This bill, the Patients Over Profit Act (POP Act), would make it illegal for a person to both (1) own, operate, or control an "applicable provider" or a management services organization that contracts with such a provider, and (2) own, operate, or control a health insurance issuer. If a person is in violation, the bill requires divestment: assets bought on or before enactment must be divested within 2 years, and assets bought after enactment must be divested within 1 year.
The bill allows the HHS Inspector General, the Assistant Attorney General in charge of the DOJ Antitrust Division, the Federal Trade Commission (FTC), or a State Attorney General to bring civil actions. A court finding a violation must order the person to stop the violation, divest the provider or insurer, and disgorge revenue earned during the violation. Disgorged funds must be deposited into an FTC-created fund to serve the health care needs of the harmed community. The FTC must receive reports on required divestitures, may toll the divestment period while reviewing transactions under Clayton Act section 7A, and must review the competitive and public interest effects of divestitures. The FTC must also issue rules to carry out the section.
The bill adds Medicare-specific enforcement: for plan years beginning on or after January 1, 2026, the Secretary of Health and Human Services may not contract with or pay a Medicare Advantage organization that has the prohibited common ownership, and such organizations must certify compliance. A claim for payment from an entity in violation is treated as a false or fraudulent claim. The bill defines "applicable provider" and excludes hospitals, critical access hospitals, rural emergency hospitals, suppliers of durable medical equipment and related supplies, and pharmacies. It defines management services agreements and management services organizations and uses the Sherman Act definition of "person."
No publicly available information on overall costs, savings, or budgetary estimates appears in the bill text. The bill requires reporting to the FTC, rulemaking by the FTC, and establishes a process for disgorged revenues to be placed into an FTC-created fund, but it does not state estimated expenses or savings.
No publicly available information on proponents' stated arguments, analyses, or expected impacts is included in the bill text or metadata provided.
No publicly available information on opponents' stated arguments, analyses, or expected impacts is included in the bill text or metadata provided.