US Laws - Affordable Health Care Act (HR3950F)
TITLE VI--TRANSPARENCY AND PROGRAM INTEGRITY
Subtitle G--Additional Program Integrity Provisions

Subtitle G--Additional Program Integrity Provisions (10257)(1-click HTML)

SEC. 6601. PROHIBITION ON FALSE STATEMENTS AND REPRESENTATIONS. (10258)(1-click HTML)

(a) Prohibition- Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.) is amended by adding at the end the following: (10259)

SEC. 519. PROHIBITION ON FALSE STATEMENTS AND REPRESENTATIONS. (10260)

"No person, in connection with a plan or other arrangement that is multiple employer welfare arrangement described in section 3(40), shall make a false statement or false representation of fact, knowing it to be false, in connection with the marketing or sale of such plan or arrangement, to any employee, any member of an employee organization, any beneficiary, any employer, any employee organization, the Secretary, or any State, or the representative or agent of any such person, State, or the Secretary, concerning-- (10261)

"(1) the financial condition or solvency of such plan or arrangement; (10262)

"(2) the benefits provided by such plan or arrangement; (10263)

"(3) the regulatory status of such plan or other arrangement under any Federal or State law governing collective bargaining, labor management relations, or intern union affairs; or (10264)

"(4) the regulatory status of such plan or other arrangement regarding exemption from state regulatory authority under this Act. (10265)

This section shall not apply to any plan or arrangement that does not fall within the meaning of the term "multiple employer welfare arrangement" under section 3(40)(A).". (10266)

(b) Criminal Penalties- Section 501 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1131) is amended-- (10267)

(1) by inserting "(a)" before "Any person"; and (10268)

(2) by adding at the end the following: (10269)

"(b) Any person that violates section 519 shall upon conviction be imprisoned not more than 10 years or fined under title 18, United States Code, or both.". (10270)

(c) Conforming Amendment- The table of sections for part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following: (10271)

"Sec. 519. Prohibition on false statement and representations.". (10272)

SEC. 6602. CLARIFYING DEFINITION. (10273)(1-click HTML)

Section 24(a)(2) of title 18, United States Code, is amended by inserting "or section 411, 518, or 511 of the Employee Retirement Income Security Act of 1974," after "1954 of this title". (10274)

SEC. 6603. DEVELOPMENT OF MODEL UNIFORM REPORT FORM. (10275)(1-click HTML)

Part C of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-91 et seq.) is amended by adding at the end the following: (10276)

SEC. 2794. UNIFORM FRAUD AND ABUSE REFERRAL FORMAT. (10277)

"The Secretary shall request the National Association of Insurance Commissioners to develop a model uniform report form for private health insurance issuer seeking to refer suspected fraud and abuse to State insurance departments or other responsible State agencies for investigation. The Secretary shall request that the National Association of Insurance Commissioners develop recommendations for uniform reporting standards for such referrals.". (10278)

SEC. 6604. APPLICABILITY OF STATE LAW TO COMBAT FRAUD AND ABUSE. (10279)(1-click HTML)

(a) In General- Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.), as amended by section 6601, is further amended by adding at the end the following: (10280)

SEC. 520. APPLICABILITY OF STATE LAW TO COMBAT FRAUD AND ABUSE. (10281)

"The Secretary may, for the purpose of identifying, preventing, or prosecuting fraud and abuse, adopt regulatory standards establishing, or issue an order relating to a specific person establishing, that a person engaged in the business of providing insurance through a multiple employer welfare arrangement described in section 3(40) is subject to the laws of the States in which such person operates which regulate insurance in such State, notwithstanding section 514(b)(6) of this Act or the Liability Risk Retention Act of 1986, and regardless of whether the law of the State is otherwise preempted under any of such provisions. This section shall not apply to any plan or arrangement that does not fall within the meaning of the term "multiple employer welfare arrangement" under section 3(40)(A).". (10282)

(b) Conforming Amendment- The table of sections for part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, as amended by section 6601, is further amended by adding at the end the following: (10283)

"Sec. 520. Applicability of State law to combat fraud and abuse.". (10284)

