This
section was buried deep inside this bill; it is a very hard read. In my
opinion, this is probably the most important section. This section should be
read carefully, studied by your attorney and understood thoroughly. This is an
example of the difficulty in reading this bill, but please; it is important! If
this bill is not repealed, it is my belief that a good percentage of our
doctors may retire and these are some of the doctors we need the most. Our
health care has been dismantled and reassembled into a system we are not
accustomed to and will not like. If you are a doctor, there is grave financial
consequence written into this section and action must be taken now!
TITLE VI—TRANSPARENCY AND
9 PROGRAM INTEGRITY
10 Subtitle A—Physician Ownership
11 and Other Transparency
12 SEC. 6001. LIMITATION ON MEDICARE EXCEPTION TO THE
13 PROHIBITION ON CERTAIN PHYSICIAN RE14
FERRALS FOR HOSPITALS.
15 (a) IN GENERAL.—Section 1877 of
the Social Security
16 Act (42 U.S.C. 1395nn) is amended—
17 (1) in subsection (d)(2)—
18 (A) in subparagraph (A), by striking ‘‘and’’
19 at the end;
20 (B) in subparagraph (B), by striking the
21 period at the end and inserting ‘‘; and’’; and
22 (C) by adding at the end the following new
23 subparagraph:
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1 ‘‘(C) in the case where the entity is a hos2
pital, the hospital meets the requirements of
3 paragraph (3)(D).’’;
4 (2) in subsection (d)(3)—
5 (A) in subparagraph (B), by striking ‘‘and’’
6 at the end;
7 (B) in subparagraph (C), by striking the
8 period at the end and inserting ‘‘; and’’; and
9 (C) by adding at the end the following new
10 subparagraph:
11 ‘‘(D) the hospital meets the requirements de12
scribed in subsection (i)(1) not later than 18
13 months after the date of the enactment of this
14 subparagraph.’’; and
15 (3) by adding at the end the following new sub16
section:
17 ‘‘(i) REQUIREMENTS FOR HOSPITALS TO QUALIFY FOR
18 RURAL
PROVIDER
AND HOSPITAL
EXCEPTION
TO OWNER19
SHIP OR INVESTMENT PROHIBITION.—
20 ‘‘(1) REQUIREMENTS DESCRIBED.—For purposes
21 of subsection (d)(3)(D), the requirements described in
22 this paragraph for a hospital are as follows:
23 ‘‘(A) PROVIDER AGREEMENT.—The hospital
24 had—
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1 ‘‘(i) physician ownership or investment
2 on February 1, 2010; and
3 ‘‘(ii) a provider agreement under sec4
tion 1866 in effect on such date.
5 ‘‘(B) LIMITATION ON EXPANSION OF FACIL6
ITY CAPACITY.—Except as
provided in para7
graph (3), the number of operating rooms, proce8
dure rooms, and beds for which the hospital is li9
censed at any time on or after the date of the en10
actment of this subsection is no greater than the
11 number of operating rooms, procedure rooms,
12 and beds for which the hospital is licensed as of
13 such date.
14 ‘‘(C) PREVENTING CONFLICTS OF INTER15
EST.—
16 ‘‘(i) The hospital submits to the Sec17
retary an annual report containing a de18
tailed description of—
19 ‘‘(I) the identity of each physician
20 owner or investor and any other own21
ers or investors of the hospital; and
22 ‘‘(II) the nature and extent of all
23 ownership and investment interests in
24 the hospital.
V
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1 ‘‘(ii) The hospital has procedures in
2 place to require that any referring physi3
cian owner or investor discloses to the pa4
tient being referred, by a time that permits
5 the patient to make a meaningful decision
6 regarding the receipt of care, as determined
7 by the Secretary—
8 ‘‘(I) the ownership or investment
9 interest, as applicable, of such referring
10 physician in the hospital; and
11 ‘‘(II) if applicable, any such own12
ership or investment interest of the
13 treating physician.
14 ‘‘(iii) The hospital does not condition
15 any physician ownership or investment in16
terests either directly or indirectly on the
17 physician owner or investor making or in18
fluencing referrals to the hospital or other19
wise generating business for the hospital.
