or other medical information for payment to be made to
the entity, the physician or practitioner shall provide that
information to the entity at the time that the item or serv-
ice is ordered by the physician or practitioner.’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) apply to items and services fur-
nished on or after January 1, 1998.
SEC. 104. REPLACEMENT OF REASONABLE CHARGE METH-
ODOLOGY BY FEE SCHEDULES.
(a) IN GENERAL.—Section 1833(a)(1) (42 U.S.C.
1395l(a)(1)) is amended in the matter preceding subpara-
graph (A) by striking ‘‘the reasonable charges for the serv-
ices’’ and inserting ‘‘the lesser of the actual charges for
the services and the amounts determined by the applicable
fee schedules developed by the Secretary for the particular
services’’.
(b) CONFORMING AMENDMENTS.—
(1) SECTION
1833(a).—Section 1833(a) (42
U.S.C. 1395l(a)) is amended—
(A) in paragraph (1)—
(i) in subparagraph (A), by striking
‘‘reasonable charges for’’ and inserting
‘‘payment basis otherwise applicable to’’;
(ii) in subparagraph (B), by striking
‘‘reasonable charges’’ and inserting ‘‘fee
schedule amounts’’; and
(iii) by inserting after subparagraph
(F) the following: ‘‘(G) with respect to
services described in clause (i) or (ii) of
section 1861(s)(2)(K) (relating to physi-
cian assistants and nurse practitioners),
the amounts paid shall be 80 percent of
the lesser of the actual charge for the serv-
ices and the applicable amount determined
under subclause (I) or (II) of section
1842(b)(12)(A)(ii),’’; and
(B) in paragraph (2)—
(i) in subparagraph (B), in the matter
preceding clause (i), by striking ‘‘(C),
(D),’’ and inserting ‘‘(D)’’; and
(ii) by striking subparagraph (C).
(2) SECTION
1833(l).—Section 1833(l) (42
U.S.C. 1395l(l)) is amended—
(A) in paragraph (3)—
(i) by striking subparagraph (B); and
(ii) by striking ‘‘(3)(A)’’ and inserting
‘‘(3)’’; and
(B) by striking paragraph (6).
(3) SECTION
1834.—Section 1834(g)(1)(A)(ii)
(42 U.S.C. 1395m(g)(1)(A)(ii)) is amended in the
heading by striking ‘‘REASONABLE
CHARGES
FOR
PROFESSIONAL’’ and inserting ‘‘PROFESSIONAL’’.
(4) SECTION
1842(a).—Section 1842(a) (42
U.S.C. 1395u(a)) is amended—
(A) in the matter preceding paragraph (1),
by striking ‘‘reasonable charge’’ and inserting
‘‘fee schedule’’; and
(B) in paragraph (1)(A), by striking ‘‘rea-
sonable charge’’ and inserting ‘‘other’’.
(5) SECTION
1842(b).—Section 1842(b) (42
U.S.C. 1395u(b)) is amended—
(A) in paragraph (3)—
(i) in subparagraph (B)—
(I) in the matter preceding clause
(i), by striking ‘‘assure that,’’ and all
that follows through ‘‘such payment’’
and inserting the following: ‘‘where
payment under this part for a service
is on a basis other than a cost basis,
such payment’’; and
(II) in clause (ii), by amending
subclause (I) to read as follows: ‘‘(I)
the amount determined by the appli-
cable payment basis under this part is
the full charge for the service,’’; and
(ii) by striking the second through the
ninth sentences;
(B) by amending paragraph (4) to read as
follows:
‘‘(4) In the case of an enteral or parenteral pump
that is furnished on a rental basis during a period of medi-
cal need—
‘‘(A) monthly rental payments shall not be
made under this part for more than 15 months dur-
ing that period, and
‘‘(B) after monthly rental payments have been
made for 15 months during that period, payment
under this part shall be made for maintenance and
servicing of the pump in amounts that the Secretary
determines to be reasonable and necessary to ensure
