HR-10716-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
Sponsored by David Taylor (R-OH)
What it does
The bill would amend Section 1128(b)(8) and (b)(15) of the Social Security Act, which let the HHS Inspector General exclude certain entities and individuals from federal health care programs. Under the bill, the ownership, control, or officer relationship that triggers exclusion would be measured at the time of the conviction, civil monetary penalty, or exclusion, not at the time of the exclusion decision. In subsection (b)(15), it would also remove language about the timing of the action and fix a cross-reference from section 1128A(i)(6) to (i)(7). The exclusion authority itself remains permissive.
Who benefits
Federal health programs such as Medicare and Medicaid, and taxpayers who fund them, could benefit if OIG can exclude entities that were tied to a sanctioned person even after that person divested or resigned. OIG enforcement staff would gain clearer statutory authority and could face fewer disputes over timing. Compliant providers might benefit if bad actors are less able to re-enter programs through restructuring.
Who is hurt
Owners, officers, and managing employees who held a role when a sanction occurred but later left could face exclusion based on that past link. Entities that changed ownership or management after a sanction, including new owners who bought in good faith, could face exclusion risk and lost program revenue. Patients who rely on an excluded provider might lose access to care, and affected parties may incur legal costs to contest exclusions.
Supporters argue
Supporters argue the bill closes a loophole in which a sanctioned person can resign or sell an interest after a conviction or penalty and then keep the entity in federal programs. They contend that fixing the relevant moment at the time of the sanction gives OIG a clear, administrable test and better protects program funds from fraud.
Opponents argue
Opponents argue the bill could reach people and entities that cut ties with a wrongdoer long before an exclusion decision, penalizing divestiture and good-faith reorganizations. They contend that looking back to a past relationship expands exclusion power, which can end a provider's program revenue, and that it needs clear due process safeguards.
Constitutional context
Congress conditions participation in Medicare and Medicaid under its Spending Clause and Commerce Clause powers. Exclusion decisions implicate Fifth Amendment procedural due process (Mathews v. Eldridge, 1976), and courts now review OIG's statutory readings independently after Loper Bright (2024).
Checks and balances
The bill would modestly strengthen the executive branch's (HHS OIG) exclusion authority, with checks in administrative appeals, judicial review of exclusion decisions, and congressional oversight.
Historical precedent
Congress has repeatedly adjusted the exclusion authorities in Section 1128 of the Social Security Act, which was enacted in 1977 and expanded in the 1980s and 1990s, but no closely analogous timing amendment is identifiable.