20 ‘‘(iv) The hospital discloses the fact
21 that the hospital is partially owned or in22
vested in by physicians—
23 ‘‘(I) on any public website for the
24 hospital; and
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1 ‘‘(II) in any public advertising
2 for the hospital.
3 ‘‘(D) ENSURING BONA FIDE INVESTMENT.—
4 ‘‘(i) The percentage of the total value of
5 the ownership or investment interests held
6 in the hospital, or in an entity whose assets
7 include the hospital, by physician owners or
8 investors in the aggregate does not exceed
9 such percentage as of the date of enactment
10 of this subsection.
11 ‘‘(ii) Any ownership or investment in12
terests that the hospital offers to a physician
13 owner or investor are not offered on more
14 favorable terms than the terms offered to a
15 person who is not a physician owner or in16
vestor.
17 ‘‘(iii) The hospital (or any owner or
18 investor in the hospital) does not directly or
19 indirectly provide loans or financing for
20 any investment in the hospital by a physi21
cian owner or investor.
22 ‘‘(iv) The hospital (or any owner or in23
vestor in the hospital) does not directly or
24 indirectly guarantee a loan, make a pay25
ment toward a loan, or otherwise subsidize
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1 a loan, for any individual physician owner
2 or investor or group of physician owners or
3 investors that is related to acquiring any
4 ownership or investment interest in the hos5
pital.
6 ‘‘(v) Ownership or investment returns
7 are distributed to each owner or investor in
8 the hospital in an amount that is directly
9 proportional to the ownership or investment
10 interest of such owner or investor in the
11 hospital.
12 ‘‘(vi) Physician owners and investors
13 do not receive, directly or indirectly, any
14 guaranteed receipt of or right to purchase
15 other business interests related to the hos16
pital, including the purchase or lease of any
17 property under the control of other owners
18 or investors in the hospital or located near
19 the premises of the hospital.
20 ‘‘(vii) The hospital does not offer a
21 physician owner or investor the opportunity
22 to purchase or lease any property under the
23 control of the hospital or any other owner
24 or investor in the hospital on more favor25
able terms than the terms offered to an indi-
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1 vidual who is not a physician owner or in2
vestor.
Every
doctor in America needs to read and completely understand this. Your
information is about to become a matter of public record.
‘‘(2)
PUBLICATION OF
INFORMATION RE4
PORTED.—The Secretary shall
publish, and update on
5
an annual
basis, the information submitted by hos6
pitals
under paragraph (1)(C)(i) on the public Inter7
net
website of the Centers for Medicare & Medicaid
8
Services.
‘‘(iii)
that does not discriminate
2
against
beneficiaries of Federal health care
3
programs
and does not permit physicians
4
practicing
at the hospital to discriminate
5
against
such beneficiaries;
If
you are a doctor, you had better pick your words carefully when it comes to
Medicare and Medicaid patients.
‘‘(4) COLLECTION OF OWNERSHIP AND INVEST9
MENT INFORMATION.—For purposes of subparagraphs
10 (A)(i) and (D)(i) of paragraph (1), the Secretary
11 shall collect physician ownership and investment in12
formation for each hospital.
13 ‘‘(5) PHYSICIAN OWNER OR INVESTOR DE14
FINED.—For purposes of this subsection, the term
15 ‘physician owner or investor’ means a physician (or
16 an immediate family member of such physician) with
17 a direct or an indirect ownership or investment inter18
est in the hospital.
19 ‘‘(6) CLARIFICATION.—Nothing in this subsection
20 shall be construed as preventing the Secretary from
21 revoking a hospital’s provider agreement if not in
22 compliance with regulations implementing section
23 1866.’’.
24 (b) ENFORCEMENT.—
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1 (1) ENSURING COMPLIANCE.—The Secretary of
2 Health and Human Services shall establish policies
3 and procedures to ensure compliance with the require4
ments described in subsection (i)(1) of section 1877 of
5 the Social Security Act, as added by subsection
6 (a)(3), beginning on the date such requirements first
7 apply. Such policies and procedures may include un8
announced site reviews of hospitals.
