Q: In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.
SECTION 1. SHORT TITLE.

This Act may be cited as the ''Fairness in Health Care Claims,
Guidance, and Investigations Act''.

SEC. 2. RULES FOR ACTIONS UNDER FALSE CLAIMS PROVISIONS 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:
''Sec. 3734. Rules for certain actions based on health care claims
''(a) In General.--In the case of any action that is brought under
section 3730 and is based on a claim submitted with respect to a
Federal health care program, sections 3729 through 3733 shall apply
only to the extent that such sections are consistent with the
provisions of this section.
''(b) Investigations of False Claims to Federal Health Care
Programs.--
''(1) In general.--Before requesting any information from a
physician, hospital, or other provider or supplier of health
care services, by any formal or informal means, directly or in
cooperation with an investigating law enforcement agency, in
connection with an investigation reasonably expected to concern
10 or more claims submitted to a Federal health care program by
or on behalf of a single entity, the Attorney General shall
certify, in writing, that--
''(A) each agency responsible for promulgating
relevant regulations, guidelines, and billing
instructions, directly or through intermediaries, has
examined all regulations, guidelines, and billing
instructions relevant to the allegations, all
communications between the alleged perpetrator and the
agency and its intermediaries, and each of the
allegedly false claims;
''(B) in the view of the responsible agency
officials and the Attorney General, the allegations
under investigation are viable, and the relevant
regulations, guidelines and billing instructions 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 Attorney 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
Attorney General shall notify the court and the court shall
dismiss these allegations.
''(c) Actions if Amount of Damages Are Material 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
retained with respect to a Federal health care program--
''(1) in good faith reliance on erroneous information
supplied by an agency (or an agent thereof) about matters of
fact at issue;
''(2) in good faith reliance on written statements 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 review 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
overpayment violated the regulations, guidelines, or
instructions 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 Compliance 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 overpayment 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 substituting 'clear and convincing evidence' for 'a
preponderance of the evidence'.
''(g) Rule of Construction.--Nothing in this section shall be
construed to limit the authority of the Government of the United States
to recover damages with respect to a claim submitted, or an overpayment
retained, with respect to a Federal health care program under
provisions 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 directly, in whole or in
part, by the United States Government;
''(B) any State health care program, as defined 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' 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 program, 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 damages 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 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
aggregate damages were based was submitted;
''(5) the term 'intermediary' means, with respect to a
Federal health care program, a contractor with an agency, a
State, or other entity that is engaged 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 sections 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.
A:
Fairness in Health Care Claims, Guidance, and Investigations Act - Amends the False Claims Act to set forth special rules for the investigation and prosecution of false claims submitted with respect to a federal health care program (i.e., a health care program funded by the federal government, a state health care program defined by the Social Security Act, or a health plan offered under the Patient Protection and Affordable Care Act). Requires the Attorney General to certify in writing, prior to requesting any information from a physician, hospital, or other provider or supplier of health care services in connection with an investigation reasonably expected to concern 10 or more claims submitted to a federal health care program by or on behalf of a single entity, that: (1) each agency responsible for promulgating relevant regulations, guidelines, and billing instructions relevant to any allegations of fraud has examined such regulations, guidelines, and instructions, all communications between the alleged perpetrator of the fraud and the agency, and each of the allegedly false claims; (2) the allegations under investigation are viewed as viable based on unambiguous regulations, guidelines, and billing instructions issued during the relevant time period; and (3) if proven to be true, the allegations will be pursued under the False Claims Act. Prohibits an action against a health care provider or supplier under the False Claims Act: (1) unless the amount of damages alleged to have been sustained by the government is a material amount, (2) if a claim is submitted in good faith reliance on erroneous information or written statements of federal policy provided by a federal agency or in good faith reliance on an audit or review by an agency of the entity submitting the claim or retaining an overpayment, or (3) if a claim is submitted in substantial compliance with a model compliance plan issued by the Secretary of Health and Human Services (HHS). Establishes the standard of proof necessary for a civil prosecution of a claim submitted with respect to a federal health care program as clear and convincing evidence (currently, a preponderance of the evidence is required for all other claims).