[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 545 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 545

     To combat fraud in, and to improve the administration of, the 
disability programs under titles II and XVI of the Social Security Act.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 3, 1999

Mrs. Johnson of Connecticut (for herself and Mr. Cardin) introduced the 
 following bill; which was referred to the Committee on Ways and Means

_______________________________________________________________________

                                 A BILL


 
     To combat fraud in, and to improve the administration of, the 
disability programs under titles II and XVI of the Social Security Act.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``SSI Fraud 
Prevention Act of 1999''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Primary liability of representative payees for overpayments to 
                            deceased recipients.
Sec. 3. Requirement to provide State prisoner information to Federal 
                            and federally assisted benefit programs.
Sec. 4. Recovery of overpayments of SSI benefits from lump sum SSI 
                            benefit payments.
Sec. 5. Rules relating to collection of overpayments from individuals 
                            convicted of crimes.
Sec. 6. Additional debt collection practices.
Sec. 7. Treatment of assets held in trust under the SSI program.
Sec. 8. Disposal of resources for less than fair market value under the 
                            SSI program.
Sec. 9. Loss of benefits as penalty for fraud.
Sec. 10. Exclusion of attorneys and physicians convicted of violations 
                            from participation in social security 
                            disability programs.
Sec. 11. Annual reviews by State disability determination services of 
                            professionals conducting consultative 
                            examinations.
Sec. 12. Computer matches with medicare and medicaid 
                            institutionalization data.
Sec. 13. Access to information held by financial institutions.
Sec. 14. State data exchanges.
Sec. 15. Study on possible measures to improve fraud prevention and 
                            administrative processing.
Sec. 16. Annual report on amounts necessary to combat fraud.

SEC. 2. PRIMARY LIABILITY OF REPRESENTATIVE PAYEES FOR OVERPAYMENTS TO 
              DECEASED RECIPIENTS.

    (a) Amendment to Title II.--Section 204(a)(2) of the Social 
Security Act (42 U.S.C. 404(a)(2)) is amended by adding at the end the 
following new sentence: ``If the payment is made to a representative 
payee on behalf of an individual who has died, the representative payee 
shall be primarily liable for the repayment of the overpayment, and the 
Commissioner of Social Security shall establish an overpayment control 
record under the social security account number of the representative 
payee.''.
    (b) Amendment to Title XVI.--Section 1631(b)(2) of such Act (42 
U.S.C. 1383(b)(2)) is amended by adding at the end the following new 
sentence: ``If the payment is made to a representative payee on behalf 
of an individual who has died, the representative payee shall be 
primarily liable for the repayment of the overpayment, and the 
Commissioner of Social Security shall establish an overpayment control 
record under the social security account number of the representative 
payee.''.

SEC. 3. REQUIREMENT TO PROVIDE STATE PRISONER INFORMATION TO FEDERAL 
              AND FEDERALLY ASSISTED BENEFIT PROGRAMS.

    Section 1611(e)(1)(I)(ii)(II) of the Social Security Act (42 U.S.C. 
1382(e)(1)(I)(ii)(II)) is amended by striking ``is authorized to'' and 
inserting ``shall''.

SEC. 4. RECOVERY OF OVERPAYMENTS OF SSI BENEFITS FROM LUMP SUM SSI 
              BENEFIT PAYMENTS.

    (a) In General.--Section 1631(b)(1)(B)(ii) of the Social Security 
Act (42 U.S.C. 1383(b)(1)(B)(ii)) is amended--
            (1) by inserting ``monthly'' before ``benefit payments''; 
        and
            (2) by inserting ``and in the case of an individual or 
        eligible spouse to whom a lump sum is payable under this title 
        (including under section 1616(a) of this Act or under an 
        agreement entered into under section 212(a) of Public Law 93-
        66) shall, as at least one means of recovering such 
        overpayment, make the adjustment or recovery from the lump sum 
        payment in an amount equal to not less than the lesser of the 
        amount of the overpayment or 50 percent of the lump sum 
        payment,'' before ``unless fraud''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act and shall apply to 
amounts incorrectly paid which remain outstanding on or after such 
date.

SEC. 5. RULES RELATING TO COLLECTION OF OVERPAYMENTS FROM INDIVIDUALS 
              CONVICTED OF CRIMES.

