§211. MANDATORY EXCLUSION FROM PARTICIPATION IN MEDICARE AND STATE HEALTH CARE PROGRAMS. (42 U.S.C. 1320a-7(a))

Health Insurance Portability and Accountability Act of 1996

TITLE II—PREVENTING HEALTH CARE FRAUD AND ABUSE; ADMINISTRATIVE SIMPLIFICATION

(a) Individual Convicted of Felony Relating to Health Care Fraud.—

(a)(1) In general.—Section 1128(a) (42 U.S.C. 1320a-7(a)) is amended by adding at the end the following new paragraph:

‘‘(3) Felony conviction relating to health care fraud.— Any individual or entity that has been convicted for an offense which occurred after the date of the enactment of the Health Insurance Portability and Accountability Act of 1996, under Federal or State law, in connection with the delivery of a health care item or service or with respect to any act or omission in a health care program (other than those specifically described in paragraph (1)) operated by or financed in whole or in part by any Federal, State, or local government agency, of a criminal offense consisting of a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct.’’.

(a)(2) Conforming amendment.—Paragraph (1) of section 1128(b) (42 U.S.C. 1320a-7(b) is amended to read as follows:

‘‘(1) Conviction relating to fraud.—Any individual or entity that has been convicted for an offense which occurred after the date of the enactment of the Health Insurance Portability and Accountability Act of 1996, under Federal or State law—

‘‘(A) of a criminal offense consisting of a misdemeanor relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct—

‘‘(i) in connection with the delivery of a health care item or service, or

‘‘(ii) with respect to any act or omission in a health care program (other than those specifically described in subsection (a)(1)) operated by or financed in whole or in part by any Federal, State, or local government agency; or

‘‘(B) of a criminal offense relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct with respect to any act or omission in a program (other than a health care program) operated by or financed in whole or in part by any Federal, State, or local government agency.’’.

(b) Individual Convicted of Felony Relating to Controlled Substance.—

(b)(1) In general.—Section 1128(a) (42 U.S.C. 1320a-7(a)), as amended by subsection (a), is amended by adding at the end the following new paragraph:

‘‘(4) Felony conviction relating to controlled substance.—Any individual or entity that has been convicted for an offense which occurred after the date of the enactment of the Health Insurance Portability and Accountability Act of 1996, under Federal or State law, of a criminal offense consisting of a felony relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance.’’.

(b)(2) Conforming amendment.—Section 1128(b)(3)(42 U.S.C. 1320a-7(b)(3)) is amended—

(b)(2)(A) in the heading, by striking ‘‘Conviction’’ and inserting ‘‘Misdemeanor conviction’’; and

(b)(2)(B) by striking ‘‘criminal offense’’ and inserting ‘‘criminal offense consisting of a misdemeanor’’.