I
105TH CONGRESS
2D SESSION
H. R. 3523
To amend the false claims provisions of title 31, United States Code.
IN THE HOUSE OF REPRESENTATIVES
MARCH 19, 1998
Mr. MCCOLLUM (for himself, Mr. DELAHUNT, Mr. ADERHOLT, Mr. ALLEN,
Mr. BACHUS, Mr. BALDACCI, Mr. BARR of Georgia, Mr. BOEHNER, Mr.
BOUCHER, Mr. BOYD, Mr. CHAMBLISS, Mr. COLLINS, Mr. COOKSEY, Mr.
DIAZ-BALART, Mr. FOLEY, Mrs. FOWLER, Mr. GEKAS, Mr. GOSS, Mr.
HASTINGS of Florida, Mr. HOBSON, Mr. INGLIS of South Carolina, Mr.
KENNEDY of Massachusetts, Mr. LIVINGSTON, Mr. MCCRERY, Mr.
MCGOVERN, Mrs. MEEK of Florida, Mr. MICA, Mr. MILLER of Florida,
Mr. MOAKLEY, Mr. NETHERCUTT, Mr. NEAL of Massachusetts, Mr. NEY,
Mr. NORWOOD, Mr. OLVER, Mr. PAUL, Mr. PORTER, Mr. REGULA, Mr.
ROTHMAN, Mr. SCARBOROUGH, Mr. SHAW, Mr. SPENCE, Mr. STEARNS,
Mr. STENHOLM, Mr. TALENT, Mr. THORNBERRY, Mrs. THURMAN, Mr.
WELDON of Florida, and Mr. WEXLER) introduced the following bill;
which was referred to the Committee on the Judiciary
A BILL
To amend the false claims provisions of title 31, United
States Code.
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 ‘‘Health Care Claims
Guidance Act’’.
SEC. 2. RULES FOR ACTIONS UNDER FALSE CLAIMS PROVI-
SIONS BASED ON CLAIMS SUBMITTED UNDER
CERTAIN HEALTH CARE PROGRAMS.
(a) IN GENERAL.—Subchapter III of chapter 37 of
title 31, United States Code, is amended by adding at the
end the following:
‘‘§ 3734. Rules for certain actions based on health
care claims
‘‘(a) IN GENERAL.—In the case of any action that
is brought under this subchapter based on a claim submit-
ted with respect to a federally funded health care program,
the preceding provisions of this subchapter shall apply
only to the extent that such provisions are consistent with
the provisions of this section.
‘‘(b) ACTIONS IF AMOUNT OF DAMAGES ARE MATE-
RIAL AMOUNT.—Notwithstanding the preceding sections
of this subchapter, no action may be brought under this
subchapter based on a claim that is submitted under a
federally funded health care program unless the amount
of damages alleged to have been sustained by the United
States Government with respect to such claim is a mate-
rial amount.
‘‘(c) ACTIONS FOR CLAIMS SUBMITTED IN RELIANCE
ON OFFICIAL GUIDANCE.—Notwithstanding the preceding
sections of this subchapter, no action may be brought
under this subchapter based on a claim submitted—
‘‘(1) in reliance on (and correctly using) erro-
neous information supplied by a Federal agency (or
an agent thereof) about matters of fact at issue; or
‘‘(2) in reliance on (and correctly applying)
written statements of Federal policy which affects
such claim provided by a Federal agency (or an
agent thereof).
‘‘(d) ACTION FOR CLAIMS SUBMITTED BY PERSONS
IN SUBSTANTIAL COMPLIANCE WITH MODEL COMPLI-
ANCE PLAN.—Notwithstanding the preceding sections of
this subchapter, no action may be brought under this sub-
chapter based on a claim submitted by a person that is
in substantial compliance with a model compliance plan
issued by the Secretary of Health and Human Services
(in consultation with the Secretary of Defense).
‘‘(e) STANDARD OF PROOF.—In any action brought
under this subchapter with respect to a claim submitted
to a federally funded health care program, section 3731(c)
shall be applied by substituting ‘clear and convincing evi-
dence’ for ‘a preponderance of the evidence’.
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as limiting the authority of the
Government of the United States to recoup or otherwise
recover damages with respect to a claim submitted to a
federally funded health care program under provisions of
law other than this subchapter.
‘‘(g) DEFINITIONS; RELATED RULES.—For purposes
of this section—
‘‘(1) the term ‘claim’ means a claim (as defined
in section 3729(c)) made with respect to a federally
funded health care program;
‘‘(2) the term ‘damages’ means the amount of
any overpayment made by the United States Govern-
ment with respect to a claim;
‘‘(3) the term ‘federally funded health care pro-
gram’ means a program that provides health bene-
fits, whether directly, through the purchase of insur-
ance, or otherwise, that is established under—
‘‘(A) title XVIII, XIX, or XXI of the So-
cial Security Act, or
‘‘(B) title 10, United States Code;
‘‘(4) the amount of damages alleged to have
been sustained by the United States Government
with respect to a claim submitted by (or on behalf
of) a person shall be treated as a ‘material amount’
only if such amount exceeds a proportion (specified
in regulations promulgated by the Secretary of
Health and Human Services in consultation with the
Secretary of Defense) of the total of the amounts for
which claims were submitted by (or on behalf of)
such person—
‘‘(A) to the same federally funded health
care program, and
‘‘(B) for the same calendar year,
as the claim upon which an action under this sub-
chapter is based;
‘‘(5) the regulations specifying the proportion
referred to in paragraph (4) shall be based on the
definition of the term ‘material’ used by the Amer-
ican Institute of Certified Public Accountants as of
the date of the enactment of this section; and
‘‘(6) in determining whether an amount of dam-
ages is a ‘material amount’ under paragraph (4),
with respect to a person—
‘‘(A) the amount of damages for more than
1 claim may be aggregated only if the acts or
omissions resulting in such damages were part
of a pattern of related acts or omissions by
such person, and
‘‘(B) if damages for more than 1 claim are
aggregated in accordance with subparagraph
(A), the proportion referred to in such para-
graph shall be determined by comparing the
amount of such aggregate damages to the total
of the amounts for which claims were submitted
by (or on behalf of) such person to the same
federally funded health care program for each
of the calendar years for which any claim upon
which such aggregate damages were based was
submitted.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to actions brought under sub-
chapter III of chapter 37 of title 31, United States Code,
with respect to claims submitted before, on, and after the
date of the enactment of this Act.
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