    (a) Waivers Inapplicable to Overpayments by Reason of Payment in 
Months in Which Beneficiary Is a Prisoner or a Fugitive.--
            (1) Amendment to title ii.--Section 204(b) of the Social 
        Security Act (42 U.S.C. 404(b)) is amended--
                    (A) by inserting ``(1)'' after ``(b)''; and
                    (B) by adding at the end the following:
    ``(2) Paragraph (1) shall not apply with respect to any payment to 
any person made during a month in which such benefit was not payable 
under section 202(x).''.
            (2) Amendment to title xvi.--Section 1631(b)(1)(B)(i) of 
        such Act (42 U.S.C. 1383(b)(1)(B)(i)) is amended by inserting 
        ``unless (I) section 1611(e)(1) prohibits payment to the person 
        of a benefit under this title for the month by reason of 
        confinement of a type described in clause (i) or (ii) of 
        section 202(x)(1)(A), or (II) section 1611(e)(5) prohibits 
        payment to the person of a benefit under this title for the 
        month,'' after ``administration of this title''.
    (b) 10-Year Period of Ineligibility for Persons Failing To Notify 
Commissioner of Overpayments in Months in Which Beneficiary Is a 
Prisoner or a Fugitive or Failing To Comply With Repayment Schedule for 
Such Overpayments.--
            (1) Amendment to title ii.--Section 202(x) of such Act (42 
        U.S.C. 402(x)) is amended by adding at the end the following:
    ``(4)(A) No person shall be considered entitled to monthly 
insurance benefits under this section based on the person's disability 
or to disability insurance benefits under section 223 otherwise payable 
during the 10-year period that begins on the date the person--
            ``(i) knowingly fails to timely notify the Commissioner of 
        Social Security, in connection with any application for 
        benefits under this title, of any prior receipt by such person 
        of any benefit under this title or title XVI in any month in 
        which such benefit was not payable under the preceding 
        provisions of this subsection, or
            ``(ii) knowingly fails to comply with any schedule imposed 
        by the Commissioner which is for repayment of overpayments 
        comprised of payments described in subparagraph (A) and which 
        is in compliance with section 204.
    ``(B) The Commissioner of Social Security shall, in addition to any 
other relevant factors, take into account any mental or linguistic 
limitations of a person (including any lack of facility with the 
English language) in determining whether the person has knowingly 
failed to comply with a requirement of clause (i) or (ii) of 
subparagraph (A).''.
            (2) Amendment to title xvi.--Section 1611(e)(1) of such Act 
        (42 U.S.C. 1382(e)(1)) is amended by adding at the end the 
        following:
    ``(J)(i) A person shall not be considered an eligible individual or 
eligible spouse for purposes of benefits under this title by reason of 
disability, during the 10-year period that begins on the date the 
person--
            ``(I) knowingly fails to timely notify the Commissioner of 
        Social Security, in an application for benefits under this 
        title, of any prior receipt by the person of a benefit under 
        this title or title II in a month in which payment to the 
        person of a benefit under this title was prohibited by--
                    ``(aa) the preceding provisions of this paragraph 
                by reason of confinement of a type described in clause 
                (i) or (ii) of section 202(x)(1)(A); or
                    ``(bb) section 1611(e)(5); or
            ``(II) knowingly fails to comply with any schedule imposed 
        by the Commissioner which is for repayment of overpayments 
        comprised of payments described in clause (i) of this 
        subparagraph and which is in compliance with section 1631(b).
    ``(ii) The Commissioner of Social Security shall, in addition to 
any other relevant factors, take into account any mental or linguistic 
limitations of a person (including any lack of facility with the 
English language) in determining whether the person has knowingly 
failed to comply with a requirement of subclause (I) or (II) of clause 
(i).''.
    (c) Continued Collection Efforts Against Prisoners.--
            (1) Amendment to title ii.--Section 204(b) of such Act (as 
        amended by subsection (a)(1)) is amended further by adding at 
        the end the following new paragraph:
    ``(3) The Commissioner shall not refrain from recovering 
overpayments from resources currently available to any overpaid person 
or to such person's estate solely because such individual is confined 
as described in clause (i) or (ii) of section 202(x)(1)(A).''.
            (2) Amendment to title xvi.--Section 1631(b)(1)(A) of such 
        Act (42 U.S.C. 1383(b)(1)(A)) is amended by adding after and 
        below clause (ii) the following flush left sentence:
``The Commissioner shall not refrain from recovering overpayments from 
resources currently available to any individual solely because the 
individual is confined as described in clause (i) or (ii) of section 
202(x)(1)(A).''.

SEC. 6. ADDITIONAL DEBT COLLECTION PRACTICES.

    (a) In General.--Section 1631(d)(1) of the Social Security Act (42 
U.S.C. 1383(d)(1)) is amended by striking ``section 207'' and inserting 
``sections 204(f) and 207''.
    (b) Effective Date.--The amendment made by this section shall apply 
to debt outstanding on or after the date of the enactment of this Act.

SEC. 7. TREATMENT OF ASSETS HELD IN TRUST UNDER THE SSI PROGRAM.

