Bill > S2836

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 under Medicare. Specifically, the bill makes it unlawful for a single entity or person to simultaneously 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 found in violation must divest either their health insurance issuer or applicable provider within 1-2 years, depending on when the ownership was acquired. The bill empowers various federal agencies, including the Department of Health and Human Services, Department of Justice, and Federal Trade Commission, to bring civil actions against violators. Penalties include cease and desist orders, mandatory divestment, and the requirement to surrender revenues earned during the period of violation. For Medicare Advantage and Medicare Part D plans, the bill introduces additional compliance requirements, mandating that organizations certify they do not have prohibited ownership structures and subjecting claims from non-compliant entities to potential fraud classification. The legislation is designed to prevent potential conflicts of interest and reduce the likelihood of profit-driven healthcare decisions that might not prioritize patient care.

Justice

https://www.congress.gov/bill/119th-congress/senate-bill/2836/all-info