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 c…
This bill amends section 1128 of the Social Security Act to make certain exclusions from participation in Federal health care programs mandatory. It adds a new mandatory exclusion for any individual or entity convicted (under Federal or State law) after a one-year delay of a misdemeanor or other criminal offense involving fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct tied to health care delivery or to any government‑financed program.
Whether mandatory exclusions should apply to misdemeanor convictions: liberals/centrists worry about access and proportionality; conservatives worry about overreach and disproportionate penalties.
Relative to its intended legislative type, this bill is a focused substantive statutory amendment that clearly defines mandatory exclusion triggers for fraud-related convictions and Secretary determinations, integrates those triggers into the existing section 1128 exclusion framework, and sets a clear effective date.
This bill amends section 1128 of the Social Security Act to make certain exclusions from participation in Federal health care programs mandatory.
It adds a new mandatory exclusion for any individual or entity convicted (under Federal or State law) after a one-year delay of a misdemeanor or other criminal offense involving fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct tied to health care delivery or to any government‑financed program.
It also requires mandatory exclusion (after a one‑year delay) for any individual or entity the Secretary determines committed acts described in sections 1128A, 1128B, or 1129 (civil monetary penalties, anti‑kickback, and criminal health care fraud provisions).
By content alone, the bill is a focused program-integrity amendment that could attract cross-aisle support because it targets fraud. However, mandatory exclusions for misdemeanor offenses and broad Secretary-determination language introduce substantive objections (due process, workforce impacts, potential overbreadth) that may prompt amendment requests or stakeholder opposition. The absence of detailed procedural safeguards, cost offsets, or compensating exceptions makes enactment plausible but not straightforward without negotiation.
Relative to its intended legislative type, this bill is a focused substantive statutory amendment that clearly defines mandatory exclusion triggers for fraud-related convictions and Secretary determinations, integrates those triggers into the existing section 1128 exclusion framework, and sets a clear effective date.
Whether mandatory exclusions should apply to misdemeanor convictions: liberals/centrists worry about access and proportionality; conservatives worry about overreach and disproportionate penalties.
These are examples from the analysis, not a ranked list of the most-affected groups.
Whether mandatory exclusions should apply to misdemeanor convictions: liberals/centrists worry about access and proportionality; conservatives worry about overreach and disproportionate penalties.
A mainstream liberal/left-leaning observer would likely view the bill as a serious effort to strengthen program integrity by removing bad actors who defraud federal and state health programs.
They would generally welcome mandatory exclusion for fraudsters because it protects public funds and vulnerable patients; however, they would also be concerned about overly broad application (e.g., misdemeanor convictions or administrative determinations) that could reduce access to care in underserved communities or disproportionately impact marginalized providers.
They would want safeguards for due process, proportionality, and pathways to reinstatement so exclusions do not unintentionally harm patient access.
A centrist/moderate observer would recognize the need to protect federal health programs from fraud and would generally favor stronger, predictable enforcement tools.
At the same time, they would be cautious about expanding mandatory exclusion to misdemeanor convictions and to administrative findings without clear due process, because that could impose costs, access problems, and legal challenges.
They would emphasize implementation details, the projected fiscal savings versus administrative burdens, and want guardrails to prevent unintended consequences.
A mainstream conservative observer would welcome stronger action against fraud in federal health programs in principle, since protecting taxpayer funds aligns with conservative priorities.
However, they would likely object to parts of the bill that expand mandatory exclusion to misdemeanors and to exclusions based on an administrative 'determination' by the Secretary rather than a criminal conviction, seeing that as an expansion of federal administrative power and a potential due‑process problem.
They would also be wary of additional regulatory complexity and the risk of reducing provider participation due to heavy‑handed federal penalties.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
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Still ahead
By content alone, the bill is a focused program-integrity amendment that could attract cross-aisle support because it targets fraud. However, mandatory exclusions for misdemeanor offenses and broad Secretary-determination language introduce substantive objections (due process, workforce impacts, potential overbreadth) that may prompt amendment requests or stakeholder opposition. The absence of detailed procedural safeguards, cost offsets, or compensating exceptions makes enactment plausible but not straightforward without negotiation.
The bill has not accumulated any surfaced votes yet.
Whether mandatory exclusions should apply to misdemeanor convictions: liberals/centrists worry about access and proportionality; conservati…
By content alone, the bill is a focused program-integrity amendment that could attract cross-aisle support because it targets fraud. Howeve…
Relative to its intended legislative type, this bill is a focused substantive statutory amendment that clearly defines mandatory exclusion triggers for fraud-related convictions and Secretary determinations, integrates…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.