[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4503 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 4503
To prevent exploitative private equity practices, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 11, 2024
Ms. Warren (for herself and Mr. Markey) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To prevent exploitative private equity practices, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Corporate Crimes Against Health Care
Act''.
SEC. 2. UNJUST ENRICHMENT CLAWBACK AUTHORITY AND CRIMINAL PENALTY.
(a) Unjust Enrichment Clawback.--Chapter 31 of title 18, United
States Code, is amended by adding at the end the following:
``Sec. 671. Unjust enrichment clawback and criminal penalty
``(a) Prohibited Conduct.--Any covered party whose actions
contributed to a triggering event that results in the death or injury
of a patient or patients under the care of the target firm, shall be
punished in accordance with sections 672 and 673.
``Sec. 672. Criminal penalty
``Whoever violates section 671 shall be imprisoned for not less
than 1 year or greater than 6 years.
``Sec. 673. Civil penalty
``(a) Amount of Penalty.--Whoever violates section 671 shall be
subject to a civil penalty in an amount of not more than 5 times the
amount of any clawback authorized under section 674.
``(b) Deposit.--Any amount of civil penalty collected under this
section shall be deposited as miscellaneous receipts in the Treasury of
the United States.
``Sec. 674. Clawback
``(a) In General.--
``(1) Prohibition.--It shall be unlawful for any covered
party to acquire from a target firm covered compensation by
unjust enrichment, and any such covered party shall be subject
to the penalties described in sections 672 and 673 in addition
to the required clawbacks under this section.
``(2) Penalty.--
``(A) Required clawbacks.--If a target firm
experiences a triggering event, the Attorney General or
a State attorney general may claw back all or part of
the covered compensation received by the covered party
that is obtained from the target firm during the
preceding or succeeding 10 years.
``(B) Actions to recover required clawbacks.--
``(i) Powers of the attorney general.--
``(I) In general.--Except as
provided in clause (ii), the Attorney
General may enforce this section.
``(II) Authority preserved.--
Nothing in this section shall be
construed to limit the authority of the
Attorney General under any provision of
law.
``(III) Penalty.--In an action
brought by the Attorney General to
enforce this section and the
regulations promulgated under this
section, a covered party shall be
liable for all or part of the covered
compensation received by the covered
party that is obtained from the target
firm during the preceding or succeeding
10 years.
``(ii) Enforcement by state attorneys
general.--
``(I) Civil action.--If an attorney
general of a State has reason to
believe that a triggering event has
harmed the residents of that State, the
attorney general of the State may, as
parens patriae, bring a civil action on
behalf of the residents of the State in
an appropriate district court of the
United States to recover all or part of
the covered compensation received by
the covered party that is obtained from
the target firm during the preceding or
succeeding 10 years.
``(II) Rights of the attorney
general.--
``(aa) Notice to attorney
general.--
``(AA) In
general.--Except as
provided in subitem
(CC), the attorney
general of a State
shall notify the
Attorney General in
writing that the
attorney general of the
State intends to bring
a civil action under
subclause (I) not later
than 10 days before
initiating the civil
action.
``(BB) Contents.--
The notification
required under subitem
(AA) with respect to a
civil action shall
include a copy of the
complaint to be filed
to initiate the civil
action.
``(CC) Exception.--
If it is not feasible
for the attorney
general of a State to
provide the
notification required
by subitem (AA) before
initiating an action
under subclause (I),
the attorney general of
the State shall notify
the Attorney General
immediately upon
instituting the civil
action.
``(bb) Intervention by the
attorney general.--The Attorney
General may--
``(AA) intervene in
any action brought by
the attorney general of
a State under subclause
(I); and
``(BB) upon
intervening under
subitem (aa), be heard
on all matters arising
in the civil action and
file petitions for
appeal of a decision in
the action.
``(iii) Limitation on state action while
federal action is pending.--If the Attorney
General institutes an action under clause (i)
with respect to a triggering event, a State may
not, during the pendency of that action,
institute an action under clause (ii) against
any defendant named in the complaint in the
action instituted by the Attorney General based
on the same set of facts giving rise to the
triggering event with respect to which the
Attorney General instituted the action.
``(iv) Affirmative defense.--It shall be an
affirmative defense in an action under this
section if the applicable covered party shows
by clear and convincing evidence that the
covered party could not prevent the triggering
event.
