Section 1 Short title
This Act may be cited as the “Strengthening Medicare Anti-Fraud Measures Act of 2013”.
Strengthening Medicare Anti-Fraud Measures Act of 2013
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.
Sec. 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)).”