the proper operation of the pump.’’;
(C) in paragraph (7)—
(i) in subparagraph (D)—
(I) in clause (i), in the matter
preceding subclause (I), by striking ‘‘,
to the extent that such payment is
otherwise allowed under this para-
graph’’; and
(II) in clause (ii), by striking
‘‘subparagraph’’ and inserting ‘‘para-
graph’’;
(ii) by striking subparagraphs (A),
(B), and (C);
(iii) by striking ‘‘(D)(i)’’ and inserting
‘‘(7)(A)’’; and
(iv) in subparagraph (A), as redesig-
nated by clause (iii), by—
(I) redesignating clauses (ii) and
(iii) as subparagraphs (B) and (C),
respectively; and
(II) by redesignating subclauses
(I), (II), and (III) as clauses (i), (ii),
and (iii), respectively;
(D) by striking paragraphs (9) and (10);
(E) in paragraph (11)—
(i) by striking subparagraphs (B),
(C), and (D);
(ii) by striking ‘‘(11)(A)’’ and insert-
ing ‘‘(11)’’, and
(iii) by redesignating clauses (i) and
(ii) as subparagraphs (A) and (B), respec-
tively;
(F) in paragraph (12)(A)(ii)—
(i) in the matter preceding subclause
(I), by striking ‘‘prevailing charges deter-
mined under paragraph (3)’’ and inserting
‘‘the amounts determined under section
1833(a)(1)(G)’’; and
(ii) in subclause (II), by striking ‘‘pre-
vailing charge rate’’ and all that follows
through the period and inserting ‘‘fee
schedule amount specified in section 1848
for such services performed by physi-
cians.’’;
(G) by striking paragraphs (14), (15),
(16), and (17);
(H) in paragraph (18)(A), by striking
‘‘reasonable charge or’’; and
(I) by redesignating paragraph (18) as
paragraph (14).
(6) 
ELIMINATION
OF
REDUNDANT
LAN-
GUAGE.—Section 6112(b) of the Omnibus Reconcili-
ation Act of 1989 (42 U.S.C. 1395m note; Public
Law 101–239) is repealed.
(7) SECTION
1842(j).—Section 1842(j) (42
U.S.C. 1395u(j)) is amended—
(A) by amending paragraph (1) to read as
follows:
‘‘(j)(1) Sanctions may be applied under paragraph
(2) as provided in subsections (k), (l), (m), (n), and (p).’’;
and
(B) in paragraph (4), by striking ‘‘under
paragraph (1)’’.
(8) SECTION
1842(n).—Section 1842(n)(1)(A)
(42 U.S.C. 1395u(n)(1)(A)) is amended by striking
‘‘reasonable charge (or other applicable limit)’’ and
inserting ‘‘other applicable limit’’.
(9) SECTION
1842(q).—Section 1842(q) (42
U.S.C. 1395u(q)) is amended—
(A) by striking paragraph (1)(B); and
(B) by striking ‘‘(q)(1)(A)’’ and inserting
‘‘(q)(1)’’.
(10) SECTION
1845.—Section 1845(b)(1) (42
U.S.C. 1395w–1(b)(1)) is amended by striking ‘‘ad-
justments to the reasonable charge levels for physi-
cians’ services recognized under section 1842(b)
and’’.
(11) SECTION
1848.—Section 1848(i)(3) (42
U.S.C. 1395w–4(i)(3)) is repealed.
(12) SECTION 1866.—Section 1866(a)(2)(A)(ii)
(42 U.S.C. 1395cc(a)(2)(A)(ii)) is amended by strik-
ing ‘‘reasonable charges’’ through ‘‘provider)’’ and
inserting ‘‘amount customarily charged for the items
and services by the provider’’.
(13) SECTION 1881.—Section 1881(b)(3)(A) (42
U.S.C. 1395rr(b)(3)(A)) is amended by striking ‘‘a
reasonable charge’’ and all that follows through
‘‘section 1848)’’ and inserting ‘‘the basis described
in section 1848’’.
(14) OBRA-86.—Section 9340 of the Omnibus
Budget Reconciliation Act of 1986 (42 U.S.C.
1395u note; Public Law 99–509) is repealed.
(c) EFFECTIVE DATES.—The amendments made by
subsections (a) and (b), to the extent the amendments
substitute fee schedules for reasonable charges, apply to
particular services as of the date specified by the Secretary
of Health and Human Services.
