‘‘(A) each agency responsible for promul-
gating relevant regulations, guidelines, and bill-
ing instructions, directly or through inter-
mediaries, has examined all regulations, guide-
lines, and billing instructions relevant to the al-
legations, all communications between the al-
leged perpetrator and the agency and its inter-
mediaries, and each of the allegedly false 
claims; 
‘‘(B) in the view of the responsible agency 
officials and the Attorney General, the allega-
tions under investigation are viable, and the rel-
evant regulations, guidelines and billing instruc-
tions were unambiguous during the relevant 
time period; and 
‘‘(C) if proven to be true, the allegations 
are appropriately pursued under section 3729. 
‘‘(2) IF CERTIFICATION NOT MADE.—If the At-
torney General (or his or her designee) is unable to 
make the certifications required under paragraph 
(1), and the allegations were included in an action 
brought by a person under section 3730(b), the At-
torney General shall notify the court and the court 
shall dismiss these allegations. 
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‘‘(c) ACTIONS IF AMOUNT OF DAMAGES ARE MATE-
RIAL AMOUNT.—Notwithstanding sections 3729 through 
3733, no action may be brought under section 3730 that 
is based on a claim submitted or an overpayment retained 
with respect to a Federal health care program unless the 
amount of damages alleged to have been sustained by the 
United States Government with respect to such claim or 
overpayment is a material amount. 
‘‘(d) ACTIONS FOR CLAIMS SUBMITTED IN RELIANCE 
ON OFFICIAL GUIDANCE.—Notwithstanding sections 3729 
through 3733, no action may be brought under section 
3730 based on a claim submitted or an overpayment re-
tained with respect to a Federal health care program— 
‘‘(1) in good faith reliance on erroneous infor-
mation supplied by an agency (or an agent thereof) 
about matters of fact at issue; 
‘‘(2) in good faith reliance on written state-
ments of Federal policy that affects the claim or 
overpayment that were provided by a Federal agency 
(or an agent thereof); or 
‘‘(3) in good faith reliance on an audit or re-
view by an agency of the person submitting the 
claim or on whose behalf the claim was submitted, 
or of the person retaining the overpayment, in which 
no findings were made that the claim or overpay-
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ment violated the regulations, guidelines, or instruc-
tions applicable to the Federal health care program 
at issue in the claim or overpayment. 
‘‘(e) ACTION FOR CLAIMS SUBMITTED BY PERSONS 
IN SUBSTANTIAL COMPLIANCE WITH MODEL COMPLI-
ANCE PLAN.—Notwithstanding sections 3729 through 
3733, no action may be brought under section 3730 based 
on a claim submitted by or on behalf of a person, or an 
overpayment retained, with respect to a Federal health 
care program if the claim is submitted, or the overpay-
ment retained, in substantial compliance with a model 
compliance plan issued by the Secretary of Health and 
Human Services with respect to that Federal health care 
program. 
‘‘(f) STANDARD OF PROOF.—In any action brought 
under section 3730 with respect to a claim submitted, or 
an overpayment retained, with respect to a Federal health 
care program, section 3731(c) shall be applied by sub-
stituting ‘clear and convincing evidence’ for ‘a preponder-
ance of the evidence’. 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to limit the authority of the Gov-
ernment of the United States to recover damages with re-
spect to a claim submitted, or an overpayment retained, 
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with respect to a Federal health care program under provi-
sions of law other than section 3729. 
‘‘(h) DEFINITIONS; SPECIAL RULES.—For purposes 
of this section— 
‘‘(1) the term ‘claim’ means a claim as defined 
in section 3729(c); 
‘‘(2) the term ‘Federal health care program’ 
means— 
‘‘(A) any plan or program that provides 
health care benefits, whether directly, through 
insurance, or otherwise, and that is funded di-
rectly, in whole or in part, by the United States 
Government; 
‘‘(B) any State health care program, as de-
fined in section 1128(h) of the Social Security 
Act; or 
‘‘(C) any qualifying health plan offered 
through an Exchange established under, or any 
other health plan established under, the Patient 
Protection and Affordable Care Act (Public 
Law 111–148); 
‘‘(3) 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’ 
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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 Federal health care pro-
gram, and 
‘‘(B) for the same calendar year, 
as the claim upon which an action under section 
3730 is based; 
‘‘(4) in determining whether an amount of dam-
ages is a ‘material amount’ under paragraph (3), 
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 paragraph (3) 
shall be determined by comparing the amount 
of such aggregate damages to the total of the 
amounts for which claims were submitted by (or 
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on behalf of) such person to the same Federal 
health care program for each of the calendar 
years for which any claim upon which such ag-
gregate damages were based was submitted; 
‘‘(5) the term ‘intermediary’ means, with re-
spect to a Federal health care program, a contractor 
with an agency, a State, or other entity that is en-
gaged in the implementation of that Federal health 
care program; and 
‘‘(6) the term ‘State’ means each of the several 
States, the District of Columbia, and any territory 
or possession of the United States.’’. 
(b) CONFORMING AMENDMENT.—The table of sec-
tions for chapter 37 of title 31, United States Code, is 
amended by adding at the end the following new item: 
‘‘3734. Rules for certain actions based on health care claims.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to any action or investigation 
under sections 3729 through 3733 of title 31, United 
States Code, that is pending on, or commenced on or after, 
the date of the enactment of this Act. 
Æ 
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