579
Title VI, Subtitle E
(b) CLERICAL AMENDMENT.—The table of chapters
for part I of title 18, United States Code, is amended by
inserting after the item relating to chapter 89 the follow-
ing:
‘‘90. Protected health information .............................................. 1831’’.
PART 6—AMENDMENTS TO TITLE 5, UNITED
STATES CODE
SEC. 6461. AMENDMENTS TO TITLE 5, UNITED STATES
CODE.
(a) NEW SUBSECTION.—Section 552a of title 5,
United States Code, is amended by adding at the end the
following:
‘‘(w) MEDICAL EXEMPTIONS.—The head of an agen-
cy that is a health information trustee (as defined in sec-
tion 6400(b)(5) of the Bipartisan Health Care Reform Act
of 1994) shall promulgate rules, in accordance with the
requirements (including general notice) of subsections
(b)(1), (b)(2), (b)(3), (c), and (e) of section 553 of this
title, to exempt a system of records within the agency, to
the extent that the system of records contains protected
health information (as defined in section 6400(a)(3) of
such Act), from all provisions of this section except sub-
sections (e)(1), (e)(2), subparagraphs (A) through (C) and
(E) through (I) of subsection (e)(4), and subsections
580
Title VI, Subtitle E
(e)(5), (e)(6), (e)(9), (e)(12), (l), (n), (o), (p), (q), (r), and
(u).’’.
(b) REPEAL.—Section 552a(f)(3) of title 5, United
States Code, is amended by striking ‘‘pertaining to him,’’
and all that follows through the semicolon and inserting
‘‘pertaining to the individual;’’.
PART 7—REGULATIONS, RESEARCH, AND EDU-
CATION; EFFECTIVE DATES; APPLICABILITY;
AND RELATIONSHIP TO OTHER LAWS
SEC. 6471. REGULATIONS; RESEARCH AND EDUCATION.
(a) REGULATIONS.—Not later than July 1, 1996, the
Secretary shall prescribe regulations to carry out this sub-
title.
(b) RESEARCH
AND TECHNICAL SUPPORT.—The
Secretary may sponsor—
(1) research relating to the privacy and security
of protected health information;
(2) the development of consent forms governing
disclosure of such information; and
(3) the development of technology to implement
standards regarding such information.
(c) EDUCATION.—The Secretary shall establish edu-
cation and awareness programs—
(1) to foster adequate security practices by
health information trustees;
581
Title VI, Subtitle E
(2) to train personnel of health information
trustees respecting the duties of such personnel with
respect to protected health information; and
(3) to inform individuals and employers who
purchase health care respecting their rights with re-
spect to such information.
SEC. 6472. EFFECTIVE DATES.
(a) IN GENERAL.—Except as provided in subsection
(b), this subtitle, and the amendments made by this sub-
title, shall take effect on January 1, 1997.
(b) PROVISIONS EFFECTIVE IMMEDIATELY.—A pro-
vision of this subtitle shall take effect on the date of the
enactment of this Act if the provision—
(1) imposes a duty on the Secretary to develop,
establish, or promulgate regulations, guidelines, no-
tices, statements, or education and awareness pro-
grams; or
(2) authorizes the Secretary to sponsor research
or the development of forms or technology.
SEC. 6473. APPLICABILITY.
(a) PROTECTED HEALTH INFORMATION.—Except as
provided in subsections (b) and (c), the provisions of this
subtitle shall apply to any protected health information
that is received, created, used, maintained, or disclosed by
a health information trustee in a State on or after Janu-
582
Title VI, Subtitle E
ary 1, 1997, regardless of whether the information existed
or was disclosed prior to such date.
(b) EXCEPTION.—
(1) IN GENERAL.—The provisions of this sub-
title shall not apply to a trustee described in para-
graph (2), except with respect to protected health in-
formation that is received by the trustee on or after
January 1, 1997.