(d) INITIAL BUDGET NEUTRALITY.—The Secretary,
in developing a fee schedule for particular services (under
the amendments made by subsections (a) and (b)), shall
set amounts for the first year period to which the fee
schedule applies at such a level that the total payments
under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) for those services for that period shall be
approximately equal to the estimated total payments for
those services if the amendments had not been made.
SEC. 105. APPLICATION OF INHERENT REASONABLENESS.
(a) IN
GENERAL.—Section 1834(a)(10)(B) (42
U.S.C. 1395m(a)(10)(B)) is amended—
(1) in the first sentence, by striking ‘‘apply the
provisions’’ and all that follows through the period
and inserting ‘‘describe by regulation the factors to
be used in determining the cases (or particular
items) in which the application of this subsection re-
sults in the determination of an amount that, by
reason of its being grossly excessive or grossly defi-
cient, is not inherently reasonable, and to provide in
such cases for the factors that will be considered in
establishing an amount that is realistic and equi-
table.’’; and
(2) in the second sentence, by striking ‘‘apply-
ing such provisions’’ and inserting ‘‘applying the
previous provisions of this subsection’’.
(b) CONFORMING
AMENDMENT.—Section 1834(i)
(42 U.S.C. 1395m(i)) is amended by adding at the end
the following:
‘‘(3) ADJUSTMENT
FOR
INHERENT
REASON-
ABLENESS.—The provisions of subsection (a)(10)(B)
shall apply to payment for surgical dressings under
this subsection.’’.
SEC. 106. EXCLUSION OF ENTITY CONTROLLED BY FAMILY
MEMBER OF A SANCTIONED INDIVIDUAL.
Section 1128 (42 U.S.C. 1320a–7) is amended—
(1) in subsection (b)(8), by inserting in the
matter preceding subparagraph (A) ‘‘, an immediate
family member of such person (as defined in section
1128(j)), or a member of the household of such per-
son (as defined in section 1128(k))’’ after ‘‘the Sec-
retary determines that a person’’; and
(2) by adding at the end the following:
‘‘(j) DEFINITION
OF IMMEDIATE FAMILY MEM-
BER.—For purposes of subsection (b)(8), the term ‘imme-
diate family member’ means—
‘‘(1) a spouse;
‘‘(2) a biological or adoptive parent of the indi-
vidual and the individual’s spouse;
‘‘(3) a child or sibling;
‘‘(4) a grandparent or grandchild; or
‘‘(5) an individual that is married to any of the
individuals listed in paragraphs (2) through (5).
‘‘(k) DEFINITION
OF MEMBER
OF
THE HOUSE-
HOLD.—For purposes of subsection (b)(8), the term
‘member of the household’ means a person sharing a com-
mon abode as part of a single family unit, including do-
mestic employees and others who live together as a family
unit, but not including a roomer or boarder.’’.
SEC. 107. LIABILITY OF MEDICARE CARRIERS AND FISCAL
INTERMEDIARIES AND STATES FOR CLAIMS
SUBMITTED BY EXCLUDED PROVIDERS.
(a) REIMBURSEMENT
TO
THE
SECRETARY
FOR
AMOUNTS PAID TO EXCLUDED PROVIDERS.—
(1) 
REQUIREMENTS
FOR
FISCAL
INTERMEDIARIES.—
(A) IN
GENERAL.—Section 1816 (42
U.S.C. 1395h) is amended by adding at the end
the following:
‘‘(m) An agreement with an agency or organization
under this section shall require that the agency or organi-
zation reimburse the Secretary for any amounts paid for
a service under this title which is furnished, directed, or
prescribed by an individual or entity during any period
for which the individual or entity is excluded pursuant to
section 1128, 1128A, or 1156 from participation in the
program under this title, if the amounts are paid after
the Secretary notifies the agency or organization of the
exclusion.’’.
(B) CONFORMING
AMENDMENT.—Section
1816(i) (42 U.S.C. 1395h(i)) is amended by
adding at the end the following:
‘‘(4) Nothing in this subsection shall be con-
strued to prohibit reimbursement by an agency or
organization under subsection (m).’’.