``(C) Deposit.--
``(i) In general.--Subject to clause (ii),
any covered compensation clawed back in an
action under this section shall be deposited in
a fund created by the Attorney General and
distributed by the Attorney General, in the
interests of justice--
``(I) to cover shortfalls in the
salaries, employee benefit plans, or
other benefits owed to current or past
employees of the target firm negatively
affected by the behavior that is the
basis of the action; and
``(II) to be put to use in the
interest of serving the health care
needs of the harmed community.
``(ii) Bankruptcy as a triggering event.--
Notwithstanding any other provision of law, if
the entry of an order for relief under title 11
or the commencement of any other insolvency
proceeding is the triggering event that a
target firm experiences, the Attorney General
shall prioritize covering funding shortfalls in
any pension funds benefitting harmed current or
past employees of the target firm.
``(b) Definitions.--In this section:
``(1) Affiliate.--The term `affiliate' means--
``(A) a person that directly or indirectly owns,
controls, or holds with power to vote, 5 percent or
more of the outstanding voting securities of another
entity, other than a person that holds such
securities--
``(i) in a fiduciary or agency capacity
without sole discretionary power to vote such
securities; or
``(ii) solely to secure a debt, if such
entity has not in fact exercised such power to
vote;
``(B) a corporation 10 percent or more of whose
outstanding voting securities are directly or
indirectly owned, controlled, or held with power to
vote, by another entity (referred to in this
subparagraph as a `covered entity'), or by an entity
that directly or indirectly owns, controls, or holds
with power to vote, 10 percent or more of the
outstanding voting securities of the covered entity,
other than an entity that holds such securities--
``(i) in a fiduciary or agency capacity
without sole discretionary power to vote such
securities; or
``(ii) solely to secure a debt, if such
entity has not in fact exercised such power to
vote;
``(C) a person whose business is operated under a
lease or operating agreement by another entity, or
person substantially all of whose property is operated
under an operating agreement with that other entity; or
``(D) an entity that operates the business or
substantially all of the property of another entity
under a lease or operating agreement.
``(2) Change in control.--The term `change in control'
means a change in a legal right with respect to--
``(A) the power to vote more than 50 per centum of
any class of voting securities of a corporation that
engages in interstate commerce; or
``(B) any lesser per centum of any class of voting
securities of a corporation that engages in interstate
commerce that is sufficient to make the acquirer of
such an interest a person that has the ability to
direct the actions of that corporation.
``(3) Control person.--The term `control person'--
``(A) means--
``(i) a person--
``(I) that directly or indirectly
owns, controls, or holds with power to
vote, including through coordination
with other persons, 10 percent or more
of the outstanding voting interests of
a corporation; or
``(II) that operates the business
or substantially all of the property of
a corporation under a lease or an
operating or management agreement;
``(ii) a corporation, other than a target
firm, that has 10 percent or more of its
outstanding voting interests directly or
indirectly owned, controlled, or held with
power to vote by a person that directly or
indirectly owns, controls, or holds with power
to vote, including through coordination with
other persons, 10 percent or more of the
outstanding voting interests of another
corporation; or
``(iii) a person that otherwise has the
ability to direct the actions of a corporation;
and
``(B) does not include a person that--
``(i)(I) is a limited partner with respect
to a controlling private fund that is a
partnership;
``(II) does not participate in the
direction of the management or policy of a
corporation; and
``(III) is not an insider with respect to
the controlling private fund described in
subclause (I);
``(ii) is a pension fund or employee
welfare benefit plan, if neither the fund nor
plan (as applicable), nor any beneficiary or
affiliate of the benefit or plan, is an insider
with respect to a controlling private fund; or
``(iii) holds the voting interests of a
corporation solely--
``(I) in a fiduciary or agency
capacity without sole discretionary
power to vote the securities; or
``(II) to secure a debt, if the
person has not--
``(aa) exercised the power
to vote; or
``(bb) exercised any other
governance rights with respect
to the corporation.
``(4) Controlling private fund.--The term `controlling
private fund' means a private fund that, directly or through an
affiliate, becomes a control person with respect to a target
firm through the change in control transaction with respect to
the target firm.
``(5) Corporation.--The term `corporation' means--
``(A) a joint-stock company;
``(B) a company or partnership association
organized under a law that makes only the capital
subscribed or callable up to a specified amount
responsible for the debts of the association, including
a limited partnership and a limited liability company;
``(C) a trust; and
``(D) an association having a power or privilege
that a private corporation, but not an individual or a
partnership, possesses.