(2) APPLICABILITY.—A trustee referred to in
paragraph (1) is—
(A) a health researcher; or
(B) a person who, with respect to specific
protected health information, received the
information—
(i) pursuant to—
(I) section 6417 (relating to
emergency circumstances);
(II) section 6418 (relating to ju-
dicial and administrative purposes);
(III) section 6419 (relating to
law enforcement); or
(IV) section 6420 (relating to
subpoenas, warrants, and search war-
rants); or
583
Title VI, Subtitle E
(ii) while acting in whole or in part in
the capacity of an officer or employee of a
person described in clause (i).
(c) AUTHORIZATIONS FOR DISCLOSURES.—An au-
thorization for the disclosure of protected health informa-
tion about a protected individual that is executed by the
individual before January 1, 1997, and is recognized and
valid under State law on December 31, 1996, shall remain
valid and shall not be subject to the requirements of sec-
tion 6412 until January 1, 1998, or the occurrence of the
date or event (if any) specified in the authorization upon
which the authorization expires, whichever occurs earlier.
SEC. 6474. RELATIONSHIP TO OTHER LAWS.
(a) STATE LAW.—Except as otherwise provided in
subsections (b), (c), (d), and (f), a State may not estab-
lish, continue in effect, or enforce any State law to the
extent that the law is inconsistent with, or imposes addi-
tional requirements with respect to, any of the following:
(1) A duty of a health information trustee
under this subtitle.
(2) An authority of a health information trustee
under this subtitle to disclose protected health infor-
mation.
584
Title VI, Subtitle E
(3) A provision of part 3 (relating to access
procedures and challenge rights), part 4 (miscellane-
ous provisions), or part 5 (relating to enforcement).
(b) LAWS RELATING TO PUBLIC HEALTH AND MEN-
TAL HEALTH.—This subtitle does not preempt, supersede,
or modify the operation of any State law regarding public
health or mental health to the extent that the law prohibits
or regulates a disclosure of protected health information
that is permitted under this subtitle.
(c) CRIMINAL PENALTIES.—A State may establish
and enforce criminal penalties with respect to a failure to
comply with a provision of this subtitle.
(d) PRIVILEGES.—A privilege that a person has
under law in a court of a State or the United States or
under the rules of any agency of a State or the United
States may not be diminished, waived, or otherwise af-
fected by—
(1) the execution by a protected individual of an
authorization for disclosure of protected health in-
formation under this subtitle, if the authorization is
executed for the purpose of receiving health care or
providing for the payment for health care; or
(2) any provision of this subtitle that authorizes
the disclosure of protected health information for the
585
Title VI, Subtitle E
purpose of receiving health care or providing for the
payment for health care.
(e) DEPARTMENT OF VETERANS AFFAIRS.—The lim-
itations on use and disclosure of protected health informa-
tion under this subtitle shall not be construed to prevent
any exchange of such information within and among com-
ponents of the Department of Veterans Affairs that deter-
mine eligibility for or entitlement to, or that provide, bene-
fits under laws administered by the Secretary of Veterans
Affairs.
(f) CERTAIN DUTIES UNDER STATE OR FEDERAL
LAW.—This subtitle shall not be construed to preempt,
supersede, or modify the operation of any of the following:
(1) Any law that provides for the reporting of
vital statistics such as birth or death information.
(2) Any law requiring the reporting of abuse or
neglect information about any individual.
(3) Subpart II of part E of title XXVI of the
Public Health Service Act (relating to notifications
of emergency response employees of possible expo-
sure to infectious diseases).
(4) The Americans with Disabilities Act of
1990.
586
Title VI, Subtitle E
(5) Any Federal or State statute that estab-
lishes a privilege for records used in health profes-
sional peer review activities.
(g) SECRETARIAL AUTHORITY.—
(1) SECRETARY OF HEALTH AND HUMAN SERV-
ICES.—A provision of this subtitle does not preempt,
supersede, or modify the operation of section 543 of
the Public Health Service Act, except to the extent
that the Secretary of Health and Human Services
determines through regulations promulgated by such
Secretary that the provision provides greater protec-
tion for protected health information, and the rights
of protected individuals, than is provided under such
section 543.