SEC. 6605. ENABLING THE DEPARTMENT OF LABOR TO ISSUE ADMINISTRATIVE SUMMARY CEASE AND DESIST ORDERS AND SUMMARY SEIZURES ORDERS AGAINST PLANS THAT ARE IN FINANCIALLY HAZARDOUS CONDITION. (10285)(1-click HTML)

(a) In General- Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.), as amended by section 6604, is further amended by adding at the end the following: (10286)

SEC. 521. ADMINISTRATIVE SUMMARY CEASE AND DESIST ORDERS AND SUMMARY SEIZURE ORDERS AGAINST MULTIPLE EMPLOYER WELFARE ARRANGEMENTS IN FINANCIALLY HAZARDOUS CONDITION. (10287)

"(a) In General- The Secretary may issue a cease and desist (ex parte) order under this title if it appears to the Secretary that the alleged conduct of a multiple employer welfare arrangement described in section 3(40), other than a plan or arrangement described in subsection (g), is fraudulent, or creates an immediate danger to the public safety or welfare, or is causing or can be reasonably expected to cause significant, imminent, and irreparable public injury. (10288)

"(b) Hearing- A person that is adversely affected by the issuance of a cease and desist order under subsection (a) may request a hearing by the Secretary regarding such order. The Secretary may require that a proceeding under this section, including all related information and evidence, be conducted in a confidential manner. (10289)

"(c) Burden of Proof- The burden of proof in any hearing conducted under subsection (b) shall be on the party requesting the hearing to show cause why the cease and desist order should be set aside. (10290)

"(d) Determination- Based upon the evidence presented at a hearing under subsection (b), the cease and desist order involved may be affirmed, modified, or set aside by the Secretary in whole or in part. (10291)

"(e) Seizure- The Secretary may issue a summary seizure order under this title if it appears that a multiple employer welfare arrangement is in a financially hazardous condition. (10292)

"(f) Regulations- The Secretary may promulgate such regulations or other guidance as may be necessary or appropriate to carry out this section. (10293)

"(g) Exception- This section shall not apply to any plan or arrangement that does not fall within the meaning of the term "multiple employer welfare arrangement" under section 3(40)(A).". (10294)

(b) Conforming Amendment- The table of sections for part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, as amended by section 6604, is further amended by adding at the end the following: (10295)

"Sec. 521. Administrative summary cease and desist orders and summary seizure orders against health plans in financially hazardous condition.". (10296)

SEC. 6606. MEWA PLAN REGISTRATION WITH DEPARTMENT OF LABOR. (10297)(1-click HTML)

Section 101(g) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1021(g)) is amended-- (10298)

(1) by striking "Secretary may" and inserting "Secretary shall"; and (10299)

(2) by inserting "to register with the Secretary prior to operating in a State and may, by regulation, require such multiple employer welfare arrangements" after "not group health plans". (10300)

SEC. 6607. PERMITTING EVIDENTIARY PRIVILEGE AND CONFIDENTIAL COMMUNICATIONS. (10301)(1-click HTML)

Section 504 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1134) is amended by adding at the end the following: (10302)

"(d) The Secretary may promulgate a regulation that provides an evidentiary privilege for, and provides for the confidentiality of communications between or among, any of the following entities or their agents, consultants, or employees: (10303)

"(1) A State insurance department. (10304)

"(2) A State attorney general. (10305)

"(3) The National Association of Insurance Commissioners. (10306)

"(4) The Department of Labor. (10307)

"(5) The Department of the Treasury. (10308)

"(6) The Department of Justice. (10309)

"(7) The Department of Health and Human Services. (10310)

"(8) Any other Federal or State authority that the Secretary determines is appropriate for the purposes of enforcing the provisions of this title. (10311)

"(e) The privilege established under subsection (d) shall apply to communications related to any investigation, audit, examination, or inquiry conducted or coordinated by any of the agencies. A communication that is privileged under subsection (d) shall not waive any privilege otherwise available to the communicating agency or to any person who provided the information that is communicated.". (10312)

  

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