``(6) Covered compensation.--The term `covered
compensation' means--
``(A) salary;
``(B) any bonus;
``(C) any compensation that is granted, earned, or
vested based wholly or in part upon the attainment of
any financial reporting measure or other performance
metric;
``(D) equity-based compensation;
``(E) time- or service-based awards;
``(F) awards based on nonfinancial metrics;
``(G) any monitoring fees, management fees,
advisory fees, accelerated monitoring fees, transaction
fees, or fees for services not rendered;
``(H) any profits realized from the buying or
selling of securities or assets, including any real
property;
``(I) any severance pay;
``(J) any golden parachute benefit; or
``(K) any other transaction similar to a
transaction described in subparagraph (H) or (I).
``(7) Covered party.--The term `covered party' means--
``(A) any current or former director, officer, or
control person of, or agent for, a private equity firm
or target firm;
``(B) any current or former shareholder or joint
venture partner that participates in the conduct of the
affairs of a target firm; or
``(C) any private fund.
``(8) Employee welfare benefit plan.--The term `employee
welfare benefit plan' has the meaning given the term in section
3 of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1002).
``(9) Insider.--The term `insider' means any--
``(A) director of a corporation;
``(B) officer of a corporation;
``(C) managing agent of a corporation;
``(D) control person with respect to a corporation;
``(E) affiliate of a corporation;
``(F) general partner of a corporation that is a
partnership;
``(G) consultant or contractor retained by a
corporation;
``(H) affiliate, relative, or agent of a person
described in any of subparagraphs (A) through (F); or
``(I) affiliate, relative, or agent of a person
described in subparagraph (H).
``(10) Interest coverage.--The term `interest coverage'
means the revenue of the target firm less the expenses of the
target firm, excluding tax and interest, during the most recent
fiscal year of the target firm.
``(11) Pension fund.--The term `pension fund' has the
meaning given the term `pension plan' in section 3 of the
Employee Retirement Security Act of 1974 (29 U.S.C. 1002).
``(12) Private fund.--The term `private fund' means a
corporation that--
``(A) would be considered an investment company
under section 3 of the Investment Company Act of 1940
(15 U.S.C. 80a-3) but for the application of paragraph
(1) or (7) of subsection (c) of that section;
``(B) is not a venture capital fund, as defined in
section 275.203(l)-1 of title 17, Code of Federal
Regulations, as in effect on the date of enactment of
this Act; and
``(C) is not an institution selected under section
107 of the Community Development Banking and Financial
Institutions Act of 1994 (12 U.S.C. 4706).
``(13) Reasonable salary.--The term `reasonable salary'
means the amount that would ordinarily be paid for like
services by like enterprises under like circumstances.
``(14) Relative.--The term `relative' means an individual
related by affinity or consanguinity within the third degree as
determined by the common law, or individual in a step or
adoptive relationship within such third degree.
``(15) Security.--The term `security' has the meaning given
the term in section 2(a) of the Securities Act of 1933 (15
U.S.C. 77b(a)).
``(16) Target firm.--The term `target firm' means a health
care corporation that is acquired in a change in control
transaction.
``(17) Triggering event.--The term `triggering event'
means--
``(A) any time at which a target firm is behind on
salary payments greater than 25 percent of the total
workforce of the target firm for a period of more than
90 days;
``(B) closure of the target firm;
``(C) if the target firm is behind on rent payments
for a period of more than 90 days;
``(D) if the target firm defaults on a loan for a
period of more than 90 days; or
``(E) the entry of an order for relief under title
11 on behalf of the target firm or the commencement of
any other insolvency proceeding.
``(18) Unjust enrichment.--The term `unjust enrichment'
means the acquisition of covered compensation by a covered
party from the target firm during the 10-year period preceding
or succeeding a triggering event if any of the following
aggravating circumstances are established:
``(A) The covered compensation was obtained through
a dividend recapitalization, a sale-leaseback of real
estate or equipment, or a related person transaction,
as set forth in section 229.404 of title 17, Code of
Federal Regulations.
``(B) The covered party has been implicated in any
white-collar crime, as defined in section 901 of title
I of the Omnibus Crime Control and Safe Streets Act of
1968 (34 U.S.C. 10251), committed in the course of the
current or former employment of the covered party.
