Sec. 2114. Assuring Quality of Care in Hospice Care.: Pplication To

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1 in the same manner as such provisions apply to a hospice
2 program providing hospice care under title XVIII.’’.
3 (c) APPLICATION TO CHIP.—Title XXI of the Social
4 Security Act is amended by adding at the end the fol-
5 lowing new section:
6 ‘‘SEC. 2114. ASSURING QUALITY OF CARE IN HOSPICE CARE.
7 ‘‘The provisions of section 1819A shall apply to a

8 hospice program providing hospice care under this title in
9 the same manner such provisions apply to a hospice pro-
10 gram providing hospice care under title XVIII.’’.
11 SEC. 1615. ENHANCED PENALTIES FOR INDIVIDUALS EX-
12 CLUDED FROM PROGRAM PARTICIPATION.
13 (a) IN GENERAL.—Section 1128A(a) of the Social

14 Security Act (42 U.S.C. 1320a–7a(a)), as amended by the
15 previous sections, is further amended—
16 (1) by striking ‘‘or’’ at the end of paragraph
17 (9);
18 (2) by inserting ‘‘or’’ at the end of paragraph
19 (10);
20 (3) by inserting after paragraph (10) the fol-
21 lowing new paragraph:
22 ‘‘(11) orders or prescribes an item or service,
23 including without limitation home health care, diag-
24 nostic and clinical lab tests, prescription drugs, du-
25 rable medical equipment, ambulance services, phys-
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1 ical or occupational therapy, or any other item or
2 service, during a period when the person has been
3 excluded from participation in a Federal health care
4 program, and the person knows or should know that
5 a claim for such item or service will be presented to
6 such a program;’’; and
7 (4) in the matter following paragraph (11), as
8 inserted by paragraph (2), by striking ‘‘$15,000 for
9 each day of the failure described in such paragraph’’
10 and inserting ‘‘$15,000 for each day of the failure
11 described in such paragraph, or in cases under para-
12 graph (11), $50,000 for each order or prescription
13 for an item or service by an excluded individual’’.
14 (b) EFFECTIVE DATE.—The amendments made by
15 subsection (a) shall apply to violations committed on or
16 after January 1, 2010.
17 SEC. 1616. ENHANCED PENALTIES FOR PROVISION OF
18 FALSE INFORMATION BY MEDICARE ADVAN-
19 TAGE AND PART D PLANS.
20 (a) IN GENERAL.—Section 1857(g)(2)(A) of the So-

21 cial Security Act (42 U.S.C. 1395w—27(g)(2)(A)) is
22 amended by inserting ‘‘except with respect to a determina-
23 tion under subparagraph (E), an assessment of not more
24 than 3 times the amount claimed by such plan or plan
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699
1 sponsor based upon the misrepresentation or falsified in-
2 formation involved,’’ after ‘‘for each such determination,’’.
3 (b) EFFECTIVE DATE.—The amendment made by
6 SEC. 1617. ENHANCED PENALTIES FOR MEDICARE ADVAN-
7 TAGE AND PART D MARKETING VIOLATIONS.
8 (a) IN GENERAL.—Section 1857(g)(1) of the Social

9 Security Act (42 U.S.C. 1395w—27(g)(1)), as amended
10 by section 1221(b), is amended—
11 (1) in subparagraph (G), by striking ‘‘or’’ at
12 the end;
13 (2) by inserting after subparagraph (H) the fol-
14 lowing new subparagraphs:
15 ‘‘(I) except as provided under subpara-
16 graph (C) or (D) of section 1860D–1(b)(1), en-
17 rolls an individual in any plan under this part
18 without the prior consent of the individual or
19 the designee of the individual;
20 ‘‘(J) transfers an individual enrolled under
21 this part from one plan to another without the
22 prior consent of the individual or the designee
23 of the individual or solely for the purpose of
24 earning a commission;
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1 ‘‘(K) fails to comply with marketing re-
2 strictions described in subsections (h) and (j) of
3 section 1851 or applicable implementing regula-
4 tions or guidance; or
5 ‘‘(L) employs or contracts with any indi-
6 vidual or entity who engages in the conduct de-
7 scribed in subparagraphs (A) through (K) of
8 this paragraph;’’; and
9 (3) by adding at the end the following new sen-
10 tence: ‘‘The Secretary may provide, in addition to
11 any other remedies authorized by law, for any of the
12 remedies described in paragraph (2), if the Secretary
13 determines that any employee or agent of such orga-
14 nization, or any provider or supplier who contracts
15 with such organization, has engaged in any conduct
16 described in subparagraphs (A) through (L) of this
17 paragraph.’’
21 SEC. 1618. ENHANCED PENALTIES FOR OBSTRUCTION OF
22 PROGRAM AUDITS.
23 (a) IN GENERAL.—Section 1128(b)(2) of the Social

24 Security Act (42 U.S.C. 1320a–7(b)(2)) is amended—
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701
1 (1) in the heading, by inserting ‘‘OR AUDIT’’
2 after ‘‘INVESTIGATION’’; and