(2) REQUIREMENTS
FOR
CARRIERS.—Section
1842(b)(3) (42 U.S.C. 1395u(b)(3)) is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (I); and
(B) by inserting after subparagraph (I) the
following:
‘‘(J) will reimburse the Secretary for any
amounts paid for an item or service under this part
which is furnished, directed, or prescribed by an in-
dividual or entity during any period for which the in-
dividual or entity is excluded pursuant to section
1128, 1128A, or 1156 from participation in the pro-
gram under this title, if the amounts are paid after
the Secretary notifies the carrier of the exclusion;
and’’.
(3) REQUIREMENTS
FOR
STATES.—Section
1902(a)(39) (42 U.S.C. 1396a(a)(39)) is amended
by striking the semicolon at the end and inserting ‘‘,
and provide further for reimbursement to the Sec-
retary of any payments made under the plan for any
item or service furnished, directed, or prescribed by
the excluded individual or entity during such period,
after the Secretary notifies the State of such exclu-
sion;’’.
(b) CONFORMING REPEAL OF MANDATORY PAYMENT
RULE.—Section 1862(e)(2) (42 U.S.C. 1395y(e)(2)) is
amended to read as follows:
‘‘(2) No individual or entity may bill (or collect any
amount from) any individual for any item or service for
which payment is denied under paragraph (1). No person
is liable for payment of any amounts billed for such an
item or service in violation of the previous sentence.’’.
SEC. 108. AUTHORITY TO REFUSE TO ENTER INTO MEDI-
CARE OR MEDICAID AGREEMENTS WITH IN-
DIVIDUALS 
OR 
ENTITIES 
CONVICTED 
OF
FELONIES.
(a) MEDICARE PART A.—Section 1866(b)(2) (42
U.S.C. 1395cc(b)(2)) is amended—
(1) in subparagraph (B), by striking ‘‘or’’ at
the end;
(2) in subparagraph (C), by striking the period
at the end and inserting ‘‘, or’’; and
(3) by adding at the end the following:
‘‘(D) has ascertained that the provider has
been convicted of a felony under Federal or
State law for an offense that the Secretary de-
termines is inconsistent with the best interests
of program beneficiaries.’’.
(b) MEDICARE PART B.—Section 1842 (42 U.S.C.
1395u) is amended by adding at the end the following:
‘‘(s) The Secretary may refuse to enter into an agree-
ment with a physician or supplier under subsection (h)
or may terminate or refuse to renew such agreement, in
the event that such physician or supplier has been con-
victed of a felony under Federal or State law for an of-
fense which the Secretary determines is inconsistent with
the best interests of program beneficiaries.’’.
(c) MEDICAID.—Section 1902(a)(23) (42 U.S.C.
1396(a)(23)) is amended—
(1) by inserting a comma after ‘‘1915’’; and
(2) by inserting after ‘‘Guam,’’ the following:
‘‘and except that this provision does not require a State
to provide medical assistance for such services furnished
by a person or entity convicted of a felony under Federal
or State law for an offense which the State agency deter-
mines is inconsistent with the best interests of bene-
ficiaries under the State plan,’’.
SEC. 109. APPLICATION OF CERTAIN PROVISIONS OF THE
BANKRUPTCY CODE.
(a) RESTRICTED APPLICABILITY
OF BANKRUPTCY
STAY, DISCHARGE, AND PREFERENTIAL TRANSFER PRO-
VISIONS TO MEDICARE AND MEDICAID DEBTS.—Part A
of title XI (42 U.S.C. 1301 et seq.) is amended by insert-
ing after section 1143 the following:
‘‘APPLICATION OF CERTAIN PROVISIONS OF THE
BANKRUPTCY CODE
‘‘SEC. 1144. (a) MEDICARE AND MEDICAID-RELAT-
ED ACTIONS NOT STAYED BY BANKRUPTCY PROCEED-
INGS.—The commencement or continuation of any action
against a debtor under this title or title XVIII or XIX
(other than an action with respect to health care services
for the debtor under title XVIII), including any action or
proceeding to exclude or suspend the debtor from program
participation, assess civil money penalties, recoup or set
off overpayments, or deny or suspend payment of claims
shall not be subject to the provisions of section 362(a) of
title 11, United States Code.