``(C) The covered party has charged the target firm
accelerated monitoring fees or fees for services not
rendered.
``(D) At the time of the issuance of the covered
compensation, or as the result of the issuance of the
covered compensation, the target firm had an interest
coverage in excess of 100 percent.''.
(b) Technical and Conforming Amendment.--The table of sections for
chapter 31 of title 18, United States Code, is amended by adding at the
end the following:
``671. Unjust enrichment clawback and criminal penalty.
``672. Criminal penalty.
``673. Civil penalty.
``674. Clawback.''.
SEC. 3. PROHIBITING PAYMENTS FROM FEDERAL HEALTH CARE PROGRAMS TO
ENTITIES THAT SELL ASSETS TO OR USE ASSETS AS COLLATERAL
FOR A LOAN WITH A REAL ESTATE INVESTMENT TRUST.
Section 1128(a) of the Social Security Act (42 U.S.C. 1320a-7(a))
is amended by adding at the end the following new paragraph:
``(5) Selling assets to or using assets as collateral for a
loan with a real estate investment trust.--
``(A) In general.--Any individual or entity that,
on or after the date of enactment of this paragraph,
sells any assets to, or newly pledges any assets as
collateral for a loan with, a real estate investment
trust (as defined in section 856(a) of the Internal
Revenue Code of 1986).
``(B) Clarification.--Subparagraph (A) shall not
apply in the case where an individual or entity agreed
to pledge an asset as collateral for a loan with a real
estate investment trust prior to the date of enactment
of this paragraph, including with respect to any future
agreement between the individual or entity and the real
estate investment trust regarding that same asset.''.
SEC. 4. REPEAL OF SPECIAL RULE FOR TAXABLE REIT SUBSIDIARIES WITH
INTERESTS IN CERTAIN HEALTH CARE PROPERTY.
(a) In General.--Section 856(d)(8)(B) of the Internal Revenue Code
of 1986 is amended--
(1) by striking ``or a qualified health care property (as
defined in subsection (e)(6)(D)(i))'', and
(2) by striking ``qualified health care property or''.
(b) Conforming Amendments.--Section 856(d)(9) of such Code is
amended--
(1) in subparagraph (A)--
(A) by striking ``or a qualified health care
property (as defined in subsection (e)(6)(D)(i))'',
(B) by striking ``or qualified health care
property'', and
(C) by striking ``or qualified health care
properties'', and
(2) in subparagraph (B)--
(A) by striking ``or qualified health care property
(as so defined)'', and
(B) by striking ``or qualified health care
property'' each place it appears in clauses (i), (ii),
and (iii)(II).
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
SEC. 5. ELIMINATION OF QUALIFIED REIT DIVIDENDS FROM QUALIFIED BUSINESS
INCOME.
(a) In General.--Paragraph (1) of section 199A(b) of the Internal
Revenue Code of 1986 is amended to read as follows:
``(1) In general.--The term `combined qualified business
income amount' means, with respect to any taxable year, an
amount equal to the sum of the amounts determined under
paragraph (2) for each qualified trade or business carried on
by the taxpayer.''.
(b) Conforming Amendments.--
(1) Section 199A(c)(1) of such Code is amended by striking
the last sentence.
(2) Section 199A(e) of such Code is amended by striking
paragraph (3) and by redesignating paragraph (4) as paragraph
(3).
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
SEC. 6. MANDATORY REPORTING WITH RESPECT TO CERTAIN HEALTH-RELATED
OWNERSHIP INFORMATION.
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et
seq.) is amended by adding at the end the following new section:
``SEC. 1150D. MANDATORY REPORTING WITH RESPECT TO CERTAIN HEALTH-
RELATED OWNERSHIP INFORMATION.
``(a) Mandatory Reporting With Respect Certain Health-Related
Ownership Information.--
``(1) Reporting.--Not later than January 1, 2026 (or in the
case of a specified entity formed after January 1, 2026, within
60 days of becoming a specified entity), and each year
thereafter, each specified entity (as defined in subsection
(e)(8)) shall submit to the Secretary, in a form and manner
specified by the Secretary, a report containing the following
information, subject to paragraph (3)(B):
``(A) Data on mergers, acquisitions, changes in
ownership, changes in control, transactions to form new
affiliations, changes in partnerships, joint ventures,
and/or management services agreements, to which such
specified entity is a party for the previous 1-year
period, including--
``(i) the primary reason the reporting
entity completed the acquisition; and
``(ii) a description of how the acquirer
obtained control of the acquiree, and the
percentage of ownership acquired (i.e., voting
equity interests).