    (a) Treatment as Resource.--Section 1613 of the Social Security Act 
(42 U.S.C. 1382b) is amended by adding at the end the following:

                                ``Trusts

    ``(e)(1) In determining the resources of an individual, paragraph 
(3) shall apply to a trust (other than a trust described in paragraph 
(5)) established by the individual.
    ``(2)(A) For purposes of this subsection, an individual shall be 
considered to have established a trust if any assets of the individual 
(or of the individual's spouse) are transferred to the trust other than 
by will.
    ``(B) In the case of an irrevocable trust to which are transferred 
the assets of an individual (or of the individual's spouse) and the 
assets of any other person, this subsection shall apply to the portion 
of the trust attributable to the assets of the individual (or of the 
individual's spouse).
    ``(C) This subsection shall apply to a trust without regard to--
            ``(i) the purposes for which the trust is established;
            ``(ii) whether the trustees have or exercise any discretion 
        under the trust;
            ``(iii) any restrictions on when or whether distributions 
        may be made from the trust; or
            ``(iv) any restrictions on the use of distributions from 
        the trust.
    ``(3)(A) In the case of a revocable trust established by an 
individual, the corpus of the trust shall be considered a resource 
available to the individual.
    ``(B) In the case of an irrevocable trust established by an 
individual, if there are any circumstances under which payment from the 
trust could be made to or for the benefit of the individual or the 
individual's spouse, the portion of the corpus from which payment to or 
for the benefit of the individual or the individual's spouse could be 
made shall be considered a resource available to the individual.
    ``(4) The Commissioner of Social Security may waive the application 
of this subsection with respect to an individual if the Commissioner 
determines that such application would work an undue hardship on the 
individual.
    ``(5) This subsection shall not apply to a trust described in 
subparagraph (A) or (C) of section 1917(d)(4).
    ``(6) For purposes of this subsection--
            ``(A) the term `trust' includes any legal instrument or 
        device that is similar to a trust;
            ``(B) the term `corpus' means, with respect to a trust, all 
        property and other interests held by the trust, including 
        accumulated earnings and any other addition to the trust after 
        its establishment (except that such term does not include any 
        such earnings or addition in the month in which the earnings or 
        addition is credited or otherwise transferred to the trust); 
        and
            ``(C) the term `asset' includes any income or resource of 
        the individual or of the individual's spouse, including--
                    ``(i) any income excluded by section 1612(b);
                    ``(ii) any resource otherwise excluded by this 
                section; and
                    ``(iii) any other payment or property to which the 
                individual or the individual's spouse is entitled but 
                does not receive or have access to because of action 
                by--
                            ``(I) the individual or spouse;
                            ``(II) a person or entity (including a 
                        court) with legal authority to act in place of, 
                        or on behalf of, the individual or spouse; or
                            ``(III) a person or entity (including a 
                        court) acting at the direction of, or on the 
                        request of, the individual or spouse.''.
    (b) Treatment as Income.--Section 1612(a)(2) of such Act (42 U.S.C. 
1382a(a)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (E);
            (2) by striking the period at the end of subparagraph (F) 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(G) any earnings of, and additions to, the corpus of a 
        trust established by an individual (within the meaning of 
        section 1613(e)), of which the individual is a beneficiary, to 
        which section 1613(e) applies, and, in the case of an 
        irrevocable trust, with respect to which circumstances exist 
        under which a payment from the earnings or additions could be 
        made to or for the benefit of the individual.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2000, and shall apply to trusts established on or 
after such date.

SEC. 8. DISPOSAL OF RESOURCES FOR LESS THAN FAIR MARKET VALUE UNDER THE 
              SSI PROGRAM.