(2) SECRETARY
OF
VETERANS
AFFAIRS.—A
provision of this subtitle does not preempt, super-
sede, or modify the operation of section 7332 of title
38, United States Code, except to the extent that
the Secretary of Veterans Affairs determines
through regulations promulgated by such Secretary
that the provision provides greater protection for
protected health information, and the rights of pro-
tected individuals, than is provided under such sec-
tion 7332.
587
Title VI, Subtitle F
Subtitle F—Antitrust
SEC. 6501. PUBLICATION OF ANTITRUST GUIDELINES ON
ACTIVITIES OF HEALTH PLANS.
(a) IN GENERAL.—The Attorney General shall pro-
vide for the development and publication of explicit guide-
lines on the application of antitrust laws to the activities
of health plans. The guidelines shall be designed to facili-
tate development and operation of plans, consistent with
the antitrust laws.
(b) REVIEW PROCESS.—The Attorney General shall
establish a review process under which the administrator
or sponsor of a health plan (or organization that proposes
to administer or sponsor a health plan) may submit a re-
quest to the Attorney General to obtain a prompt opinion
(but in no event later than 90 days after the Attorney
General receives the request) from the Department of Jus-
tice on the plan’s conformity with the Federal antitrust
laws.
(c) DEFINITIONS.—In this section—
(1) the term ‘‘antitrust laws’’—
(A) has the meaning given it in subsection
(a) of the first section of the Clayton Act (15
U.S.C. 12(a)), except that such term includes
section 5 of the Federal Trade Commission Act
588
Title VI, Subtitle F
(15 U.S.C. 45) to the extent such section ap-
plies to unfair methods of competition, and
(B) includes any State law similar to the
laws referred to in subparagraph (A); and
(2) the term ‘‘health plan’’ means any contract
or arrangement under which an entity bears all or
part of the cost of providing health care items and
services, including a hospital or medical expense in-
curred policy or certificate, hospital or medical serv-
ice plan contract, or health maintenance subscriber
contract, but does not include—
(A) coverage only for accident, dental, vi-
sion, disability, or long term care, medicare
supplemental health insurance, or any combina-
tion thereof,
(B) coverage issued as a supplement to li-
ability insurance,
(C) workers’ compensation or similar in-
surance, or
(D) automobile medical-payment insur-
ance.
SEC. 6502. ISSUANCE OF HEALTH CARE CERTIFICATES OF
PUBLIC ADVANTAGE.
(a) ISSUANCE AND EFFECT OF CERTIFICATE.—The
Attorney General, after consultation with the Secretary,
589
Title VI, Subtitle F
shall issue in accordance with this section a certificate of
public advantage to each eligible health care collaborative
activity that complies with the requirements in effect
under this section on or after the expiration of the 1-year
period that begins on the date of the enactment of this
Act (without regard to whether or not the Attorney Gen-
eral has promulgated regulations to carry out this section
by such date). Such activity, and the parties to such activ-
ity, shall not be liable under any of the antitrust laws for
conduct described in such certificate and engaged in by
such activity if such conduct occurs while such certificate
is in effect.
(b) REQUIREMENTS APPLICABLE TO ISSUANCE OF
CERTIFICATES.—
(1) STANDARDS
TO
BE
MET.—The Attorney
General shall issue a certificate to an eligible health
care collaborative activity if the Attorney General
finds that—
(A) the benefits that are likely to result
from carrying out the activity outweigh the re-
duction in competition (if any) that is likely to
result from the activity, and
(B) such reduction in competition is nec-
essary to obtain such benefits.
(2) FACTORS TO BE CONSIDERED.—
590
Title VI, Subtitle F
(A) WEIGHING OF BENEFITS AGAINST RE-
DUCTION
IN
COMPETITION.—For purposes of
making the finding described in paragraph
(1)(A), the Attorney General shall consider
whether the activity is likely—
(i) to maintain or to increase the
quality of health care by providing new
services not currently offered in the rel-
evant market,
(ii) to increase access to health care,
(iii) to achieve cost efficiencies that
will be passed on to health care consumers,
such as economies of scale, reduced trans-
action costs, and reduced administrative
costs, that cannot be achieved by the provi-
sion of available services and facilities in
the relevant market,
(iv) to preserve the operation of
health care facilities located in underserved
geographical areas,
(v) to improve utilization of health
care resources, and
(vi) to reduce inefficient health care
resource duplication.