``(B) As applicable, the name, address, tax or
health plan identification numbers (including, without
limitation, the tax identification number, National
Association of Insurance Commissioners identification
number, State insurance identification number, Medicare
provider number, and the standard unique health
identifier (as described in section 1173(b)) of all
health care providers within the specified entity that
furnish items or services.
``(C) Business structure of any controlling entity,
including the business type and the tax identification
number of such entity, other affiliates under common
control, subsidiaries, and management services entities
of such specified entity, as of the date of the
submission of this report.
``(D) Information regarding--
``(i) the debt-to-earnings ratio of the
specified entity;
``(ii) the amount of debt incurred--
``(I) by each hospital or separate
entity within the health system; and
``(II) by the entire specified
entity;
``(iii) real estate leases and purchases
for property used, or intended to be used, to
furnish or otherwise support the provision of
health care services, including expenditures on
rents and maintenance, property taxes paid, and
the name of the company leased from;
``(iv) details of other companies' revenue
sharing arrangement;
``(v) fees charged or dividends paid to
investors;
``(vi) in the case of a non-profit
hospital, a subsidiary of a non-profit
hospital, or a 501(c)(3) entity that shares
common ownership with a non-profit hospital,
capital gains investments (disaggregated by the
type of investment) and any taxes paid on such
gains from such investments; and
``(vii) information with respect to any
controlling entity of such specified entity.
``(E) The value of quality payments received for
performance under any value-based or other performance-
based program such as the shared savings program under
section 1899.
``(F) Any other information with respect to
ownership or control of a specified entity, as
determined by the Secretary.
``(G) Any changes to the health care providers
within the specified entity that furnish items or
services during the previous 1-year period, identified
by the National Provider identifier described in
section 1173(b).
``(H) The domicile and business registration
information for any controlling entity or subsidiary of
such controlling entity that is domiciled outside of
the United States.
``(2) Avoiding duplicate reporting.--If a specified entity
is owned or controlled by an entity described in subparagraph
(G) of subsection (f)(8), only the entity described in such
subparagraph (G) shall be required to submit reports under this
subsection with respect to such entity and any specified entity
owned or controlled by the entity.
``(3) Availability of information and public reporting.--
``(A) In general.--Not later than January 1, 2027,
and annually thereafter, subject to subparagraph (B),
the Secretary shall post on a publicly available
website of the Department of Health and Human Services
the information reported under this subsection with
respect to the previous 1-year period for which the
information was collected.
``(B) Requirement.--In making information reported
under this subsection publicly available under
subparagraph (A), the Secretary shall do so in a manner
that does not disclose the social security number of
any individual provider of services or supplier.
``(b) Audits.--The Secretary shall conduct an annual audit
consisting of a random sample of specified entities to verify
compliance with the requirements of this section and the accuracy of
information submitted pursuant to this section.
``(c) Penalty for Failure To Report.--If a specified entity fails
to provide a complete report under subsection (a), or submits a report
containing false information, such entity shall be subject to a civil
monetary penalty of not more than $5,000,000 for each such report not
provided or containing false information. Such penalty shall be imposed
and collected in the same manner as civil money penalties under
subsection (a) of section 1128A are imposed and collected under that
section.
``(d) Inapplicability of Paperwork Reduction Act.--Chapter 35 of
title 44, United States Code, shall not apply to collections of
information made under this section.
``(e) Definitions.--In this section:
``(1) Control.--The term `control' means the direct or
indirect power through ownership, contractual agreement, or
otherwise--
``(A) to vote more than 5 percent of any class of
voting securities of a specified entity; or
``(B) to direct the actions of the specified
entity.
``(2) Controlling entity.--
``(A) In general.--The term `controlling entity'
means, with respect to any specified entity, a parent
company or other entity that owns or controls the
specified entity through ownership, contractual
agreement, or otherwise.
``(B) Inclusion of reits.--Such term includes, with
respect to a specified entity, a real estate investment
trust (as defined in section 856 of the Internal
Revenue Code of 1986) that owns property where the
specified entity furnishes health care items or
services.
``(3) Health plan.--The term `health plan' has the meaning
given such term in section 1128C(c).
