I 112th CONGRESS 1st Session H. R. 675 IN THE HOUSE OF REPRESENTATIVES February 11, 2011 Mr. Herger (for himself, Mr. Stark, Mr. Nunes, Mr. Levin, Mr. Tiberi, Mr. Rangel, Mr. Davis of Kentucky, Mr. McDermott, Mr. Reichert, Mr. Lewis of Georgia, Mr. Boustany, Mr. Neal, Mr. Heller, Mr. Doggett, Mr. Gerlach, Mr. Larson of Connecticut, Mr. Buchanan, Mr. Blumenauer, Mr. Paulsen, Mr. Kind, and Mr. Pascrell) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means and the Budget, 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 amend title XI of the Social Security Act to expand the permissive exclusion from participation in Federal health care programs to individuals and entities affiliated with sanctioned entities.

1.

Short title

This Act may be cited as the Strengthening Medicare Anti-Fraud Measures Act of 2011.

2.

Permissive exclusion from Federal health care programs expanded to individuals and entities affiliated with sanctioned entities

Section 1128(b)(15) of the Social Security Act (42 U.S.C. 1320a–7(b)(15)) is amended to read as follows: (15)

Individuals or entities affiliated with a sanctioned entity

(A)Any of the following: (i)Any individual who— (I)is a person with an ownership or control interest (as defined in section 1124(a)(3)) in a sanctioned entity or an affiliated entity of such sanctioned entity (or was a person with such an interest at the time of any of the conduct that formed a basis for the conviction or exclusion described in subparagraph (B)); and (II)knows or should know (as defined in section 1128A(i)(7)) (or knew or should have known) of such conduct. (ii)Any individual who is an officer or managing employee (as defined in section 1126(b)) of a sanctioned entity or affiliated entity 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 conviction 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) or in paragraph (1), (2), or (3) of this subsection; or (ii)that has been excluded from participation under a program under title XVIII or under a State health care program. (C)(i)For purposes of this paragraph, the term affiliated entity means, with respect to a sanctioned entity— (I)an entity affiliated with such sanctioned entity; and (II)an entity that was so affiliated at the time of any of the conduct that formed the basis for the conviction or exclusion described in subparagraph (B). (ii)For purposes of clause (i), an entity shall be treated as affiliated with another entity if— (I)one of the entities is a person with an ownership or control interest (as defined in section 1124(a)(3)) in the other entity (or had such an interest at the time of any of the conduct that formed a basis for the conviction or exclusion described in subparagraph (B)); (II)there is a person with an ownership or control interest (as defined in section 1124(a)(3)) in both entities (or had such an interest at the time of any of the conduct that formed a basis for the conviction or exclusion described in subparagraph (B)); or (III)there is a person who is an officer or managing employee (as defined in section 1126(b)) of both entities (or was such an officer or managing employee at the time of any of the conduct that formed a basis for the conviction or exclusion described in subparagraph (B)). .

3.

Budgetary effects of PAYGO legislation

The budgetary effects of this Act, for the purpose of complying with the Statutory Pay-As-You-Go Act of 2010, shall be determined by reference to the latest statement titled Budgetary Effects of PAYGO Legislation for this Act, submitted for printing in the Congressional Record by the Chairman of the House Budget Committee, provided that such statement has been submitted prior to the vote on passage.