‘‘(b) MEDICARE- AND MEDICAID-RELATED DEBT
NOT DISCHARGEABLE IN BANKRUPTCY.—A debt owed to
the United States or to a State for an overpayment under
title XVIII or XIX (other than an overpayment for health
care services for the debtor under title XVIII), or for a
penalty, fine, or assessment under this title or title XVIII
or XIX, shall not be dischargeable under any provision
of title 11, United States Code.
‘‘(c) REPAYMENT OF CERTAIN DEBTS CONSIDERED
FINAL.—Payments made to repay a debt to the United
States or to a State with respect to items or services pro-
vided, or claims for payment made, under title XVIII or
XIX (including repayment of an overpayment (other than
an overpayment for health care services for the debtor
under title XVIII)), or to pay a penalty, fine, or assess-
ment under this title or title XVIII or XIX, shall be con-
sidered final and not preferential transfers under section
547 of title 11, United States Code.’’.
(b) MEDICARE RULES APPLICABLE TO BANKRUPTCY
PROCEEDINGS.—Title XVIII (42 U.S.C. 1395 et seq.) is
amended by adding at the end the following:
‘‘APPLICATION OF PROVISIONS OF THE BANKRUPTCY
CODE
‘‘SEC. 1894. (a) USE OF MEDICARE STANDARDS AND
PROCEDURES.—Notwithstanding any provision of title 11,
United States Code, or any other provision of law, in the
case of claims by a debtor in bankruptcy for payment
under this title, the determination of whether the claim
is allowable and of the amount payable, shall be made in
accordance with the provisions of this title and title XI
and implementing regulations.
‘‘(b) NOTICE TO CREDITOR OF BANKRUPTCY PETI-
TIONER.—In the case of a debt owed to the United States
with respect to items or services provided, or claims for
payment made, under this title (including a debt arising
from an overpayment or a penalty, fine, or assessment
under title XI or this title), the notices to the creditor of
bankruptcy petitions, proceedings, and relief required
under title 11, United States Code (including under sec-
tion 342 of that title and section 2002(j) of the Federal
Rules of Bankruptcy Procedure), shall be given to the Sec-
retary. Provision of such notice to a fiscal agent of the
Secretary shall not be considered to satisfy this require-
ment.
‘‘(c) TURNOVER OF PROPERTY TO THE BANKRUPTCY
ESTATE.—For purposes of section 542(b) of title 11,
United States Code, a claim for payment under this title
shall not be considered to be a matured debt payable to
the estate of a debtor until such claim has been allowed
by the Secretary in accordance with procedures under this
title.’’.
SEC. 110. INSPECTOR GENERAL ACCESS TO NATIONAL
PRACTITIONER DATA BANK.
Section 427 of the Health Care Quality Improvement
Act of 1986 (42 U.S.C. 11137) is amended—
(1) in subsection (a), by adding at the end the
following: ‘‘Information reported under this part
shall also be made available, upon request, to the In-
spector General of the Departments of Health and
Human Services, Defense, and Labor, the Office of
Personnel Management, and the Railroad Retire-
ment Board.’’; and
(2) by amending subsection (b)(4) to read as
follows:
‘‘(4) FEES.—
‘‘(A) IMPOSITION
OF
FEES.—The Sec-
retary may impose fees for the disclosure of in-
formation under this part sufficient to recover
the full costs of carrying out the provisions of
this part, including reporting, disclosure, and
administration, except that a fee may not be
imposed for requests made by the Inspector
General of the Department of Health and
Human Services.
‘‘(B) AVAILABILITY
OF
FEES.—The fees
shall remain available to the Secretary (or, in
the Secretary’s discretion, to the agency des-
ignated in section 424(b)) until expended.’’.
SEC. 111. STATE HEALTH CARE FRAUD CONTROL UNITS.
