S.Amdt. 4633

This amendment, proposed by Mr. Merkley, aims to replace the entire content of bill S. 1383 with a new act called the Patients Over Profit Act (or the POP Act).

The purpose of this amendment is to make it unlawful for any person to own, operate, or control both a health insurance issuer and certain health care providers (referred to as applicable providers) or management services organizations that work with those providers under Medicare.

Key changes and additions include:

• Divestment Requirements: People in violation of the common ownership ban must sell off (divest) either the insurance issuer or the provider/management organization. This must happen within 2 years for assets owned before the act's enactment, or within 1 year for assets acquired after.

• Enforcement and Penalties: The FTC, DOJ, HHS Inspector General, or State Attorneys General can bring civil actions to force divestment. Violators must also give up (disgorge) any revenue earned from health care services during the violation, which will be used to serve the needs of the harmed community.

• Medicare Restrictions: Starting January 1, 2027, the Secretary cannot contract with or pay Medicare Advantage organizations that violate these ownership rules. Any payment claims submitted by entities in violation are considered false or fraudulent.

• Exclusions: The ban on common ownership does not apply to pharmacies, suppliers of durable medical equipment, prosthetics, orthotics, or supplies, or certain hospitals (including critical access and rural emergency hospitals).