591
Title VI, Subtitle F
(B) NECESSITY OF REDUCTION IN COM-
PETITION.—For purposes of making the finding
described in paragraph (1)(B), the Attorney
General shall consider—
(i) the ability of the providers of
health care services that are (or likely to
be) affected by the health care collabo-
rative activity and the entities responsible
for making payments to such providers to
negotiate societally optimal payment and
service arrangements,
(ii) the effects of the health care col-
laborative activity on premiums and other
charges imposed by the entities described
in clause (i), and
(iii) the availability of equally effi-
cient, less restrictive alternatives to achieve
the benefits that are intended to be
achieved by carrying out the activity.
(c) ESTABLISHMENT
OF CRITERIA
AND PROCE-
DURES.—Subject to subsections (d) and (e), not later than
1 year after the date of the enactment of this Act, the
Attorney General and the Secretary shall establish jointly
by rule the criteria and procedures applicable to the issu-
ance of certificates under subsection (a). The rules shall
592
Title VI, Subtitle F
specify the form and content of the application to be sub-
mitted to the Attorney General to request a certificate,
the information required to be submitted in support of
such application, the procedures applicable to denying and
to revoking a certificate, and the procedures applicable to
the administrative appeal (if such appeal is authorized by
rule) of the denial and the revocation of a certificate. Such
information may include the terms of the health care col-
laborative activity (in the case of an activity in existence
as of the time of the application) and implementation plan
for the collaborative activity.
(d) ELIGIBLE HEALTH CARE COLLABORATIVE AC-
TIVITY.—To be an eligible health care collaborative activ-
ity for purposes of this section, a health care collaborative
activity shall submit to the Attorney General an applica-
tion that complies with the rules in effect under subsection
(c) and that includes—
(1) an agreement by the parties to the activity
that the activity will not foreclose competition by en-
tering into contracts that prevent health care provid-
ers from providing health care in competition with
the activity,
(2) an agreement that the activity will submit
to the Attorney General annually a report that de-
scribes the operations of the activity and information
593
Title VI, Subtitle F
regarding the impact of the activity on health care
and on competition in health care, and
(3) an agreement that the parties to the activity
will notify the Attorney General and the Secretary of
the termination of the activity not later than 30
days after such termination occurs.
(e) REVIEW OF APPLICATIONS FOR CERTIFICATES.—
Not later than 90 days after an eligible health care col-
laborative activity submits to the Attorney General an ap-
plication that complies with the rules in effect under sub-
section (c) and with subsection (d), the Attorney General
shall issue or deny the issuance of such certificate. If, be-
fore the expiration of such 90-day period, the Attorney
General may extend the time for issuance for good cause.
(f) REVOCATION OF CERTIFICATE.—Whenever the
Attorney General finds that a health care collaborative ac-
tivity with respect to which a certificate is in effect does
not meet the standards specified in subsection (b), the At-
torney General shall revoke such certificate.
(g) WRITTEN REASONS; JUDICIAL REVIEW.—
(1) DENIAL
AND
REVOCATION
OF
CERTIFI-
CATES.—If the Attorney General denies an applica-
tion for a certificate or revokes a certificate, the At-
torney General shall include in the notice of denial
594
Title VI, Subtitle F
or revocation a statement of the reasons relied upon
for the denial or revocation of such certificate.
(2) JUDICIAL REVIEW.—
(A) AFTER
ADMINISTRATIVE
PROCEED-
ING.—(i) If the Attorney General denies an ap-
plication submitted or revokes a certificate is-
sued under this section after an opportunity for
hearing on the record, then any party to the
health care collaborative activity involved may
commence a civil action, not later than 60 days
after receiving notice of the denial or revoca-
tion, in an appropriate district court of the
United States for review of the record of such
denial or revocation.
(ii) As part of the Attorney General’s an-
swer, the Attorney General shall file in such
court a certified copy of the record on which
such denial or revocation is based. The findings
of fact of the Attorney General may be set aside
only if found to be unsupported by substantial
evidence in such record taken as a whole.
