[Congressional Record Volume 172, Number 49 (Wednesday, March 18, 2026)]
[Senate]
[Pages S1283-S1284]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 4633. Mr. MERKLEY submitted an amendment intended to be proposed
by him to the bill S. 1383, to establish the Veterans Advisory
Committee on Equal Access, and for other purposes; which was ordered to
lie on the table; as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patients Over Profit Act''
or the ``POP Act''.
SEC. 2. PROHIBITION ON COMMON OWNERSHIP OF HEALTH INSURANCE
ISSUERS AND CERTAIN HEALTH CARE PROVIDERS UNDER
MEDICARE.
(a) In General.--It shall be unlawful for any person to
both--
(1) directly or indirectly own, operate, or control the
whole or any part of an applicable provider or a management
services organization that has a management services
agreement with an applicable provider; and
(2) directly or indirectly own, operate, or control the
whole or any part of a health insurance issuer.
(b) Divestment.--Any person in violation of subsection (a)
shall divest either the applicable provider (or, if
applicable, the management services organization) or the
health insurance issuer of such person--
(1) in the case of an applicable provider, management
services organization, or health insurance issuer acquired on
or before the date of enactment of this Act, not later than 2
years after such date of enactment; or
(2) in the case of an applicable provider, management
services organization, or health insurance issuer acquired
after the date of enactment of this Act, not later than 1
year after the date of acquisition.
(c) Civil Actions.--
(1) In general.--When the Inspector General of the
Department of Health and Human Services, the Assistant
Attorney General in charge of the Antitrust Division of the
Department of Justice, the Federal Trade Commission, or an
Attorney General of a State has reason to believe that a
person is in violation of subsection (a) or (b), such
Inspector General, Assistant Attorney General, Federal Trade
Commission, or Attorney General of a State may bring a civil
action in an applicable district court of the United States
for the relief described in paragraph (2).
(2) Injunctive and equitable relief.--In any action
described in paragraph (1), the applicable court, on a
finding that a person is in violation of subsection (a) or
(b), shall issue an order requiring such person--
(A) to cease and desist from such violation, and divest
either the applicable provider (or, if applicable, the
management services organization) or the health insurance
issuer of such person; and
(B) to disgorge any revenue received from the provision of
health care services during the period of such violation.
(3) Deposit and distribution.--Any revenue disgorged
pursuant to an action under this subsection for a violation
of subsection (a) or (b) shall be deposited into a fund
created by the Federal Trade Commission and distributed by
the Federal Trade Commission to be put to use in the interest
of serving the health care needs of the harmed community.
Receipt of any funds under this paragraph shall not alter or
diminish the rights of an individual to bring an action or
recover any amount as otherwise authorized by law.
(d) FTC Review.--
(1) Reporting required.--Any divestment of an applicable
provider, management services organization, or health
insurance issuer required under subsection (b) shall be
reported to the Federal Trade Commission and the Assistant
Attorney General in charge of the Antitrust Division of the
Department of Justice under section 7A of the Clayton Act (15
U.S.C. 18a) without respect to the thresholds under
subsection (a)(2) of that section.
(2) Tolling of divestment period during review.--The
divestment period under subsection (b) shall be tolled during
the pendency of any waiting period required under section 7A
of the Clayton Act (15 U.S.C. 18a).
(3) Review of effect of divestiture.--With respect to each
divestiture undertaken pursuant to subsection (b), in
addition to any applicable review under section 7A of the
Clayton Act (15 U.S.C. 18a), the Federal Trade Commission and
the Assistant Attorney General in charge of the Antitrust
Division of the Department of Justice shall review the effect
on competition, financial viability, and the public
interest--
(A) of the divestiture; and
(B) of the subsequent acquisition of the applicable
provider (or, if applicable, the management services
organization) or the health insurance issuer of such person
by the acquiring person.
(e) Rulemaking Authority.--The Federal Trade Commission
shall promulgate rules to carry out this section. Such rules
shall not diminish any obligation under this section.
(f) Rule of Construction.--Nothing in this section shall be
construed to limit the authority of the Federal Trade
Commission, the Inspector General of the Department of
Justice, the Department of Health and Human Services, or the
Attorney General of a State under any other provision of law.
