POP Act
Senate Bill Would Ban Insurers From Owning Medicare Doctor Practices Under POP Act
Stalled
No legislative action in over 90 days.
Legislative Progress
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.
Impact Analysis
Personal Impact
How this policy affects specific groups of people
Milestones
Read twice and referred to the Committee on the Judiciary.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in Senate
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
7 articles
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.
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.
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.
Source Information
Document Type
Congressional Bill
Official Title
POP Act
Data Sources
Sponsor
Cosponsors
(2)Analysis generated by AI. Always verify with official sources.