    (a) In General.--Section 1613(c) of the Social Security Act (42 
U.S.C. 1382b(c)) is amended--
            (1) in the caption, by striking ``Notification of Medicaid 
        Policy Restricting Eligibility of Institutionalized Individuals 
        for Benefits Based on'';
            (2) in paragraph (1)--
                    (A) in subparagraph (A)--
                            (i) by inserting ``paragraph (1) and'' 
                        after ``provisions of'';
                            (ii) by striking ``title XIX'' the first 
                        place it appears and inserting ``this title and 
                        title XIX, respectively,'';
                            (iii) by striking ``subparagraph (B)'' and 
                        inserting ``clause (ii)'';
                            (iv) by striking ``paragraph (2)'' and 
                        inserting ``subparagraph (B)'';
                    (B) in subparagraph (B)--
                            (i) by striking ``by the State agency''; 
                        and
                            (ii) by striking ``section 1917(c)'' and 
                        all that follows and inserting ``paragraph (1) 
                        or section 1917(c).''; and
                    (C) by redesignating subparagraphs (A) and (B) as 
                clauses (i) and (ii), respectively;
            (3) in paragraph (2)--
                    (A) by striking ``(2)'' and inserting ``(B)''; and
                    (B) by striking ``paragraph (1)(B)'' and inserting 
                ``subparagraph (A)(ii)'';
            (4) by striking ``(c)(1)'' and inserting ``(2)(A)''; and
            (5) by inserting before paragraph (2) (as redesignated by 
        paragraph (4) of this subsection) the following:
    ``(c)(1)(A)(i) If an individual or the spouse of an individual 
disposes of resources for less than fair market value on or after the 
look-back date described in clause (ii)(I), the individual is 
ineligible for benefits under this title for months during the period 
beginning on the date described in clause (iii) and equal to the number 
of months calculated as provided in clause (iv).
    ``(ii)(I) The look-back date described in this subclause is a date 
that is 36 months before the date described in subclause (II).
    ``(II) The date described in this subclause is the date on which 
the individual applies for benefits under this title or, if later, the 
date on which the individual (or the spouse of the individual) disposes 
of resources for less than fair market value.
    ``(iii) The date described in this clause is the first day of the 
first month that follows the month in which resources were disposed of 
for less than fair market value and that does not occur in any other 
period of ineligibility under this paragraph.
    ``(iv) The number of months calculated under this clause shall be 
equal to--
            ``(I) the total, cumulative uncompensated value of all 
        resources so disposed of by the individual (or the spouse of 
        the individual) on or after the look-back date described in 
        clause (ii)(I); divided by
            ``(II) the amount of the maximum monthly benefit payable 
        under section 1611(b) for the month in which occurs the date 
        described in clause (ii)(II),
rounded up, in the case of any fraction, to the next whole number.
    ``(B)(i) Notwithstanding subparagraph (A), this subsection shall 
not apply to a transfer of a resource to a trust if the portion of the 
trust attributable to the resource is considered a resource available 
to the individual pursuant to subsection (e)(3) (or would be so 
considered but for the application of subsection (e)(4)).
    ``(ii) In the case of a trust established by an individual or an 
individual's spouse (within the meaning of subsection (e)), if from 
such portion of the trust, if any, that is considered a resource 
available to the individual pursuant to subsection (e)(3) (or would be 
so considered but for the application of subsection (e)(4)) or the 
residue of the portion on the termination of the trust--
            ``(I) there is made a payment other than to or for the 
        benefit of the individual; or
            ``(II) no payment could under any circumstance be made to 
        the individual,
then, for purposes of this subsection, the payment described in clause 
(I) or the foreclosure of payment described in clause (II) shall be 
considered a transfer of resources by the individual or the 
individual's spouse as of the date of the payment or foreclosure, as 
the case may be.
    ``(C) An individual shall not be ineligible for benefits under this 
title by reason of the application of this paragraph to a disposal of 
resources by the individual or the spouse of the individual, to the 
extent that--
            ``(i) the resources are a home and title to the home was 
        transferred to--
                    ``(I) the spouse of the transferor;
                    ``(II) a child of the transferor who has not 
                attained 21 years of age, or is blind or disabled;
                    ``(III) a sibling of the transferor who has an 
                equity interest in such home and who was residing in 
                the transferor's home for a period of at least 1 year 
                immediately before the date the transferor becomes an 
                institutionalized individual; or
                    ``(IV) a son or daughter of the transferor (other 
                than a child described in subclause (II)) who was 
                residing in the transferor's home for a period of at 
                least 2 years immediately before the date the 
                transferor becomes an institutionalized individual, and 
                who provided care to the transferor which permitted the 
                transferor to reside at home rather than in such an 
                institution or facility;
            ``(ii) the resources--
                    ``(I) were transferred to the transferor's spouse 
                or to another for the sole benefit of the transferor's 
                spouse;
                    ``(II) were transferred from the transferor's 
                spouse to another for the sole benefit of the 
                transferor's spouse;
                    ``(III) were transferred to, or to a trust 
                (including a trust described in section 1917(d)(4)) 
                established solely for the benefit of, the transferor's 
                child who is blind or disabled; or
                    ``(IV) were transferred to a trust (including a 
                trust described in section 1917(d)(4)) established 
                solely for the benefit of an individual who has not 
                attained 65 years of age and who is disabled;
            ``(iii) a satisfactory showing is made to the Secretary (in 
        accordance with regulations promulgated by the Secretary) 
        that--
                    ``(I) the individual who disposed of the resources 
                intended to dispose of the resources either at fair 
                market value, or for other valuable consideration;
                    ``(II) the resources were transferred exclusively 
                for a purpose other than to qualify for benefits under 
                this title; or
                    ``(III) all resources transferred for less than 
                fair market value have been returned to the transferor; 
                or
            ``(iv) the Secretary determines, under procedures 
        established by the Secretary, that the denial of eligibility 
        would work an undue hardship as determined on the basis of 
        criteria established by the Secretary;
    ``(D) For purposes of this subsection, in the case of a resource 
held by an individual in common with another person or persons in a 
joint tenancy, tenancy in common, or similar arrangement, the resource 
(or the affected portion of such resource) shall be considered to be 
disposed of by the individual when any action is taken, either by the 
individual or by any other person, that reduces or eliminates the 
individual's ownership or control of such resource.
    ``(E) In the case of a transfer by the spouse of an individual that 
results in a period of ineligibility for the individual under this 
subsection, the Commissioner shall apportion the period (or any portion 
of the period) among the individual and the individual's spouse if the 
spouse becomes eligible for benefits under this title.
    ``(F) For purposes of this paragraph--
            ``(i) the term `benefits under this title' includes 
        payments of the type described in section 1616(a) of this Act 
        and of the type described in section 212(b) of Public Law 93-
        66;
            ``(ii) the term `institutionalized individual' has the 
        meaning given such term in section 1917(e)(3); and
            ``(iii) the term `trust' has the meaning given such term in 
        subsection (e)(5)(A) of this section.''.
    (b) Effective Date.--The amendments made by this section shall be 
effective with respect to disposals made on or after the date of 
enactment of this Act.

