Bill > HR5433

This bill, known as the "Patients Over Profit Act" (POP Act), aims to prohibit common ownership between health insurance issuers and certain health care providers participating in Medicare. Specifically, it makes it unlawful for a single entity to own or control both a health insurance issuer and an "applicable provider" (which includes most medical service providers except hospitals, critical access hospitals, rural emergency hospitals, medical equipment suppliers, and pharmacies). Entities currently in violation must divest either their health insurance or medical provider business within 1-2 years of the act's enactment, depending on when they acquired the assets. The bill empowers various government agencies, including the Federal Trade Commission, Department of Justice, and state attorneys general, to bring civil actions against violators, with potential penalties including mandatory divestment and disgorgement of revenues. For Medicare Advantage and Part D plans, the bill introduces additional enforcement mechanisms, requiring organizations to certify compliance and potentially facing false claims allegations if they violate the ownership restrictions. Starting January 1, 2026, Medicare will be prohibited from contracting with or providing payment to organizations that do not comply with these ownership restrictions. The overall goal is to prevent potential conflicts of interest and reduce healthcare costs by separating insurance and medical service providers.

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https://www.congress.gov/bill/119th-congress/house-bill/5433/all-info