(a) EXTENSION OF CONCURRENT AUTHORITY TO IN-
VESTIGATE AND PROSECUTE FRAUD IN OTHER FEDERAL
PROGRAMS.—Section 1903(q)(3) (42 U.S.C. 1396b(q)(3))
is amended—
(1) by striking ‘‘in connection with any aspect’’
and inserting ‘‘in connection with—
‘‘(A) any aspect’’;
(2) by striking the period at the end and insert-
ing ‘‘; and’’; and
(3) by adding at the end the following:
‘‘(B) in cases where the entity’s function is
also described by subparagraph (A), and upon
the approval of the relevant Federal agency,
any aspect of the provision of health care serv-
ices and activities of providers of such services
under any Federal health care program (as de-
fined in section 1128B(f)).’’.
(b) EXTENSION
OF AUTHORITY TO INVESTIGATE
AND PROSECUTE PATIENT ABUSE
IN NON-MEDICAID
BOARD AND CARE FACILITIES.—Section 1903(q)(4) (42
U.S.C. 1396b(q)(4)) is amended to read as follows:
‘‘(4)(A) The entity has—
‘‘(i) procedures for reviewing complaints of
abuse or neglect of patients in health care fa-
cilities which receive payments under the State
plan under this title;
‘‘(ii) at the option of the entity, procedures
for reviewing complaints of abuse or neglect of
patients residing in board and care facilities;
and
‘‘(iii) procedures for acting upon such com-
plaints under the criminal laws of the State or
for referring such complaints to other State
agencies for action.
‘‘(B) For purposes of this paragraph, the term
‘board and care facility’ means a residential setting
which receives payment from or on behalf of two or
more unrelated adults who reside in such facility,
and for whom one or both of the following is pro-
vided:
‘‘(i) Nursing care services provided by, or
under the supervision of, a registered nurse, li-
censed practical nurse, or licensed nursing as-
sistant.
‘‘(ii) Personal care services that assist resi-
dents with the activities of daily living, includ-
ing personal hygiene, dressing, bathing, eating,
toileting, ambulation, transfer, positioning, self-
medication, body care, travel to medical serv-
ices, essential shopping, meal preparation, laun-
dry, and housework.’’.
SEC. 112. ENSURING THE INTEGRITY OF THE FEDERAL
HOSPITAL INSURANCE TRUST FUND.
(a) DETERMINATION.—Prior to the end of each fiscal
year, the Secretary of Health and Human Services (in this
section referred to as the ‘‘Secretary’’) and the Attorney
General shall jointly determine—
(1) the portion of the costs charged during the
fiscal year to any account established within the
Federal Hospital Insurance Trust Fund (in this sec-
tion referred to as ‘‘trust fund’’) under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.)
to combat health care waste, fraud, and abuse, that
do not relate to the administration of the medicare
program; and
(2) the amount of funds deposited into such ac-
count of the trust fund during a fiscal year that
were attributable to enforcement activities that were
intended to combat health care waste, fraud, and
abuse, that do not relate to the administration of the
medicare program.
(b) CERTIFICATION.—If the portion determined
under paragraph (1) of subsection (a) exceeds the amount
determined under paragraph (2) of such subsection, the
Secretary and the Attorney General shall certify to the
Secretary of the Treasury the amount, which shall be
equal to the amount of the excess, which should be trans-
ferred from the General Fund of the Treasury to the trust
fund, in order to ensure that the trust fund is fully reim-
bursed for any expenditures made from the account de-
scribed in subsection (a) that are not related to the admin-
istration of the medicare program under title XVIII of the
Social Security Act.
(c) TRANSFER OF FUNDS.—The Secretary of the
Treasury shall transfer to the trust fund from the General
Fund of the Treasury, out of any funds in the General
Fund that are not otherwise appropriated, an amount
equal to the amount certified under subsection (b).
SEC. 113. REQUIREMENT FOR ANNUAL GAO REPORT.
Section 1817(k)(6) (42 U.S.C. 1395i(k)(6)) is
amended—
(1) in the matter preceding subparagraph (A),
by striking ‘‘2000, 2002, and 2004,’’ and inserting
‘‘2000 and each subsequent year through 2004’’;
and
(2) in subparagraph (A)—
(A) in clause (i), by striking ‘‘two fiscal
years’’ and inserting ‘‘fiscal year’’; and
(B) in clause (ii), by striking ‘‘fiscal years’’
and inserting ‘‘fiscal year’’.