SEC. 9. LOSS OF BENEFITS AS PENALTY FOR FRAUD.

    (a) In General.--Part A of title XI of the Social Security Act (42 
U.S.C. 1301 et seq.) is amended by inserting after section 1129 the 
following:

``SEC. 1129A. LOSS OF BENEFITS AS PENALTY FOR FRAUD.

    ``(a) In General.--Any person who makes, or causes to be made, a 
statement or representation of a material fact for use in determining 
any initial or continuing right to or the amount of--
            ``(1) monthly insurance benefits under title II; or
            ``(2) benefits or payments under title XVI,
that the person knows or should know is false or misleading or knows or 
should know omits a material fact or makes such a statement with 
knowing disregard for the truth shall be subject to, in addition to any 
other penalties that may be prescribed by law, a penalty described in 
subsection (b) which shall be imposed by the Commissioner of Social 
Security.
    ``(b) Penalty.--The penalty described in this subsection is--
            ``(1) nonpayment of benefits under title II that would 
        otherwise be payable to the person; and
            ``(2) ineligibility for cash benefits under title XVI,
for each month that begins during the applicable period described in 
subsection (c).
    ``(c) Duration of Penalty.--The applicable period begins with the 
date the Commissioner makes a determination that the person has engaged 
in conduct described in subsection (a), and the duration of the period 
shall be--
            ``(1) 6 consecutive months, in the case of the first such 
        determination with respect to the person;
            ``(2) 12 consecutive months, in the case of a second such 
        determination with respect to the person;
            ``(3) 24 consecutive months, in the case of a third or 
        subsequent such determination with respect to the person.
    ``(d) Effect on Other Assistance.--A person subject to a period of 
nonpayment of benefits under title II or ineligibility for title XVI 
benefits by reason of this section nevertheless shall be considered to 
be receiving such benefits for purposes of--
            ``(1) determination of the eligibility of the person for 
        benefits under titles XVIII and XIX; and
            ``(2) determination of the eligibility or amount of 
        benefits payable under title II or XVI to another person.
    ``(e) Definition.--In this section, the term `benefits under title 
XVI' includes State supplementary payments made by the Commissioner 
pursuant to an agreement under section 1616(a) of this Act or section 
212(b) of Public Law 93-66.
    ``(f) Consultations.--The Commissioner of Social Security shall 
consult with the Inspector General of the Social Security 
Administration before initiating an action under this section.''.
    (b) Conforming Amendment Precluding Delayed Retirement Credit for 
any Month to Which a Nonpayment of Benefits Penalty Applies.--Section 
202(w)(2)(B) of such Act (42 U.S.C. 402(w)(2)(B)) is amended--
            (1) by striking ``and'' at the end of clause (i);
            (2) by striking the period at the end of clause (ii) and 
        inserting ``, and''; and
            (3) by adding at the end the following:
                    ``(iii) such individual was not subject to a 
                penalty imposed under section 1129A.''.
    (c) Elimination of Redundant Provision.--Section 1611(e) of such 
Act (42 U.S.C. 1382(e)) is amended--
            (1) by striking paragraph (4);
            (2) in paragraph (6)(A)(i), by striking ``(5)'' and 
        inserting ``(4)''; and
            (3) by redesignating paragraphs (5) and (6) as paragraphs 
        (4) and (5), respectively.
    (d) Regulations.--Within 6 months after the date of the enactment 
of this Act, the Commissioner of Social Security shall develop 
regulations that prescribe the administrative process for making 
determinations under section 1129A of the Social Security Act.

SEC. 10. EXCLUSION OF ATTORNEYS AND PHYSICIANS CONVICTED OF VIOLATIONS 
              FROM PARTICIPATION IN SOCIAL SECURITY DISABILITY 
              PROGRAMS.