(g) Enforcement Under Medicare Advantage and Medicare Part
D.--
(1) Medicare advantage.--Section 1857 of the Social
Security Act (42 U.S.C. 1395w-27) is amended by adding at the
end the following new subsection:
``(j) Prohibition on Common Ownership of MA Organizations
and Applicable Providers.--
``(1) In general.--For plan years beginning on or after
January 1, 2027, the Secretary may not contract with, or
provide payment under this part to, a Medicare Advantage
organization with respect to offering an MA plan or MA-PD
plan under this part if the organization--
``(A) directly or indirectly owns, operates, or controls
the whole or any part of an applicable provider or a
management services organization that has a management
services agreement with an applicable provider; or
``(B) is directly or indirectly owned, operated, or
controlled in whole or part by a person who also directly or
indirectly owns, operates, or controls the whole or any part
of an applicable provider or a management services
organization that has a management services agreement with an
applicable provider.
``(2) Certification.--Each Medicare Advantage organization
shall furnish to the Secretary (in a form and manner, and at
a time, specified by the Secretary) a certification of
compliance with this subsection, as well as such information
as the Secretary determines necessary to carry out this
subsection.
``(3) False claims submitted by entities in violation of
prohibition on common ownership.--Any claim for payment from
an entity in violation of paragraph (1) constitutes a false
or fraudulent claim for purposes of subchapter III of title
31, United States Code.
``(4) Definitions.--In this subsection:
``(A) Applicable provider.--
``(i) In general.--Subject to clause (ii), the term
`applicable provider' means any entity that receives payment
for furnishing services covered under part B or under a
Medicare Advantage plan under part C.
``(ii) Exclusions.--Such term does not include--
``(I) a hospital (as defined in section 1861(e)), a
critical access hospital (as defined in section 1861(mm)(1)),
or a rural emergency hospital (as defined in section
1861(kkk)(2));
``(II) a supplier of durable medical equipment,
prosthetics, orthotics, or supplies; or
``(III) a pharmacy.
``(B) Management services agreement.--The term `management
services agreement' means a contract between a management
services organization and an applicable provider for
management or administrative services relating to,
supporting, or facilitating the provision of health care
services.
``(C) Management services organization.--The term
`management services organization' means any organization or
entity that contracts with an applicable provider to perform
management or administrative services relating to,
supporting, or facilitating the provision of health care
services.''.
(2) Medicare part d.--Section 1860D-12(b)(3) of the Social
Security Act (42 U.S.C. 1395w-112(b)(3)) is amended by adding
at the end the following new subparagraph:
``(G) Prohibition on common ownership.--Section 1857(j).''.
(h) Definitions.--In this section:
(1) Applicable provider.--
(A) In general.--Subject to subparagraph (B), the term
``applicable provider'' means any entity that receives
payment for furnishing services covered under part B of title
XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) or
under a Medicare Advantage plan under part C of such title
(42 U.S.C. 1395w-21 et seq.).
(B) Exclusions.--Such term does not include--
(i) a hospital (as defined in section 1861(e) of the Social
Security Act (42 U.S.C. 1395x(e))), a critical access
hospital (as defined in section 1861(mm)(1) of such Act (42
U.S.C. 1395x(mm)(1))), or a rural emergency hospital (as
defined in section 1861(kkk)(2));
(ii) a supplier of durable medical equipment, prosthetics,
orthotics, and supplies; or
(iii) a pharmacy.
(2) Health insurance issuer.--The term ``health insurance
issuer'' has the meaning given that term in section 2791 of
the Public Health Service Act (42 U.S.C. 300gg-91).
(3) Management services agreement.--The term ``management
services agreement'' means a contract between a management
services organization and an applicable provider for
management or administrative services relating to,
supporting, or facilitating the provision of health care
services.
(4) Management services organization.--The term
``management services organization'' means any organization
or entity that contracts with an applicable provider to
perform management or administrative services relating to,
supporting, or facilitating the provision of health care
services.
(5) Person.--The term ``person'' has the meaning given the
term in section 8 of the Sherman Act (15 U.S.C. 7).
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