[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4225 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4225

To amend title I of the Employee Retirement Income Security Act of 1974 
 to establish liability for individuals practicing medicine without a 
            license in connection with a group health plan.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 15, 1998

 Mr. Kennedy of Rhode Island introduced the following bill; which was 
        referred to the Committee on Education and the Workforce

_______________________________________________________________________

                                 A BILL


 
To amend title I of the Employee Retirement Income Security Act of 1974 
 to establish liability for individuals practicing medicine without a 
            license in connection with a group health plan.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``No Practice of 
Medicine Without a License Act of 1998''.
    (b) Purpose.--It is the purpose of this Act to establish a cause of 
action against the practice of medicine by unlicensed persons in the 
provision of benefits under a group health plan.

SEC. 2. RECOVERY OF DAMAGES FOR UNAUTHORIZED PRACTICE OF MEDICINE IN 
              CONNECTION WITH A GROUP HEALTH PLAN.

    Section 502(c) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1132(c)) is amended--
            (1) by redesignating paragraph (7) as paragraph (8); and
            (2) by inserting after paragraph (6) the following new 
        paragraph:
    ``(7)(A) In any case in which a person engages in any activity in 
connection with a group health plan that constitutes the unauthorized 
practice of medicine, such person--
            ``(i) shall be liable to any participant or beneficiary 
        aggrieved by such activity for actual damages (including 
        compensatory and consequential damages proximately caused by 
        such activity), and
            ``(ii) may be liable to such participant or beneficiary for 
        punitive or exemplary damages in addition to the damages 
        described in clause (i).
    ``(B) For purposes of this paragraph, the term `unauthorized 
practice of medicine' means any of the following acts performed by an 
individual who is not authorized under applicable State law to perform 
such an act:
            ``(i) Offering or undertaking to diagnose, treat, cure, or 
        correct, to prescribe, recommend, or direct treatment for, or 
        to consult or advise regarding any human disease, ailment, 
        injury, infirmity, deformity, pain, or other condition, 
        physical or mental, real or imaginary, by any means or 
        instrumentality.
            ``(ii) Directing a group health plan to withhold or alter 
        medical care that the physician of a participant or beneficiary 
        has ordered.
            ``(iii) Performing, for compensation, a service 
        constituting the healing arts that would effect the diagnosis 
        or treatment of an individual, through the use of any medium 
        (including an electronic medium), in a State other than a State 
        in which the individual is authorized by applicable State law 
        to perform such service.
            ``(iv) Maintaining an office or place of business for the 
        purpose of doing any of the acts described in clauses (i) 
        through (iii), whether or not for compensation.
            ``(v) In the case of an individual who is not licensed 
        under applicable State law as a physician or surgeon--
                    ``(I) using, in the conduct of any occupation or 
                profession pertaining to the diagnosis or treatment of 
                human diseases or conditions, in any printed material, 
                stationery, letterhead, or envelope, the designation 
                `doctor', `doctor of medicine', `physician', or 
                `surgeon', the designation of `Dr.', `MD', or any 
                combinations of these designations, in any manner which 
                might cause a reasonable person to believe that the 
                individual is a licensed physician and surgeon, and
                    ``(II) if the individual using any designation 
                described in subclause (I) is not so licensed in 
                connection with a particular branch of the healing 
                arts, failing to disclose the lack of such a license.
    ``(C) A person referred to in subparagraph (A) may include an agent 
or employee in connection with a health maintenance organization, 
managed care organization, or other health insurance issuer that 
manages, oversees, advises, makes decisions regarding, performs 
utilization review services for, or offers health insurance coverage in 
connection with the group health plan.
    ``(D) For purposes of this paragraph, terms used in this paragraph 
which are defined in section 733 shall have the meanings provided such 
terms in such section.
    ``(E) The remedies provided under this paragraph shall be in 
addition to remedies otherwise provided under this section.''.

SEC. 3. EFFECTIVE DATE.

    The amendment made by section 2 shall apply with respect to 
activities engaged in after the date of the enactment of this Act.
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