3 (2) by striking ‘‘investigation into’’ and all that
4 follows through the period and inserting ‘‘investiga-
5 tion or audit related to—’’
6 ‘‘(i) any offense described in para-
7 graph (1) or in subsection (a); or
8 ‘‘(ii) the use of funds received, directly
9 or indirectly, from any Federal health care
10 program (as defined in section
11 1128B(f)).’’.
15 SEC. 1619. EXCLUSION OF CERTAIN INDIVIDUALS AND EN-
16 TITIES FROM PARTICIPATION IN MEDICARE
17 AND STATE HEALTH CARE PROGRAMS.
18 (a) IN GENERAL.—Section 1128(c) of the Social Se-

19 curity Act, as previously amended by this division, is fur-
20 ther amended—
21 (1) in the heading, by striking ‘‘AND PERIOD’’
22 and inserting ‘‘, PERIOD, AND EFFECT’’; and
23 (2) by adding at the end the following new
24 paragraph:
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702
1 ‘‘(4)(A) For purposes of this Act, subject to
2 subparagraph (C), the effect of exclusion is that no
3 payment may be made by any Federal health care
4 program (as defined in section 1128B(f)) with re-
5 spect to any item or service furnished—
6 ‘‘(i) by an excluded individual or entity; or
7 ‘‘(ii) at the medical direction or on the pre-
8 scription of a physician or other authorized in-
9 dividual when the person submitting a claim for
10 such item or service knew or had reason to
11 know of the exclusion of such individual.
12 ‘‘(B) For purposes of this section and sections
13 1128A and 1128B, subject to subparagraph (C), an
14 item or service has been furnished by an individual
15 or entity if the individual or entity directly or indi-
16 rectly provided, ordered, manufactured, distributed,
17 prescribed, or otherwise supplied the item or service
18 regardless of how the item or service was paid for
19 by a Federal health care program or to whom such
20 payment was made.
21 ‘‘(C)(i) Payment may be made under a Federal
22 health care program for emergency items or services
23 (not including items or services furnished in an
24 emergency room of a hospital) furnished by an ex-
25 cluded individual or entity, or at the medical direc-
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703
1 tion or on the prescription of an excluded physician
2 or other authorized individual during the period of
3 such individual’s exclusion.
4 ‘‘(ii) In the case that an individual eligible for
5 benefits under title XVIII or XIX submits a claim
6 for payment for items or services furnished by an ex-
7 cluded individual or entity, and such individual eligi-
8 ble for such benefits did not know or have reason to
9 know that such excluded individual or entity was so
10 excluded, then, notwithstanding such exclusion, pay-
11 ment shall be made for such items or services. In
12 such case the Secretary shall notify such individual
13 eligible for such benefits of the exclusion of the indi-
14 vidual or entity furnishing the items or services.
15 Payment shall not be made for items or services fur-
16 nished by an excluded individual or entity to an indi-
17 vidual eligible for such benefits after a reasonable
18 time (as determined by the Secretary in regulations)
19 after the Secretary has notified the individual eligi-
20 ble for such benefits of the exclusion of the indi-
21 vidual or entity furnishing the items or services.
22 ‘‘(iii) In the case that a claim for payment for
23 items or services furnished by an excluded individual
24 or entity is submitted by an individual or entity
25 other than an individual eligible for benefits under
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704
1 title XVIII or XIX or the excluded individual or en-
2 tity, and the Secretary determines that the indi-
3 vidual or entity that submitted the claim took rea-
4 sonable steps to learn of the exclusion and reason-
5 ably relied upon inaccurate or misleading informa-
6 tion from the relevant Federal health care program
7 or its contractor, the Secretary may waive repay-
8 ment of the amount paid in violation of the exclusion
9 to the individual or entity that submitted the claim
10 for the items or services furnished by the excluded
11 individual or entity. If a Federal health care pro-
12 gram contractor provided inaccurate or misleading
13 information that resulted in the waiver of an over-
14 payment under this clause, the Secretary shall take
15 appropriate action to recover the improperly paid
16 amount from the contractor.’’.
17 Subtitle C—Enhanced Program
18 and Provider Protections
19 SEC. 1631. ENHANCED CMS PROGRAM PROTECTION AU-
20 THORITY.
21 (a) IN GENERAL.—Title XI of the Social Security Act

22 (42 U.S.C. 1301 et seq.) is amended by inserting after
23 section 1128F the following new section:
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July 14, 2009 (12:51 p.m.)

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F:\P11\NHI\TRICOMM\AAHCA09_001.

7 ‘‘The provisions of section 1819A shall apply to a

12 CLUDED FROM PROGRAM PARTICIPATION.

13 (a) IN GENERAL.—Section 1128A(a) of the Social

18 FALSE INFORMATION BY MEDICARE ADVAN-

19 TAGE AND PART D PLANS.

20 (a) IN GENERAL.—Section 1857(g)(2)(A) of the So-

7 TAGE AND PART D MARKETING VIOLATIONS.

8 (a) IN GENERAL.—Section 1857(g)(1) of the Social

23 (a) IN GENERAL.—Section 1128(b)(2) of the Social

2 after ‘‘INVESTIGATION’’; and

16 TITIES FROM PARTICIPATION IN MEDICARE

17 AND STATE HEALTH CARE PROGRAMS.

18 (a) IN GENERAL.—Section 1128(c) of the Social Se-

21 (a) IN GENERAL.—Title XI of the Social Security Act

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