HR5433-119

What This Bill Does

The POP Act targets vertical ownership between health insurers and certain Medicare providers. It makes it unlawful for a person to own, operate, or control both an applicable provider or a management services organization with a management agreement with that provider, and a health insurance issuer. Existing common ownership must be unwound within two years after enactment; acquisitions after enactment must be divested within one year. HHS's Inspector General, DOJ's Antitrust Division, the Federal Trade Commission, or a state attorney general may sue in federal district court. Courts must order cease-and-desist relief, divestiture, and disgorgement of revenue received from health-care services during the violation. The FTC must create a fund and distribute disgorged revenue for the harmed community's health-care needs. Required divestitures must be reported under Hart-Scott-Rodino without regard to normal transaction-size thresholds, and FTC and DOJ may review whether the transaction serves the purposes of the Act.

Who Benefits and How

Medicare patients benefit if separating insurers from covered providers reduces conflicts between coverage decisions and provider ownership incentives. Independent physician practices benefit from limits on insurer ownership of provider operations and management services organizations. State attorneys general benefit from explicit authority to bring federal civil actions against prohibited common ownership. Harmed communities benefit if disgorged revenue is distributed through an FTC-created fund for community health-care needs.

Who Bears the Burden and How

Health insurance issuers with provider ownership must divest providers or insurance assets within statutory deadlines. Provider management services organizations under common ownership with insurers face divestiture pressure. FTC antitrust staff must create the disgorgement fund and review covered divestitures. DOJ Antitrust Division staff must enforce and review ownership separation under the Act.

Key Provisions

• Bars common ownership or control of applicable Medicare providers and health insurance issuers.
• Requires divestiture within two years for existing ownership and one year for later acquisitions.
• Authorizes HHS OIG, DOJ Antitrust, FTC, and state attorneys general to sue in federal court.
• Requires cease-and-desist orders, divestiture, and disgorgement for violations.
• Requires Hart-Scott-Rodino reporting for covered divestitures regardless of normal thresholds.