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.
Sponsored By: Representative Pocan
Introduced
Summary
Makes certain fraud-related convictions an automatic basis to bar people and companies from federal health care programs. This bill would add two mandatory exclusion grounds to the Social Security Act that apply to offenses occurring on or after one year after enactment.
Show full summary
- Providers and individual participants: A misdemeanor tied to fraud, theft, embezzlement, breach of fiduciary duty, or other financial misconduct connected to delivering a health care item or service would trigger automatic exclusion if it occurs on or after 1 year after enactment.
- Non-health program misconduct: An individual or entity convicted of similar financial crimes in a government-run or government-funded non-health program would also face mandatory exclusion for offenses after 1 year.
- Agency enforcement and scope: The Secretary would be able to exclude anyone found to have committed acts described in sections 1128A, 1128B, or 1129 for offenses on or after 1 year after enactment. The bill also updates timing language and a cross-reference so the new exclusion grounds align with existing rules.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 1 costs, 0 mixed.
Providers face mandatory bans for fraud
If enacted, HHS would have to bar individuals and companies from Federal health care programs for certain fraud or financial crimes. This would apply to convictions or acts that happen on or after one year after enactment. It would cover fraud, theft, embezzlement, breach of duty, or similar misconduct tied to health care or any government‑funded program. HHS could also exclude people who commit acts covered by sections 1128A, 1128B, or 1129. Conduct before that one‑year date would follow the prior rules.
Penalty rules updated for new exclusions
If enacted, the bill would update legal references so civil money penalty rules also cover the new mandatory exclusion ground. This would take effect at enactment and would mainly affect providers, suppliers, and contractors who face these penalties.
Sponsors & CoSponsors
Sponsor
Pocan
WI • D
Cosponsors
Carson
IN • D
Sponsored 11/18/2025
Cohen
TN • D
Sponsored 11/18/2025
DeLauro
CT • D
Sponsored 11/18/2025
Doggett
TX • D
Sponsored 11/18/2025
Jayapal
WA • D
Sponsored 11/18/2025
Khanna
CA • D
Sponsored 11/18/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 11/18/2025
Ocasio-Cortez
NY • D
Sponsored 11/18/2025
Schakowsky
IL • D
Sponsored 11/18/2025
Takano
CA • D
Sponsored 11/18/2025
Thanedar
MI • D
Sponsored 11/18/2025
Tlaib
MI • D
Sponsored 11/18/2025
Bell
MO • D
Sponsored 11/18/2025
Omar
MN • D
Sponsored 11/18/2025
Dingell
MI • D
Sponsored 11/20/2025
Casar
TX • D
Sponsored 12/1/2025
Pingree
ME • D
Sponsored 12/16/2025
Roll Call Votes
No roll call votes available for this bill.
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