9 (2) AUDITS.—Beginning not later than Novem10
ber 1, 2011, the Secretary of Health and Human
11 Services shall conduct audits to determine if hospitals
12 violate the requirements referred to in paragraph (1).
Unbelievable!
‘‘SEC. 1128G. TRANSPARENCY REPORTS AND
REPORTING OF
20 PHYSICIAN OWNERSHIP OR INVESTMENT IN21
TERESTS.
22 ‘‘(a) TRANSPARENCY REPORTS.—
23 ‘‘(1) PAYMENTS OR OTHER TRANSFERS OF
24 VALUE.—
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1 ‘‘(A) IN GENERAL.—On March 31,
2013,
2 and on the 90th day of each calendar year begin3
ning thereafter, any applicable manufacturer
4 that provides a payment or other transfer of
5 value to a covered recipient (or to an entity or
6 individual at the request of or designated on be7
half of a covered recipient), shall submit to the
8 Secretary, in such electronic form as the Sec9
retary shall require, the following information
10 with respect to the preceding calendar year:
11 ‘‘(i) The name of the covered recipient.
12 ‘‘(ii) The business address of the cov13
ered recipient and, in the case of a covered
14 recipient who is a physician, the specialty
15 and National Provider Identifier of the cov16
ered recipient.
17 ‘‘(iii) The amount of the payment or
18 other transfer of value.
19 ‘‘(iv) The dates on which the payment
20 or other transfer of value was provided to
21 the covered recipient.
22 ‘‘(v) A description of the form of the
23 payment or other transfer of value, indi24
cated (as appropriate for all that apply)
25 as—
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1 ‘‘(I) cash or a cash equivalent;
2 ‘‘(II) in-kind items or services;
3 ‘‘(III) stock, a stock option, or
4 any other ownership interest, dividend,
5 profit, or other return on investment;
6 or
7 ‘‘(IV) any other form of payment
8 or other transfer of value (as defined
9 by the Secretary).
10 ‘‘(vi) A description of the nature of the
11 payment or other transfer of value, indi12
cated (as appropriate for all that apply)
13 as—
14 ‘‘(I) consulting fees;
15 ‘‘(II) compensation for services
16 other than consulting;
17 ‘‘(III) honoraria;
18 ‘‘(IV) gift;
19 ‘‘(V) entertainment;
20 ‘‘(VI) food;
21 ‘‘(VII) travel (including the speci22
fied destinations);
23 ‘‘(VIII) education;
24 ‘‘(IX) research;
25 ‘‘(X) charitable contribution;
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1 ‘‘(XI) royalty or license;
2 ‘‘(XII) current or prospective
3 ownership or investment interest;
4 ‘‘(XIII) direct compensation for
5 serving as faculty or as a speaker for
6 a medical education program;
7 ‘‘(XIV) grant; or
8 ‘‘(XV) any other nature of the
9 payment or other transfer of value (as
10 defined by the Secretary).
11 ‘‘(vii) If the payment or other transfer
12 of value is related to marketing, education,
13 or research specific to a covered drug, de14
vice, biological, or medical supply, the name
15 of that covered drug, device, biological, or
16 medical supply.
17 ‘‘(viii) Any other categories of informa18
tion regarding the payment or other trans19
fer of value the Secretary determines appro20
priate.
If
you are a doctor, you better have your attorney read this. A good look at
family member’s involvement would be warranted. The liability that has been
placed upon your children is far reaching and could have grave financial
consequence!
‘‘(B) SPECIAL RULE FOR CERTAIN PAY22
MENTS OR OTHER TRANSFERS OF VALUE.—In
23 the case where an applicable manufacturer pro24
vides a payment or other transfer of value to an
25 entity or individual at the request of or des-
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1 ignated on behalf of a covered recipient, the ap2
plicable manufacturer shall disclose that pay3
ment or other transfer of value under the name
4 of the covered recipient.
