I 111th CONGRESS 2d Session H. R. 6000 IN THE HOUSE OF REPRESENTATIVES July 30, 2010 Mr. Grayson introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for criminal liability for the denial of health care coverage of a treatment or an individual, and for other purposes.

1.

Short title

This Act may be cited as the Thou Shalt Not Kill Thy Customers Act.

2.

Criminal denial of health care coverage

(a)

Offense

Any responsible officer or employee of an insurance entity that engages in a denial of coverage under a health plan offered by such entity in violation of the provisions of title XXVII of the Public Health Service Act (including amendments to such Act made by the Patient Protection and Affordable Care Act (Public Law 111–148)), and such insurance entity, shall be fined in accordance with title 18, United States Code, imprisoned for not more than one year, or both. (b)

Enhanced penalty if death results

Any conduct of any responsible officer or employee or insurance entity that subjects such person or entity to a fine or imprisonment under subsection (a) shall also be punishable as involuntary manslaughter under section 1112(b) of title 18, United States Code, if the conduct for which the person or entity is fined or imprisoned results in death.

3.

Identification and report of instances of denial of health care treatment and coverage

(a)The Inspector General of the Department of Health and Human Services shall establish an Internet Web site and a toll-free telephone number to receive reports of instances of denial of health care treatment or coverage by insurance entities for investigation of such reports. (b)Such toll-free telephone number shall be operated in a similar manner to the toll-free telephone number described in subsection (c)(4) of section 1804 of the Social Security Act (42 U.S.C. 1395b–2). (c)The Inspector General shall report to the Attorney General for further investigation and prosecution all such instances for which the Inspector General determines sufficient evidence exists of a violation described in section 2(a) by an insurance entity or responsible officer or employee of such entity.

4.

Sense of Congress

It is the sense of the Congress that each State should, through the State insurance commissioner or State official responsbile for the regulation of insurance in such State, thoroughly investigate violations of this Act by any insurance entity or responsible officer or employee of such entity.

5.

Definitions

In this Act: (1)The term denial of coverage means, with respect to a health plan offered by an insurance entity— (A)in the case of an individual enrolled in or benefitting from such plan, denying coverage of or care for a treatment for such individual; or (B)in the case of an individual seeking enrollment in or benefit from such plan, the denial of coverage of or care for such individual under such plan. (2)The term insurance entity means a group health plan or a health insurance issuer offering group or individual health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91)). (3)The term responsible officer or employee means any director, officer, employee, or agent of an insurance entity who engages in any of the following conduct: (A)Making a decision to deny coverage or care. (B)Designing the institutional policies of the insurance entity that resulted in the denial of coverage or care. (C)Materially influencing the policy or decision to deny coverage or care. (D)Any other conduct that constitutes an offense under this Act, including any related offense under section 2 of title 18, United States Code.