    (a) In General.--Part A of title XI of the Social Security Act (42 
U.S.C. 1301-1320b-17) is amended by adding at the end the following:

 ``exclusion of attorneys and physicians convicted of violations from 
          participation in social security disability programs

    ``Sec. 1148. (a) In General.--The Commissioner of Social Security 
shall exclude from participation in the social security disability 
programs any attorney or physician--
            ``(1) who is convicted of a violation of section 208 or 
        1632 of this Act,
            ``(2) who is convicted of any violation under title 18, 
        United States Code, relating to an initial application for or 
        continuing entitlement to benefits under title II of this Act, 
        or an initial application for or continuing eligibility for 
        benefits under title XVI of this Act, or
            ``(3) who becomes subject to a penalty or assessment under 
        section 1129(a)(1)(A) of this Act.
    ``(b) Notice, Effective Date, and Period of Exclusion.--(1) An 
exclusion under this section shall be effective at such time, for such 
period, and upon such reasonable notice to the public and to the 
individual excluded as may be specified in regulations consistent with 
paragraph (2).
    ``(2) Such an exclusion shall be effective with respect to services 
furnished to any individual on or after the effective date of the 
exclusion. Nothing in this section may be construed to preclude, in 
determining disability under title II or title XVI, consideration of 
any medical evidence derived from services provided by a physician 
before the effective date of the exclusion of the physician under this 
section.
    ``(3)(A) The Commissioner shall specify, in the notice of exclusion 
under paragraph (1), the period of the exclusion.
    ``(B) Subject to subparagraph (C), in the case of an exclusion 
under subsection (a), the minimum period of exclusion shall be five 
years, except that the Commissioner may waive the exclusion in the case 
of an individual who is the sole source of essential services in a 
community. The Commissioner's decision whether to waive the exclusion 
shall not be reviewable.
    ``(C) In the case of an exclusion of an individual under subsection 
(a) based on a conviction occurring on or after the date of the 
enactment of this section, if the individual has (before, on, or after 
such date) been convicted--
            ``(i) on one previous occasion of one or more offenses for 
        which an exclusion may be effected under such subsection, the 
        period of the exclusion shall be not less than 10 years, or
            ``(ii) on 2 or more previous occasions of one or more 
        offenses for which an exclusion may be effected under such 
        subsection, the period of the exclusion shall be permanent.
    ``(c) Notice to State Agencies.--The Commissioner shall promptly 
notify each appropriate State agency employed for the purpose of making 
disability determinations under section 221 or 1633(a)--
            ``(1) of the fact and circumstances of each exclusion 
        effected against an individual under this section, and
            ``(2) of the period (described in subsection (b)(3)) for 
        which the State agency is directed to exclude the individual 
        from participation in the activities of the State agency in the 
        course of its employment.
    ``(d) Notice to State Licensing Agencies.--The Commissioner shall--
            ``(1) promptly notify the appropriate State or local agency 
        or authority having responsibility for the licensing or 
        certification of an individual excluded from participation 
        under this section of the fact and circumstances of the 
        exclusion,
            ``(2) request that appropriate investigations be made and 
        sanctions invoked in accordance with applicable State law and 
        policy, and
            ``(3) request that the State or local agency or authority 
        keep the Commissioner and the Inspector General of the Social 
        Security Administration fully and currently informed with 
        respect to any actions taken in response to the request.
    ``(e) Application for Termination of Exclusion.--(1) An individual 
excluded from participation under this section may apply to the 
Commissioner, in the manner specified by the Commissioner in 
regulations and at the end of the minimum period of exclusion provided 
under subsection (b)(3) and at such other times as the Commissioner may 
provide, for termination of the exclusion effected under this section.
    ``(2) The Commissioner may terminate the exclusion if the 
Commissioner determines, on the basis of the conduct of the applicant 
which occurred after the date of the notice of exclusion or which was 
unknown to the Commissioner at the time of the exclusion, that--
            ``(A) there is no basis under subsection (a) for a 
        continuation of the exclusion, and
            ``(B) there are reasonable assurances that the types of 
        actions which formed the basis for the original exclusion have 
        not recurred and will not recur.
    ``(3) The Commissioner shall promptly notify each State agency 
employed for the purpose of making disability determinations under 
section 221 or 1633(a) of the fact and circumstances of each 
termination of exclusion made under this subsection.
    ``(f) Availability of Records of Excluded Attorneys and 
Physicians.--Nothing in this section shall be construed to have the 
effect of limiting access by any applicant or beneficiary under title 
II or XVI, any State agency acting under section 221 or 1633(a), or the 
Commissioner of Social Security to records maintained by any attorney 
or physician in connection with services provided to the applicant or 
beneficiary prior to the exclusion of such attorney or physician under 
this section.
    ``(g) Reporting Requirement.--Any attorney or physician 
participating in, or seeking to participate in, a social security 
disability program shall inform the Commissioner, in such form and 
manner as the Commissioner shall prescribe by regulation, whether such 
attorney or physician has been convicted of a violation described in 
subsection (a).
    ``(h) Definitions.--For purposes of this section.--
            ``(1) Exclude.--The term `exclude' from participation 
        means--
                    ``(A) in connection with an attorney, to prohibit 
                from engaging in representation of an applicant for, or 
                recipient of, benefits as a representative payee under 
                section 205(j) or 1631(a)(2)(A)(ii) or otherwise as a 
                representative in any hearing or other proceeding 
                relating to entitlement to benefits, and
                    ``(B) in connection with a physician, to prohibit 
                from providing items or services to an applicant for, 
                or recipient of, benefits for the purpose of assisting 
                such applicant or recipient in demonstrating 
                disability.
            ``(2) Social security disability program.--The term `social 
        security disability program' means the program providing for 
        monthly disability insurance benefits under section 223 or 
        monthly benefits based on the disability of the recipient under 
        section 202 and the program providing for supplemental security 
        income to individuals based on disability under title XVI.
            ``(3) Convicted.--An individual is considered to have been 
        `convicted' of a violation--
                    ``(A) when a judgment of conviction has been 
                entered against the individual by a Federal, State, or 
                local court, except if the judgement of conviction has 
                been set aside or expunged;
                    ``(B) when there has been a finding of guilt 
                against the individual by a Federal, State, or local 
                court;
                    ``(C) when a plea of guilty or nolo contendere by 
                the individual has been accepted by a Federal, State, 
                or local court; or
                    ``(D) when the individual has entered into 
                participation in a first offender, deferred 
                adjudication, or other arrangement or program where 
                judgment of conviction has been withheld.''.
    (b) Effective Date.--The amendment made by this section shall apply 
with respect to violations and convictions occurring on or after the 
date of the enactment of this Act.