5 ‘‘(2) PHYSICIAN OWNERSHIP.—In addition to the
6 requirement under paragraph (1)(A), on March 31,
7 2013, and on the 90th day of each calendar year be8
ginning thereafter, any applicable manufacturer or
9 applicable group purchasing organization shall sub10
mit to the Secretary, in such electronic form as the
11 Secretary shall require, the following information re12
garding any ownership or investment interest (other
13 than an ownership or investment interest in a pub14
licly traded security and mutual fund, as described in
15 section 1877(c)) held by a physician (or an imme16
diate family member of such physician (as defined for
17 purposes of section 1877(a))) in the applicable manu18
facturer or applicable group purchasing organization
19 during the preceding year:
20 ‘‘(A) The dollar amount invested by each
21 physician holding such an ownership or invest22
ment interest.
23 ‘‘(B) The value and terms of each such own24
ership or investment interest.
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1 ‘‘(C) Any payment or other transfer of
2 value provided to a physician holding such an
3 ownership or investment interest (or to an entity
4 or individual at the request of or designated on
5 behalf of a physician holding such an ownership
6 or investment interest), including the informa7
tion described in clauses (i) through (viii) of
8 paragraph (1)(A), except that in applying such
9 clauses, ‘physician’ shall be substituted for ‘cov10
ered recipient’ each place it appears.
11 ‘‘(D) Any other information regarding the
12 ownership or investment interest the Secretary
13 determines appropriate.
14 ‘‘(b) PENALTIES FOR NONCOMPLIANCE.—
15 ‘‘(1) FAILURE TO REPORT.—
16 ‘‘(A) IN GENERAL.—Subject to subpara17
graph (B) except as provided in paragraph (2),
18 any applicable manufacturer or applicable group
19 purchasing organization that fails to submit in20
formation required under subsection (a) in a
21 timely manner in accordance with rules or regu22
lations promulgated to carry out such subsection,
23 shall be subject to a civil money penalty of not
24 less than $1,000, but not more than $10,000, for
25 each payment or other transfer of value or own-
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1 ership or investment interest not reported as re2
quired under such subsection. Such penalty shall
3 be imposed and collected in the same manner as
4 civil money penalties under subsection (a) of sec5
tion 1128A are imposed and collected under that
6 section.
7 ‘‘(B) LIMITATION.—The total amount of
8 civil money penalties imposed under subpara9
graph (A) with respect to each annual submis10
sion of information under subsection (a) by an
11 applicable manufacturer or applicable group
12 purchasing organization shall not exceed
13 $150,000.
14 ‘‘(2) KNOWING FAILURE TO REPORT.—
15 ‘‘(A) IN GENERAL.—Subject to subpara16
graph (B), any applicable manufacturer or ap17
plicable group purchasing organization that
18 knowingly fails to submit information required
19 under subsection (a) in a timely manner in ac20
cordance with rules or regulations promulgated
21 to carry out such subsection, shall be subject to
22 a civil money penalty of not less than $10,000,
23 but not more than $100,000, for each payment or
24 other transfer of value or ownership or invest25
ment interest not reported as required under
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1 such subsection. Such penalty shall be imposed
2 and collected in the same manner as civil money
3 penalties under subsection (a) of section 1128A
4 are imposed and collected under that section.
5 ‘‘(B) LIMITATION.—The total amount of
6 civil money penalties imposed under subpara7
graph (A) with respect to each annual submis8
sion of information under subsection (a) by an
9 applicable manufacturer or applicable group
10 purchasing organization shall not exceed
11 $1,000,000.
12 ‘‘(3) USE OF FUNDS.—Funds collected by the
13 Secretary as a result of the imposition of a civil
14 money penalty under this subsection shall be used to
15 carry out this section.
You
better know who your friends are.
‘‘(c) PROCEDURES FOR SUBMISSION OF INFORMATION
17 AND
PUBLIC
AVAILABILITY.—
18 ‘‘(1) IN GENERAL.—
19 ‘‘(A) ESTABLISHMENT.—Not later than Oc20
tober 1, 2011, the Secretary shall establish proce21
dures—
22 ‘‘(i) for applicable manufacturers and
23 applicable group purchasing organizations
24 to submit information to the Secretary
25 under subsection (a); and
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1 ‘‘(ii) for the Secretary to make such in2
formation submitted available to the public.
3 ‘‘(B) DEFINITION OF TERMS.—The proce4
dures established under subparagraph (A) shall
5 provide for the definition of terms (other than
6 those terms defined in subsection (e)), as appro7
priate, for purposes of this section.
