I 
113TH CONGRESS 
2D SESSION 
H. R. 5340 
To amend title XI of the Social Security Act to expand the permissive 
exclusion from Federal health programs to include certain individuals 
with prior interest in sanctioned entities and entities affiliated with 
sanctioned entities and to provide a criminal penalty for the illegal 
distribution of Medicare, Medicaid, or CHIP beneficiary identification 
or provider numbers, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 31, 2014 
Ms. FRANKEL of Florida (for herself and Mr. KEATING) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XI of the Social Security Act to expand 
the permissive exclusion from Federal health programs 
to include certain individuals with prior interest in sanc-
tioned entities and entities affiliated with sanctioned enti-
ties and to provide a criminal penalty for the illegal 
distribution of Medicare, Medicaid, or CHIP beneficiary 
identification or provider numbers, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Fighting Medicare 
Fraud Act of 2014’’. 
SEC. 2. PERMISSIVE EXCLUSION FROM FEDERAL HEALTH 
PROGRAMS EXPANDED TO CERTAIN INDIVID-
UALS WITH PRIOR INTEREST IN SANCTIONED 
ENTITIES AND ENTITIES AFFILIATED WITH 
SANCTIONED ENTITIES. 
Paragraph (15) of section 1128(b) of the Social Secu-
rity Act (42 U.S.C. 1320a–7(b)) is amended to read as 
follows: 
‘‘(15) INDIVIDUALS AND ENTITIES AFFILIATED 
WITH A SANCTIONED ENTITY.—(A) Any of the fol-
lowing: 
‘‘(i) Any individual who— 
‘‘(I) is a person with an ownership or 
control interest in a sanctioned entity or 
an affiliated entity of such sanctioned enti-
ty (or was a person with such an owner-
ship or control interest at the time of any 
of the conduct that formed a basis for the 
conviction or exclusion described in sub-
paragraph (B)); and 
‘‘(II) knows or should have known (as 
defined in section 1128A(i)(7)) (or knew or 
should have known) of such conduct. 
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‘‘(ii) Any individual who is an officer or 
managing employee (as defined in section 
1126(b)) of a sanctioned entity or affiliated en-
tity of such sanctioned entity (or was such an 
officer or managing employee at the time of any 
of the conduct that formed a basis for the con-
viction or exclusion described in subparagraph 
(B)). 
‘‘(iii) Any affiliated entity of a sanctioned 
entity. 
‘‘(B) For purposes of this paragraph, the term 
‘sanctioned entity’ means an entity— 
‘‘(i) that has been convicted of any offense 
described in subsection (a) of this section or in 
paragraph (1), (2), or (3) of this subsection; or 
‘‘(ii) that has been excluded from partici-
pation under a program under title XVIII or 
under a State health care program. 
‘‘(C) For purposes of subparagraph (A), the 
term ‘affiliated entity’ means, with respect to a 
sanctioned entity, an entity that is (or was at the 
time of any of the conduct that formed the basis for 
the conviction or exclusion described in subpara-
graph (B)) affiliated with such sanctioned entity, 
and includes an entity— 
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‘‘(i) that is a person with an ownership or 
control interest in such sanctioned entity (or 
was such a person with respect to such sanc-
tioned entity at the time of any conduct that 
formed the basis for the conviction described in 
subparagraph (B)); 
‘‘(ii) with respect to which a sanctioned en-
tity is a person with an ownership or control in-
terest in such entity (or was such a person with 
respect to such entity at the time of any con-
duct that formed the basis for the conviction 
described in subparagraph (B)); 
‘‘(iii) with respect to which a person with 
an ownership or control interest in such entity 
also has such an interest in such sanctioned en-
tity; 
‘‘(iv) with respect to which a person who is 
an officer or managing employee (as defined in 
section 1126(b)) of such entity also is such an 
officer or managing employee of such sanc-
tioned entity. 
‘‘(D) For purposes of this paragraph, the term 
‘person with an ownership or control interest’ has 
the 
meaning 
given 
such 
term 
in 
section 
1124(a)(3).’’. 
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SEC. 3. CRIMINAL PENALTY FOR ILLEGAL DISTRIBUTION 
OF MEDICARE, MEDICAID, OR CHIP BENE-
FICIARY 
IDENTIFICATION 
OR 
PROVIDER 
NUMBERS. 
Section 1128B(b) of the Social Security Act (42 
U.S.C. 1320a–7b(b)) is amended by adding at the end the 
following: 
‘‘(4) Whoever knowingly and with the intent to de-
fraud purchases, sells or distributes, or arranges for the 
purchase, sale, or distribution of two or more Medicare, 
Medicaid, or Children’s Health Insurance Program bene-
ficiary identification numbers or provider numbers under 
title XVIII, XIX, or XXI shall be imprisoned for not more 
than 15 years or fined under title 18, United States Code 
(or, if greater, an amount equal to the monetary loss to 
the Federal and any State government as a result of such 
acts), or both.’’. 
SEC. 4. REPORTS ON INCIDENCES OF FRAUD AND ABUSE 
UNDER MEDICARE PARTS C AND D. 
(a) IN GENERAL.—Section 1857(d) of the Social Se-
curity Act (42 U.S.C. 1395w–27(d)) is amended by adding 
at the end the following new paragraph: 
‘‘(7) REPORT ON INCIDENCES OF FRAUD AND 
ABUSE.— 
‘‘(A) IN GENERAL.—A contract under this 
section with an MA organization offering an 
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