To amend title XI of the Social Security Act to require the Secretary to exclude certain individuals and entities who commit fraud from participation in any Federal health care program.
- Bill Number
- H.R. 6108
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-18: 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.
- Last Updated
- 2025-12-17T09:06:26Z
AI-Generated Summary
Purpose of the Legislation
This bill, H.R. 6108, aims to strengthen protections against fraud in federal health care programs by making certain exclusions from participation mandatory. It requires the Secretary of Health and Human Services (HHS) to bar individuals and entities convicted of or involved in specific fraud-related activities from receiving payments or participating in programs like Medicare and Medicaid.
Key Provisions
- Mandatory Exclusions for Convictions (New Subsection 1128(a)(5)):
- Applies to convictions occurring at least one year after the bill's enactment.
- Covers federal or state misdemeanor convictions related to fraud, theft, embezzlement, breach of fiduciary duty (a legal obligation to act in another's best interest), or other financial misconduct.
- Includes offenses connected to delivering health care items/services, participating in health care programs funded by government, or fraud in any non-health care government program.
- Mandatory Exclusions for Prohibited Acts (New Subsection 1128(a)(6)):
- Applies to acts committed at least one year after enactment.
- Targets violations of existing laws on civil monetary penalties (section 1128A), anti-kickback statutes (section 1128B, which prohibit offering or accepting bribes for health care referrals), or improper inducements to beneficiaries (section 1129).
- Adjustments to Existing Permissive Exclusions (Amendments to Subsection 1128(b)):
- Limits current discretionary exclusions (where the Secretary could choose to exclude) for fraud convictions or prohibited acts to those occurring before the one-year post-enactment date, effectively making them mandatory afterward.
- Technical Updates:
- Amends section 1128(f)(2) to include the new mandatory provisions in waiver processes.
- Updates section 1128D (on administrative processes for exclusions) for consistency.
Significant Changes to Existing Law
- Shifts certain exclusions under the Social Security Act from permissive (Secretary's discretion) to mandatory, reducing flexibility but ensuring automatic application for post-enactment fraud.
- Introduces a one-year grace period before mandatory rules take effect, allowing time for implementation.
- Expands the scope to include non-health care government program fraud if it involves financial misconduct, broadening the criteria beyond current health care-specific rules.
Potential Impacts
- On Government Agencies: HHS and related agencies (e.g., Centers for Medicare & Medicaid Services) will face increased administrative burdens to enforce mandatory exclusions, potentially leading to more investigations and fewer fraud cases slipping through. This could improve program integrity and save taxpayer funds from fraudulent claims.
- On Citizens: Beneficiaries of federal health programs may benefit from reduced fraud, leading to more sustainable funding and better access to legitimate services. However, it could temporarily limit provider options in underserved areas if many are excluded.
- On International Relations: Minimal direct impact, as the bill focuses on domestic U.S. health programs; it does not address cross-border fraud explicitly.
Main Stakeholders Affected
- Health Care Providers and Entities: Doctors, hospitals, pharmacies, and other participants in federal programs risk automatic exclusion for fraud, affecting their ability to bill government payers.
- Individuals Involved in Fraud: Those convicted of or engaging in financial misconduct in government programs will face permanent barriers to health care involvement.
- Federal Health Programs and Agencies: Medicare, Medicaid, and HHS will enforce stricter rules, impacting oversight and compliance efforts.
- Taxpayers and Program Beneficiaries: Indirectly affected through enhanced protection of public funds and program stability.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens anti-fraud enforcement under the Social Security Act but may raise due process concerns (constitutional right to fair procedures) if mandatory exclusions limit appeals or waivers without individualized review. Existing waiver provisions (subsection 1128(f)) provide some flexibility.
- Constitutional: Aligns with Congress's spending power to condition federal funds on compliance, but could be challenged if seen as overly punitive for misdemeanors.
- Political: Reflects bipartisan interest in curbing health care waste (introduced by a group of Democrats), potentially appealing to fiscal conservatives. It signals a tougher stance on accountability amid ongoing concerns about rising health care costs and program vulnerabilities.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (17)
Rep. Carson, André [D-IN-7], Rep. Cohen, Steve [D-TN-9], Rep. DeLauro, Rosa L. [D-CT-3], Rep. Doggett, Lloyd [D-TX-37], Rep. Jayapal, Pramila [D-WA-7], Rep. Khanna, Ro [D-CA-17], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Ocasio-Cortez, Alexandria [D-NY-14], Rep. Schakowsky, Janice D. [D-IL-9], Rep. Takano, Mark [D-CA-39], Rep. Thanedar, Shri [D-MI-13], Rep. Tlaib, Rashida [D-MI-12], Rep. Bell, Wesley [D-MO-1], Rep. Omar, Ilhan [D-MN-5], Rep. Dingell, Debbie [D-MI-6], Rep. Casar, Greg [D-TX-35], Rep. Pingree, Chellie [D-ME-1]
Recent Actions
- 2025-11-18: 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.
- 2025-11-18: 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.
- 2025-11-18: Introduced in House
- 2025-11-18: Introduced in House
Bill Versions
- To amend title XI of the Social Security Act to require the Secretary to exclude certain individuals and entities who commit fraud from participation in any Federal health care program. — issued 2025-11-18 — PDF (4 pages)