligations of the insurer
that is established by the Administrator under
this subparagraph. The Administrator shall es-
tablish such percentage based on the percentage
of reserves necessary to be held to protect the
interests of United States policyholders of the
insurer and other claimants under such policies.
(C) UNSAFE
FINANCIAL
CONDITIONS.—
The Administrator may increase the percentage
under subparagraph (B) for an insurer if the
Administrator determines that such insurer is
operating in a manner likely to result in an un-
safe or unsound financial condition.
(5) AGENT
FOR
SERVICE
OF
PROCESS.—The
foreign insurer shall appoint and maintain an agent
in the United States upon whom process may be
served in any action, suit, or proceeding.
(6) JURISDICTION OF COURTS.—The foreign in-
surer shall agree to submit to the jurisdiction of any
court of the United States or of any State, of com-
petent jurisdiction, to be fully bound by its decision.
(7) REGULATION
BY
DOMICILE.—The foreign
insurer shall annually submit to the Administrator a
certificate of compliance, certificate of good stand-
ing, or equivalent documentation (as determined by
the Administrator) properly attested by the body re-
sponsible for regulation of the insurer in the domi-
cile of the insurer, evidencing authority under the
laws of the domicile of the insurer to engage in the
business of insurance.
(8) BIOGRAPHICAL INFORMATION.—The foreign
insurer shall annually submit to the Administrator,
in the form and manner determined by the Adminis-
trator—
(A) biographical information on all senior
officers and directors of the insurer that dem-
onstrates a level of competency, experience, and
integrity sufficient to indicate that permitting
the insurer to conduct business in the United
States would not be hazardous to United States
policyholders and creditors of the insurer or to
the general public; and
(B) financial, management, and oper-
ational information on any entities that directly
or indirectly control the insurer, as the Admin-
istrator shall provide.
(9) INSURANCE EXPERIENCE.—The foreign in-
surer shall—
lished or maintained pursuant to paragraph (4)
shall not be subject to arbitration or other reso-
lution.
(7) REGULATION
BY
DOMICILE.—The foreign
reinsurer shall annually submit to the Administrator
a certificate of compliance, certificate of good stand-
ing, or equivalent documentation (as determined by
the Administrator) properly attested by the body re-
sponsible for regulation of the reinsurer in the domi-
cile of the reinsurer, evidencing authority under the
laws of the domicile of the reinsurer to engage in the
business of reinsurance.
(8) BIOGRAPHICAL INFORMATION.—The foreign
reinsurer shall annually submit to the Adminis-
trator, in the form and manner determined by the
Administrator—
(A) biographical information on all senior
officers and directors of the reinsurer that dem-
onstrates a level of competency, experience, and
integrity sufficient to indicate that permitting
the reinsurer to conduct business in the United
States would not be hazardous to United States
cedants and creditors of the reinsurer or to the
general public; and
‘‘(e) REGULATIONS.—The Board shall prescribe such
regulations as the Board may determine to be appropriate
to carry out the purposes of this section.
‘‘(f) ANNUAL REPORT TO BANKING COMMITTEES.—
The Board shall submit an annual report to the Commit-
tee on Banking, Finance and Urban Affairs of the House
of Representatives and the Committee on Banking, Hous-
ing, and Urban Affairs of the Senate on any liquidity as-
sistance provided by any Federal Reserve bank to any in-
surance company during the year covered by the report.’’.
SEC. 306. REGULATIONS.
The Administrator may issue any regulations the Ad-
ministrator considers appropriate to carry out the duties
of the Administrator under this title.
TITLE IV—DISCLOSURE OF IN-
SURANCE AVAILABILITY IN-
FORMATION
SEC. 401. SHORT TITLE.
This title may be cited as the ‘‘Insurance Disclosure
Act’’.
SEC. 402. FINDINGS AND CONSTRUCTION.
(a) FINDINGS.—The Congress finds that—
(1) there are disparities in property and cas-
ualty insurance coverage provided by some insurers