SEC. 114. PROHIBITION ON CONSIDERATION OF LEGISLA-
TION THAT DIVERTS SAVINGS ACHIEVED
THROUGH MEDICARE WASTE, FRAUD, AND
ABUSE ENFORCEMENT ACTIVITIES FOR PUR-
POSES OTHER THAN IMPROVING THE SOL-
VENCY OF THE FEDERAL HOSPITAL INSUR-
ANCE TRUST FUND.
(a) POINT OF ORDER.—It shall not be in order in
the Senate to consider any bill, conference report, or any
other legislation that would use savings achieved through
enforcement activities that are intended to combat waste,
fraud, and abuse under the medicare program under title
XVIII of the Social Security Act as offsets for purposes
other than to improve the solvency of the Federal Hospital
Insurance Trust Fund established under section 1817 of
such Act (42 U.S.C. 1395i).
(b) WAIVER.—The point of order described in sub-
section (a) may be waived or suspended in the Senate by
a 3⁄5 majority vote of the Senators duly chosen and sworn,
or by the unanimous consent of the Senate.
(c) APPEALS.—
(1) IN GENERAL.—Appeals in the Senate from
decisions of the Chair relating to this section shall
be limited to 1 hour, to be equally divided between
and controlled by, the appellant and the manager of
the bill, conference report, or other legislation, as
the case may be.
(2) WAIVER.—An affirmative 3⁄5 majority vote
of the Senators duly chosen and sworn, or a unani-
mous consent agreement of the Senate shall be re-
quired to sustain an appeal of the ruling of the
Chair on a point of order raised under this section.
TITLE II—SANCTIONS FOR
FRAUD AND ABUSE
SEC. 201. CIVIL MONETARY PENALTIES FOR KICKBACKS.
(a) PERMITTING SECRETARY TO IMPOSE CIVIL MON-
ETARY PENALTY.—Section 1128A(a) (42 U.S.C. 1320a–
7a(a)) is amended—
(1) by striking ‘‘or’’ at the end of paragraph
(4);
(2) by adding ‘‘or’’ at the end of paragraph (5);
and
(3) by adding after paragraph (5) the following:
‘‘(6) commits an act described in paragraph (1)
or (2) of section 1128B(b);’’.
(b) DESCRIPTION OF CIVIL MONETARY PENALTY AP-
PLICABLE.—Section 1128A(a) (42 U.S.C. 1320a–7a(a))
(as amended by subsection (a) of this section) is amended
in the matter following paragraph (6)—
(1) by striking ‘‘occurs).’’ and inserting ‘‘oc-
curs; in cases under paragraph (6), $50,000 for each
such act).’’; and
(2) by inserting after ‘‘of such claim’’ the fol-
lowing: ‘‘(or, in cases under paragraph (6), damages
of not more than 3 times the total amount of remu-
neration offered, paid, solicited, or received, without
regard to whether a portion of such remuneration
was offered, paid, solicited, or received for a lawful
purpose)’’.
SEC. 202. CIVIL MONETARY PENALTIES FOR PERSONS THAT
CONTRACT WITH EXCLUDED INDIVIDUALS.
Section 1128A(a) (42 U.S.C. 1320a–7a(a)) (as
amended by section 201(a) of this Act) is amended—
(1) by striking ‘‘or’’ at the end of paragraph
(5);
(2) by adding ‘‘or’’ at the end of paragraph (6);
and
(3) by adding after paragraph (6) the following:
‘‘(7) arranges or contracts (by employment or
otherwise) with an individual or entity that the per-
son knows or should know is excluded from partici-
pation in a Federal health care program (as defined
in section 1128B(f)), for the provision of items or
services for which payment may be made under such
a program;’’.
SEC. 203. CIVIL MONETARY PENALTIES FOR SERVICES OR-
DERED OR PRESCRIBED BY AN EXCLUDED IN-
DIVIDUAL OR ENTITY.