SEC. 11. ANNUAL REVIEWS BY STATE DISABILITY DETERMINATION SERVICES OF 
              PROFESSIONALS CONDUCTING CONSULTATIVE EXAMINATIONS.

    (a) In General.--Section 221(j) of the Social Security Act (42 
U.S.C. 421(j)) is amended--
            (1) by redesignating paragraphs (1), (2), and (3), as 
        subparagraphs (A), (B), and (C), respectively;
            (2) by inserting ``(1)'' after ``(j)''; and
            (3) by adding at the end the following new paragraph:
    ``(2) The Commissioner shall provide for annual evaluations by 
State disability determination services of the performance of 
professionals to whom cases are referred for purposes of disability 
determinations by such services. Such evaluations shall include a 
thorough analysis of the completeness of the examinations performed 
through such referrals and the extent to which any patterns of abuse 
have arisen in the referral processes. The Commissioner shall ensure 
that any such pattern of abuse which, in the course of any such 
evaluation, is determined by any State disability determination service 
to have occurred is promptly referred by such service to the Inspector 
General of the Social Security Administration.''.
    (b) Effective Date.--The first annual evaluations required pursuant 
to the amendments made by this section shall be filed not later than 
December 31, 1999.

SEC. 12. COMPUTER MATCHES WITH MEDICARE AND MEDICAID 
              INSTITUTIONALIZATION DATA.

    (a) In General.--Section 1611(e)(1) of the Social Security Act (42 
U.S.C. 1382(e)(1)) is further amended by adding at the end the 
following:
    ``(K) For the purpose of carrying out this paragraph, the 
Commissioner of Social Security shall conduct periodic computer matches 
with data maintained by the Secretary of Health and Human Services 
under title XVIII or XIX. The Secretary shall furnish to the 
Commissioner, in such form and manner and under such terms as the 
Commissioner and the Secretary shall mutually agree, such information 
as the Commissioner may request for this purpose. Information obtained 
pursuant to such a match may be substituted for the physician's 
certification otherwise required under subparagraph (G)(i).''.
    (b) Conforming Amendment.--Section 1611(e)(1)(G) of such Act (42 
U.S.C. 1382(e)(1)(G)) is amended by striking ``subparagraph (H)'' and 
inserting ``subparagraph (H) or (K)''.

SEC. 13. ACCESS TO INFORMATION HELD BY FINANCIAL INSTITUTIONS.