(B) DENIAL OR REVOCATION WITHOUT AD-
MINISTRATIVE
PROCEEDING.—If the Attorney
General denies an application submitted or re-
vokes a certificate issued under this section
595
Title VI, Subtitle F
without an opportunity for hearing on the
record, then any party to the health care col-
laborative activity involved may commence a
civil action, not later than 60 days after receiv-
ing notice of the denial or revocation, in an ap-
propriate district court of the United States for
de novo review of such denial or revocation.
(h) EXEMPTION.—A person shall not be liable under
any of the antitrust laws for conduct necessary—
(1) to prepare, agree to prepare, or attempt to
agree to prepare an application to request a certifi-
cate under this section, or
(2) to attempt to enter into any health care col-
laborative activity with respect to which such a cer-
tificate is in effect.
(i) DEFINITIONS.—In this section:
(1) The term ‘‘antitrust laws’’ has the meaning
given it in section 6501(c)(1).
(2) The term ‘‘certificate’’ means a certificate
of public advantage authorized to be issued under
subsection (a).
(3) The term ‘‘health care collaborative activ-
ity’’ means an agreement (whether existing or pro-
posed) between 2 or more providers of health care
services that is entered into solely for the purpose of
596
Title VI, Subtitle F
sharing in the provision and coordination of health
care services and that involves substantial integra-
tion and financial risk-sharing between the parties,
but does not include the exchanging of information,
the entering into of any agreement, or the engage-
ment in any other conduct that is not reasonably re-
quired to carry out such agreement.
(4) The term ‘‘health care services’’ includes
services related to the delivery or administration of
health care services.
(5) The term ‘‘liable’’ means liable for any civil
or criminal violation of the antitrust laws.
(6) The term ‘‘provider of health care services’’
means any individual or entity that is engaged in the
delivery of health care services in a State and that
is required by State law or regulation to be licensed
or certified by the State to engage in the delivery of
such services in the State.
SEC. 6503. STUDY OF IMPACT ON COMPETITION.
The Attorney General, in consultation with the Chair-
man of the Federal Trade Commission, annually shall sub-
mit to the Congress a report as part of the annual budget
oversight proceedings concerning the Antitrust Division of
the Department of Justice. The report shall enable the
Congress to determine how enforcement of antitrust laws
597
Title VI, Subtitle G
is affecting the formation of efficient, cost-saving joint
ventures and if the certificate of public advantage proce-
dure set forth in section 6502 has resulted in undesirable
reduction in competition in the health care marketplace.
The report shall include an evaluation of the factors set
forth in paragraphs (2)(A) and (2)(B) of section 6502(b).
Subtitle G—Fraud and Abuse
PART 
1—ESTABLISHMENT 
OF 
ALL-PAYER
HEALTH CARE FRAUD AND ABUSE CONTROL
PROGRAM
SEC. 6601. ALL-PAYER HEALTH CARE FRAUD AND ABUSE
CONTROL PROGRAM.
(a) IN GENERAL.—Not later than January 1, 1996,
the Attorney General shall establish a program—
(1) to coordinate Federal, State, and local law
enforcement programs to control fraud and abuse
with respect to the delivery of and payment for
health care in the United States,
(2) to conduct investigations, audits, evalua-
tions, and inspections relating to the delivery of and
payment for health care in the United States, and
(3) in consultation with the Inspector General
of the Department of Health and Human Services,
to facilitate the enforcement of the provisions of sec-
tions 1128, 1128A, and 1128B of the Social Secu-
598
Title VI, Subtitle G
rity Act and other statutes applicable to health care
fraud and abuse.
(b) COORDINATION
WITH
LAW
ENFORCEMENT
AGENCIES.—In carrying out the program under sub-
section (a), the Attorney General shall consult with, and
arrange for the sharing of data and resources with Fed-
eral, State and local law enforcement agencies, State Med-
icaid Fraud Control Units, and State agencies responsible
for the licensing and certification of health care providers.
(c) COORDINATION WITH THIRD PARTY INSUR-
ERS.—In carrying out the program established under sub-
section (a), the Attorney General shall consult with, and
arrange for the sharing of data with representatives of pri-
vate sponsors of health benefit plans and other providers
of health insurance.