Section 1128A(a)(1) (42 U.S.C. 1320a–7a(a)(1)) is
amended—
(1) in subparagraph (D)—
(A) by inserting ‘‘, ordered, or prescribed
by a person’’ after ‘‘other item or service fur-
nished’’;
(B) by inserting ‘‘(under this title or title
XVIII) after ‘‘period in which the person was
excluded’’;
(C) by striking ‘‘pursuant to a determina-
tion by the Secretary’’ and all that follows
through ‘‘the provisions of section 1842(j)’’;
and
(D) by striking ‘‘or’’ at the end; and
(2) by redesignating subparagraph (E) as sub-
paragraph (F); and
(3) by adding after subparagraph (D) the fol-
lowing:
‘‘(E) is for a medical or other item or serv-
ice ordered or prescribed by a person excluded
(under this title or title XVIII) from the pro-
gram under which the claim was made, and the
person furnishing such item or service knows or
should know of such exclusion, or’’.
TITLE 
III—TECHNICAL 
CLARI-
FICATIONS 
AND 
CORREC-
TIONS
SEC. 301. DEFINITION OF THE TERM CONVICTION.
Section 1128E(g)(5) (42 U.S.C. 1320a–7e(g)(5)) is
amended by striking ‘‘paragraph (4) of’’ and inserting
‘‘paragraphs (1) through (4)’’.
SEC. 302. PROPER REFERENCE IN ADVISORY OPINIONS.
Section 
1128D(b)(2)(D) 
(42 
U.S.C. 
1320a–
7d(b)(2)(D)) is amended by striking ‘‘1128B(b)’’ and in-
serting ‘‘1128A(b)’’.
SEC. 303. ENSURING PROPER IMPLEMENTATION OF FED-
ERAL HEALTH CARE PROGRAM EXCLUSIONS.
Section 1128 (42 U.S.C. 1320a–7) is amended—
(1) in subsection (a), by striking ‘‘program
under title XVIII and shall direct that the following
individuals and entities be excluded from participa-
tion in any State health care program (as defined in
subsection (h))’’ and inserting ‘‘Federal health care
program (as defined in section 1128B(f))’’; and
(2) in subsection (b), by striking ‘‘program
under title XVIII and may direct that the following
individuals and entities be excluded from participa-
tion in any State health care program’’ and inserting
‘‘Federal health care program (as defined in section
1128B(f))’’.
TITLE IV—COORDINATION OF
BENEFITS
SEC. 401. PERMANENT EXTENSION OF CERTAIN SECOND-
ARY PAYER PROVISIONS.
(a) WORKING DISABLED.—Section 1862(b)(1)(B)
(42 U.S.C. 1395y(b)(1)(B)) is amended by striking clause
(iii).
(b) INDIVIDUALS WITH END STAGE RENAL DIS-
EASE.—Section 
1862(b)(1)(C) 
(42 
U.S.C.
1395y(b)(1)(C)) is amended—
(1) in the first sentence, by striking ‘‘12-
month’’ each place it occurs and inserting ‘‘18-
month’’; and
(2) by striking the second sentence.
(c) IRS-SSA-HCFA DATA MATCH.—
(1) 
SOCIAL
SECURITY
ACT.—Section
1862(b)(5)(C) 
(42 
U.S.C. 
1395y(b)(5)(C)) 
is
amended by striking clause (iii).
(2) 
INTERNAL
REVENUE
CODE.—Section
6103(l)(12) of the Internal Revenue Code of 1986 is
amended by striking subparagraph (F).
SEC. 402. TECHNICAL CHANGES CONCERNING MINIMUM
SIZES OF GROUP HEALTH PLANS.
(a) PLACEMENT OF ‘‘GROUP HEALTH PLAN’’ DEFI-
NITION IN SOCIAL SECURITY ACT.—
(1) DEFINITION.—Section 1862(b)(1)(E) (42
U.S.C. 1395y(b)(1)(E)) is amended by adding at the
end the following:
‘‘(iv) GROUP
HEALTH
PLAN
DE-
FINED.—The term ‘group health plan’
means a plan (including a self-insured
plan) of, or contributed to by, an employer
or employee organization to provide health
care (directly or otherwise) to the employ-
ees, former employees, the employer, oth-
ers associated or formerly associated with
the employer in a business relationship, or
their families.’’.
(2) CONFORMING AMENDMENTS.—
(A) 
SECTION
1862(b)(1)(A).—Section
1862(b)(1)(A) (42 U.S.C. 1395y(b)(1)(A)) is
amended by striking clause (v).