    (a) In General.--Section 1631(e)(1)(B) of the Social Security Act 
(42 U.S.C. 1383(e)(1)(B)) is amended--
            (1) by striking ``(B) The'' and inserting ``(B)(i) The''; 
        and
            (2) by adding at the end the following new clause:
    ``(ii)(I) The Commissioner of Social Security may require each 
applicant for, or recipient of, benefits under this title to provide 
authorization by the applicant or recipient (or by any other person 
whose income or resources are material to the determination of the 
eligibility of the applicant or recipient for such benefits) for the 
Commissioner to obtain (subject to the cost reimbursement requirements 
of section 1115(a) of the Right to Financial Privacy Act) from any 
financial institution (within the meaning of section 1101(1) of such 
Act) any financial record (within the meaning of section 1101(2) of 
such Act) held by the institution with respect to the applicant or 
recipient (or any such other person) whenever the Commissioner 
determines the record is needed in connection with a determination with 
respect to such eligibility or the amount of such benefits.
    ``(II) Notwithstanding section 1104(a)(1) of the Right to Financial 
Privacy Act, an authorization provided by an applicant or recipient (or 
any other person whose income or resources are material to the 
determination of the eligibility of the applicant or recipient) 
pursuant to subclause (I) of this clause shall remain effective until 
the earliest of--
            ``(aa) the rendering of a final adverse decision on the 
        applicant's application for eligibility for benefits under this 
        title;
            ``(bb) the cessation of the recipient's eligibility for 
        benefits under this title; or
            ``(cc) the express revocation by the applicant or recipient 
        (or such other person referred to in subclause (I)) of the 
        authorization, in a written notification to the Commissioner.
    ``(III)(aa) An authorization obtained by the Commissioner of Social 
Security pursuant to this clause shall be considered to meet the 
requirements of the Right to Financial Privacy Act for purposes of 
section 1103(a) of such Act, and need not be furnished to the financial 
institution, notwithstanding section 1104(a) of such Act.
    ``(bb) The certification requirements of section 1103(b) of the 
Right to Financial Privacy Act shall not apply to requests by the 
Commissioner of Social Security pursuant to an authorization provided 
under this clause.
    ``(cc) A request by the Commissioner pursuant to an authorization 
provided under this clause is deemed to meet the requirements of 
section 1104(a)(3) of the Right to Financial Privacy Act and the flush 
language of section 1102 of such Act.
    ``(IV) The Commissioner shall inform any person who provides 
authorization pursuant to this clause of the duration and scope of the 
authorization.
    ``(V) If an applicant for, or recipient of, benefits under this 
title (or any such other person referred to in subclause (I)) refuses 
to provide or revokes any authorization for the Commissioner of Social 
Security to obtain from any financial institution any financial record, 
the Commissioner may, on that basis, determine that the applicant or 
recipient is ineligible for benefits under this title.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act.

SEC. 14. STATE DATA EXCHANGES.

    Whenever the Commissioner of Social Security requests information 
from a State for the purpose of ascertaining an individual's 
eligibility for benefits (or the correct amount of such benefits) under 
title II or XVI of the Social Security Act, the standards of the 
Commissioner promulgated pursuant to section 1106 of such Act or any 
other Federal law for the use, safeguarding, and disclosure of 
information are deemed to meet any standards of the State that would 
otherwise apply to the disclosure of information by the State to the 
Commissioner.

SEC. 15. STUDY ON POSSIBLE MEASURES TO IMPROVE FRAUD PREVENTION AND 
              ADMINISTRATIVE PROCESSING.

    (a) Study.--As soon as practicable after the date of the enactment 
of this Act, the Commissioner of Social Security, in consultation with 
the Inspector General of the Social Security Administration and the 
Attorney General, shall conduct a study of possible measures to 
improve--
            (1) prevention of fraud on the part of individuals entitled 
        to disability benefits under section 223 of the Social Security 
        Act or benefits under section 202 of such Act based on the 
        beneficiary's disability, individuals eligible for supplemental 
        security income benefits under title XVI of such Act, and 
        applicants for any such benefits; and
            (2) timely processing of reported income changes by 
        individuals receiving such benefits.
    (b) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Commissioner shall report in writing to the Committee 
on Ways and Means of the House of Representatives and the Committee on 
Finance of the Senate the results of the Commissioner's study under 
subsection (a). Such report shall contain such recommendations for 
legislative and administrative changes as the Commissioner considers 
appropriate.

SEC. 16. ANNUAL REPORT ON AMOUNTS NECESSARY TO COMBAT FRAUD.

    (a) In General.--Section 704(b)(1) of the Social Security Act (42 
U.S.C. 904(b)(1)) is amended--
            (1) by inserting ``(A)'' after ``(b)(1)''; and
            (2) by adding at the end the following new subparagraph:
    ``(B) The Commissioner shall include in the annual budget prepared 
pursuant to subparagraph (A) an itemization of the amount of funds 
required by the Social Security Administration for the fiscal year 
covered by the budget to support efforts to combat fraud committed by 
applicants and beneficiaries.''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to annual budgets prepared for fiscal years after 
fiscal year 1999.
                                 <all>