(d) REGULATIONS.—
(1) IN GENERAL.—The Attorney General shall
by regulation establish standards to carry out the
program under subsection (a).
(2) INFORMATION STANDARDS.—
(A) IN
GENERAL.—Such standards shall
include standards relating to the furnishing of
information by health insurers (including self-
insured health benefit plans), providers, and
others to enable the Attorney General to carry
599
Title VI, Subtitle G
out the program (including coordination with
law enforcement agencies under subsection (b)
and third party insurers under subsection (c)).
(B) CONFIDENTIALITY.—Such standards
shall include procedures to assure that such in-
formation is provided and utilized in a manner
that protects the confidentiality of the informa-
tion and the privacy of individuals receiving
health care services.
(C) QUALIFIED IMMUNITY FOR PROVIDING
INFORMATION.—The 
provisions 
of 
section
1157(a) of the Social Security Act (relating to
limitation on liability) shall apply to a person
providing information to the Attorney General
under the program under this section, with re-
spect to the Attorney General’s performance of
duties under the program, in the same manner
as such section applies to information provided
to organizations with a contract under part B
of title XI of such Act, with respect to the per-
formance of such a contract.
600
Title VI, Subtitle G
SEC. 6602. AUTHORIZATION OF ADDITIONAL APPROPRIA-
TIONS FOR INVESTIGATORS AND OTHER PER-
SONNEL.
In addition to any other amounts authorized to be
appropriated to the Attorney General for health care anti-
fraud and abuse activities for a fiscal year, there are au-
thorized to be appropriated such sums as may be nec-
essary to enable the Attorney General to conduct inves-
tigations of allegations of health care fraud and otherwise
carry out the program established under section 6601 in
a fiscal year.
SEC. 6603. ESTABLISHMENT OF ANTI-FRAUD AND ABUSE
TRUST FUND.
(a) ESTABLISHMENT.—There is hereby created on
the books of the Treasury of the United States a trust
fund to be known as the ‘‘Anti-Fraud and Abuse Trust
Fund’’ (in this section referred to as the ‘‘Trust Fund’’).
The Trust Fund shall consist of such amounts as may be
deposited in, or appropriated to, such Trust Fund as pro-
vided in this part and section 1128A(f)(3) of the Social
Security Act.
(b) MANAGEMENT.—
(1) IN GENERAL.—The Trust Fund shall be
managed by the Attorney General through a Manag-
ing Trustee designated by the Attorney General.
601
Title VI, Subtitle G
(2) INVESTMENT OF FUNDS.—It shall be the
duty of the Managing Trustee to invest such portion
of the Trust Fund as is not, in the trustee’s judg-
ment, required to meet current withdrawals. Such
investments may be made only in interest-bearing
obligations of the United States or in obligations
guaranteed as to both principal and interest by the
United States. For such purpose such obligations
may be acquired on original issue at the issue price,
or by purchase of outstanding obligations at market
price. The purposes for which obligations of the
United States may be issued under chapter 31 of
title 31, United States Code, are hereby extended to
authorize the issuance at par of public-debt obliga-
tions for purchase by the Trust Fund. Such obliga-
tions issued for purchase by the Trust Fund shall
have maturities fixed with due regard for the needs
of the Trust Fund and shall bear interest at a rate
equal to the average market yield (computed by the
Managing Trustee on the basis of market quotations
as of the end of the calendar month next preceding
the date of such issue) on all marketable interest-
bearing obligations of the United States then form-
ing a part of the public debt which are not due or
callable until after the expiration of 4 years from the
602
Title VI, Subtitle G
end of such calendar month, except that where such
average is not a multiple of 1⁄8 of 1 percent, the rate
of interest on such obligations shall be the multiple
of 1⁄8 of 1 percent nearest such market yield. The
Managing Trustee may purchase other interest-bear-
ing obligations of the United States or obligations
guaranteed as to both principal and interest by the
United States, on original issue or at the market
price, only where the Trustee determines that the
purchase of such other obligations is in the public
interest.
