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Congress·In Committee·6 months ago

Senate Bill Would Ban Insurers From Owning Medicare Doctor Practices Under POP Act

Also known as: POP Act

Legislative Progress

✓ Filed
Review
Senate
House
President

Impacts

Negative Impacts(1)
Small Business Owner
Hurts
Mixed Impacts(1)
Medicare
Neutral
Positive Impacts(1)
Chronic Illness
Helps

Key Points

  • Would make it illegal for the same owner to control both a health insurance company and many Medicare-covered doctor/provider groups.
  • Companies that already have both types of businesses would have to sell one side: within 2 years for existing holdings, or within 1 year for new ones.
  • Enforcement could come from federal and state officials, with courts able to order the company to stop, sell one side, and pay back money earned during the violation.
  • For Medicare Advantage and Medicare drug plans, the government could refuse to contract or pay plans starting in 2026 if they have the banned ownership ties.
  • Any payment request from a Medicare Advantage plan that violates the rule would be treated as a false claim, raising the legal and financial risk for noncompliance.
HealthcareMedicare MedicaidConsumer Protection

Milestones

2 milestones2 actions
Sep 17, 2025Senate

Read twice and referred to the Committee on the Judiciary.

Sep 17, 2025

Introduced in Senate

What Happens Next

Projected impacts based on AI analysis

After enactment; before or during the applicable plan year process

Medicare Advantage organizations submit compliance certifications to the federal government (timing set by the Secretary).

Plans that can’t certify may risk losing their Medicare contract, which can trigger midstream changes or forced plan switches during enrollment periods.

After enactment

FTC issues rules explaining how the ban and reporting will work in practice.

Clearer rules will determine which ownership structures are covered and what paperwork companies must file, which can speed up divestments and enforcement.

Related News

7 articles
Becker's Payer Issues·6 months ago

Lawmakers debut bill to bar insurers from buying medical clinics

The Patients Over Profits Act would prohibit insurance companies or their subsidiaries from owning Medicare Parts B and C providers and require existing conglomerates to divest their provider businesses within two years, targeting vertical integration seen in companies like UnitedHealth Group.

C=
Fierce Healthcare·6 months ago

Democrats Introduce Bill To Bar Payers From Owning Certain Clinics

A group of congressional Democrats submitted the Patients Over Profits Act to prevent large payers from buying up clinics participating in Medicare. The bill specifically targets UnitedHealth's Optum, which has acquired numerous clinics across Oregon, New York, and Washington.

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BenefitsPRO·5 months ago

Bill targets UnitedHealth, aims to break up insurer-owned clinics

The POP Act outlines three core provisions: preventing insurers from owning Medicare Part B or C providers, requiring divestiture of existing assets, and banning HHS from contracting with Medicare Advantage organizations that own such providers to remove profit incentives for vertical integration.

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Source Information

Document Type

Congressional Bill

Official Title

POP Act

Bill NumberS 2836
Congress119th Congress
ChamberSenate
Latest ActionRead twice and referred to the Committee on the Judiciary.

Sponsor

Cosponsors

(2)
D: 2

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.