``(4) Health system.--The term `health system' means a
group of health care organizations (such as physician
practices, hospitals, skilled nursing facilities) that are
jointly owned or managed.
``(5) Hospital.--The term `hospital' has the meaning given
such term in section 1861(e).
``(6) Independent freestanding emergency department.--The
term `independent freestanding emergency department' has the
meaning given such term in section 2799A-1(a)(3)(D) of the
Public Health Service Act.
``(7) Private fund.--The term `private fund' means a
corporation that--
``(A) would be considered an investment company
under section 3 of the Investment Company Act of 1940
(15 U.S.C. 80a-3) but for the application of paragraph
(1) or (7) of subsection (c) of such section 3;
``(B) is not a venture capital fund, as defined in
section 275.203(l)-1 of title 17, Code of Federal
Regulations, as in effect on the date of enactment of
this section; and
``(C) is not an institution selected under section
107 of the Community Development Banking and Financial
Institutions Act of 1994 (12 2 U.S.C. 4706).
``(8) Specified entity.--The term `specified entity'
means--
``(A) a hospital or health system;
``(B) a physician-owned physician practice (other
than a practice described in subparagraph (C)) that is
enrolled in the Medicare program under title XVIII
under section 1866(j);
``(C) a physician practice owned, controlled, under
common control, or under management agreement by a
hospital, health system, a health plan, a private fund,
a venture capital fund, a public or private
corporation, or any subsidiaries or entities under
common control thereof;
``(D) an ambulatory surgical center meeting the
standards specified under section 1832(a)(2)(F)(i);
``(E) an independent freestanding emergency
department;
``(F) a behavioral health treatment facility, a
hospice program (as defined in section 1861(dd)(2)), a
home health agency, a provider of services or renal
dialysis facility that furnishes renal dialysis
services, or an assisted living facility;
``(G) any other entity specified by the Secretary
that furnishes health care items and services; and
``(H) any entity that owns or controls 1 or more
specified entities.
``(9) Venture capital fund.--The term `venture capital
fund' has the meaning given such term in section 275.203(l)-1
of title 17, Code of Federal Regulations.''.
SEC. 7. REPORT ON MORAL INJURY IN HEALTH CARE.
(a) In General.--Not later than 3 years after the date of enactment
of this Act, the Inspector General of the Department of Health and
Human Services shall--
(1) conduct a study that evaluates profit-driven practices,
including cost-cutting practices and revenue-enhancing
practices, in health care delivery; and
(2) submit to Congress a report describing the results of
such study.
(b) Inclusions.--The study conducted under subsection (a)(1) shall
include--
(1) an evaluation of profit-driven and revenue-maximization
practices in health care delivery, including--
(A) overbilling or up-coding;
(B) inflated patient severity or patient risk
scores;
(C) executive and provider compensation designed to
increase revenue or profits, such as bonuses based on
productivity, relative value units, or service volume;
(D) reductions in staff and substitution of patient
care staff with technology;
(E) changes in the mix of services provided in
order to maximize revenue;
(F) efforts by private health insurers that are
designed to restrict, delay, deny, or discourage health
care access services, such as prior authorization or
utilization review mechanisms; and
(G) efforts by private health insurers, private
equity firms, and other corporate entities to evade
state Corporate Practice of Medicine laws;
(2) an evaluation of the impact of such practices on--
(A) the quality, safety, and outcomes of patient
care;
(B) the well-being of personnel providing health
care services;
(C) the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.);
(D) the Medicaid program under title XIX of such
Act (42 U.S.C. 1396 et seq.);
(E) health care furnished under the laws
administered by the Secretary of Veterans Affairs;
(F) the health insurance program carried out under
chapter 89 of title 5, United States Code;
(G) qualified health plans offered through American
Health Benefit Exchanges established under section 1311
or 1321 of the Patient Protection and Affordable Care
Act (42 U.S.C. 18031, 18041); and
(H) group health plans and group and individual
health insurance coverage, including managed care
plans;
(3) an estimate of the financial returns accruing to
parties that benefit from such practices, including investors
and other entities; and
(4) an evaluation of the adequacy of Federal policies
designed to prevent and penalize health care fraud and abuse,
given health care consolidation and integration, including the
transparency of health care entities' financial practices, the
enforcement resources of Federal agencies, and the adequacy of
financial and other penalties as deterrents.
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