(3) Any obligations acquired by the Trust Fund
(except public-debt obligations issued exclusively to
the Trust Fund) may be sold by the Managing
Trustee at the market price, and such public-debt
obligations may be redeemed at par plus accrued in-
terest.
(4) The interest on, and the proceeds from the
sale or redemption of, any obligations held in the
Trust Fund shall be credited to and form a part of
the Trust Fund.
(5) The receipts and disbursements of the At-
torney General in the discharge of the functions of
the Attorney General shall not be included in the to-
tals of the budget of the United States Government.
603
Title VI, Subtitle G
For purposes of part C of the Balanced Budget and
Emergency Deficit Control Act of 1985, the Attor-
ney General and the Trust Fund shall be treated in
the same manner as the Federal Retirement Thrift
Investment Board and the Thrift Savings Fund, re-
spectively. The United States is not liable for any
obligation or liability incurred by the Trust Fund.
(c) USE OF FUNDS.—Of the amounts in the Trust
Fund—
(1) not less than 60 percent shall be used to
support educational activities to prevent the occur-
rence of violations of anti-fraud and abuse laws, in-
cluding the issuance of advisory opinions under sec-
tion 1129 and 1877(i) of the Social Security Act (as
added by part 4) and fraud alerts, seminars for pro-
viders, and program updates; and
(2) any amounts remaining after use for activi-
ties under paragraph (1) shall be used to assist the
Attorney General in carrying out the all-payer fraud
and abuse control program established under section
6601(a) in the fiscal year involved.
(d) DEPOSIT
OF FEDERAL HEALTH ANTI-FRAUD
AND ABUSE PENALTIES INTO TRUST FUND.—Section
1128A(f)(3) of the Social Security Act (42 U.S.C. 1320a–
7a(f)(3)) is amended by striking ‘‘as miscellaneous re-
604
Title VI, Subtitle G
ceipts of the Treasury of the United States’’ and inserting
‘‘in the Anti-Fraud and Abuse Trust Fund established
under section 6603(a) of the Bipartisan Health Care Re-
form Act of 1994’’.
(e) USE OF FEDERAL HEALTH ANTI-FRAUD AND
ABUSE PENALTIES TO REPAY BENEFICIARIES FOR COST-
SHARING.—Section 1128A(f) of the Social Security Act
(42 U.S.C. 1320a–7a(f)) is amended in the matter preced-
ing paragraph (1) by striking ‘‘Secretary and disposed of
as follows:’’ and inserting the following: ‘‘Secretary. If the
person against whom such a penalty or assessment was
assessed collected a payment from an individual for pro-
viding to the individual the service that is the subject of
the penalty or assessment, the Secretary shall pay a por-
tion of the amount recovered to the individual in the na-
ture of restitution in an amount equal to the payment so
collected. The Secretary shall dispose of any remaining
amounts recovered under this section as follows:’’.
PART 2—REVISIONS TO CURRENT SANCTIONS
FOR FRAUD AND ABUSE
SEC. 6611. MANDATORY EXCLUSION FROM PARTICIPATION
IN MEDICARE AND STATE HEALTH CARE PRO-
GRAMS.
(a) INDIVIDUAL CONVICTED OF FELONY RELATING
TO FRAUD.—
611
Title VI, Subtitle G
availability or accessibility of services to a
medically underserved population served by
the recipient or subrecipient or an im-
provement in the quality of services to
such population, except that the recipient
or subrecipient may seek a prior deter-
mination from the Public Health Service
that this requirement is met and, if the re-
cipient or subrecipient does so, Public
Health Service approval shall be conclusive
and binding on the Federal Government;
‘‘(iii) the arrangement will not result
in private inurement to any current em-
ployees or members of the Board of Direc-
tors of the recipient or subrecipient, or to
agents of the recipient or subrecipient who
were involved in recommending or nego-
tiating the arrangement;
‘‘(iv) with respect to an arrangement
under which a recipient or subrecipient is
procuring goods or services, the provider of
the goods or services is the only provider
able to supply such goods or services, or
the recipient or subrecipient has engaged
in a competitive process to procure the