8 ‘‘(C) PUBLIC AVAILABILITY.—Except as
9 provided in subparagraph (E), the procedures es10
tablished under subparagraph (A)(ii) shall en11
sure that, not later than September 30, 2013,
12 and on June 30 of each calendar year beginning
13 thereafter, the information submitted under sub14
section (a) with respect to the preceding calendar
15 year is made available through an Internet
16 website that—
17 ‘‘(i) is searchable and is in a format
18 that is clear and understandable;
19 ‘‘(ii) contains information that is pre20
sented by the name of the applicable manu21
facturer or applicable group purchasing or22
ganization, the name of the covered recipi23
ent, the business address of the covered re24
cipient, the specialty of the covered recipi25
ent, the value of the payment or other trans-
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1 fer of value, the date on which the payment
2 or other transfer of value was provided to
3 the covered recipient, the form of the pay4
ment or other transfer of value, indicated
5 (as appropriate) under subsection
6 (a)(1)(A)(v), the nature of the payment or
7 other transfer of value, indicated (as appro8
priate) under subsection (a)(1)(A)(vi), and
9 the name of the covered drug, device, bio10
logical, or medical supply, as applicable;
11 ‘‘(iii) contains information that is able
12 to be easily aggregated and downloaded;
13 ‘‘(iv) contains a description of any en14
forcement actions taken to carry out this
15 section, including any penalties imposed
16 under subsection (b), during the preceding
17 year;
18 ‘‘(v) contains background information
19 on industry-physician relationships;
20 ‘‘(vi) in the case of information sub21
mitted with respect to a payment or other
22 transfer of value described in subparagraph
23 (E)(i), lists such information separately
24 from the other information submitted under
25 subsection (a) and designates such sepa-
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1 rately listed information as funding for
2 clinical research;
3 ‘‘(vii) contains any other information
4 the Secretary determines would be helpful to
5 the average consumer;
6 ‘‘(viii) does not contain the National
7 Provider Identifier of the covered recipient,
8 and
9 ‘‘(ix) subject to subparagraph (D), pro10
vides the applicable manufacturer, applica11
ble group purchasing organization, or cov12
ered recipient an opportunity to review and
13 submit corrections to the information sub14
mitted with respect to the applicable manu15
facturer, applicable group purchasing orga16
nization, or covered recipient, respectively,
17 for a period of not less than 45 days prior
18 to such information being made available to
19 the public.
It
seems that every aspect of a doctors business will be published on the world
wide web.
‘‘(d)
ANNUAL REPORTS AND RELATION TO STATE
4
LAWS.—
5
‘‘(1) ANNUAL REPORT TO CONGRESS.—Not later
6
than April
1 of each year beginning with 2013, the
7
Secretary
shall submit to Congress a report that in8
cludes
the following:
9
‘‘(A) The
information submitted under sub10
section
(a) during the preceding year, aggregated
11
for each
applicable manufacturer and applicable
12
group
purchasing organization that submitted
13
such
information during such year (except, in
14
the case of
information submitted with respect to
15
a payment
or other transfer of value described in
16
subsection
(c)(1)(E)(i), such information shall be
17
included in
the first report submitted to Congress
18
after the
date on which such information is made
19
available
to the public under such subsection).
20
‘‘(B) A
description of any enforcement ac21
tions
taken to carry out this section, including
22
any
penalties imposed under subsection (b), dur23
ing
the preceding year.
‘‘(6)
COVERED RECIPIENT.—
9
‘‘(A) IN GENERAL.—Except as provided in
10
subparagraph
(B), the term ‘covered recipient’
11
means the
following:
12
‘‘(i) A
physician.
13
‘‘(ii) A
teaching hospital.
‘‘(10)
PAYMENT OR OTHER
TRANSFER OF
12
VALUE.—
13
‘‘(A) IN GENERAL.—The term ‘payment or
14
other
transfer of value’ means a transfer of any15
thing
of value. Such term does not include a
16
transfer of
anything of value that is made indi17
rectly
to a covered recipient through a third
18
party in
connection with an activity or service
19
in the case
where the applicable manufacturer is
20
unaware of
the identity of the covered recipient.
