Title IV, SEC. 4041. ANTI-KICKBACK PROVISIONS. (a) Revision to Penalties. (1) Permitting secretary to impose civil monetary penalty. Section 1128A(a) (42 U.S.C. 1320a 7a(a)) is amended (A) by striking ``or'' at the end of paragraphs (1) and (2); (B) by striking the semicolon at the end of paragraph (3) and inserting ``; or''; and (C) by inserting after paragraph (3) the following new paragraph: ``(4) carries out any activity in violation of paragraph (1) or (2) of section 1128B(b);''. (2) Description of civil monetary penalty applicable. Section 1128A(a) (42 U.S.C. 1320a 7a(a)) is amended (A) by striking ``given).'' at the end of the first sentence and inserting the following: ``given or, in cases under paragraph (4), $50,000 for each such violation).''; and (B) by striking ``claim.'' at the end of the second sentence and inserting the following: ``claim (or, in cases under paragraph (4), an assessment of not more than three times the total amount of remuneration offered, paid, solicited, or received, without regard to whether a portion of such remuneration was offered, paid solicited, or received for a lawful purpose).''. (3) Increase in criminal penalty. Paragraphs (1) and (2) of section 1128B(b) (42 U.S.C. 1320a 7b(b)) are each amended (A) by striking ``$25,000'' and inserting ``$50,000''; and (B) by striking the period at the end and inserting the following: ``, and shall be subject to an assessment of not more than three times the total remuneration offered, paid, solicited, or received, without regard to whether a portion of such remuneration was offered, paid solicited, or received for a lawful purpose.''. (4) Civil remedy. Section 1128B(b) (42 U.S.C. 1320a 7b(b)) is amended by adding at the end the following new paragraph: ``(4) Any person who carries out any activity in violation of paragraph (1) or (2) shall be subject to a penalty of not more than $50,000 fo reach such violation, and shall be subject to an assessment of not more than three times the total remuneration offered, paid, solicited, or received, without regard to whether a portion of such remuneration was offered, paid solicited, or received for a lawful purpose.''. (b) Revisions to Exceptions. (1) Exception for discounts. Section 1128B(b)(3)(A) (42 U.S.C. 1320a-7b(b)(3)(A)) is amended by striking ``program;'' and inserting ``program and is not ``(i) for the furnishing of one item or service without charge or at a reduced charge in exchange for any agreement to buy a different item or service; ``(ii) applicable to one payor but not to providers of services or other entities under title XVIII or a State health care program; or ``(iii) in the form of a cash payment;''. (2) Exception for payments to employees. Section 1128B(b)(3)(B) (42 U.S.C. 1320a 7b(b)(3)(B)) is amended by inserting at the end ``if the amount of remuneration under the arrangement is consistent with the fair market value of the services and is not determined in a manner that takes into account (directly or indirectly) the volume or value of any referrals, except that such employees can be paid remuneration in the form of a productivity bonus based on services personally performed by the employee. (3) Exception for waiver of coinsurance by certain providers. Section 1128B(b)(3)(D) (42 U.S.C. 1320a-7b(b)(3)(D)) is amended to read as follows: ``(D) a waiver or reduction of any coinsurance or other copayment ``(i) if the waiver or reduction is made pursuant to a public schedule of discounts which the person is obligated as a matter of law to apply to certain individuals, or ``(ii) under part B of title XVIII by any person if the person does not routinely waive coinsurance or deductible amounts and the person ``(I) waives the coinsurance and deductible amounts after determining in good faith that the individual is indigent; ``(II) fails to collect coinsurance or deductible amounts after making reasonable collection efforts; or ``(III) provides for any permissible waiver as specified in section 1128B(b)(3) or in regulations issued by the Secretary.''. (4) New exception for certain providers. Section 1128B(b)(3) (42 U.S.C. 1320a 7b(b)(3)) is amended (A) by striking ``and'' at the end of subparagraph (D); (B) by striking the period at the end of subparagraph (E) and inserting ``; and''; and (C) by adding at the end the following new subparagraph: ``(F) any remuneration obtained by or given to an individual or entity who is obligated as a matter of law to waive or reduce coinsurance or other copayment for certain individuals pursuant to a public schedule of discounts, if the remuneration is pursuant to a written arrangement for the use or procurement of space, equipment, goods or services or for the referral of patients if ``(i) the arrangement does not result in private inurement to any current employee, officer, member of the Board of Directors, or agent of the recipient or any other person involved in recommending or negotiating the arrangement; and ``(ii) the arrangement does not preclude the referral of patients to other providers of service of the patient's own choosing and does not interfere with the ability of health professionals to refer patients to providers of services they believe are the most appropriate, except to the extent such choices or referrals are limited by the terms of a health plan in which the patient has enrolled or the terms of the Federal grant or cooperative agreement.''. (5) New exception for capitated payments. Section 1128B(b)(3) (42 U.S.C. 1320a-7b(b)(3)), as amended by paragraph (4), is further amended (A) by striking ``and'' at the end of subparagraph (E); (B) by striking the period at the end of subparagraph (F) and inserting ``; and''; and (C) by adding at the end the following new subparagraph ``(G) any reduction in cost sharing or increased benefits given to an individual, any amounts paid to a provider of services for items or services furnished to an individual, or any discount or reduction in price given by the provider for such items or services, if the individual is enrolled with and such items and services are covered under any of the following: ``(i) A health plan which is furnishing items or services under title XVIII or a State health care program to individuals on an at-risk, prepaid, capitated basis pursuant to a written agreement with the Secretary or a State health care program. ``(ii) An organization receiving payments on a prepaid basis, under a demonstration project under section 402(a) of the Social Security Amendments of 1967 or under section 222(a) of the Social Security Amendments of 1972. ``(iii) Any other plan or insurer under which a participating provider is paid wholly on an at-risk, prepaid, capitated basis for such items or services pursuant to a written arrangement between the plan and the provider.''. (c) Clarification of Coverage of Employers and Employees. Section 1128B(b) (42 U.S.C. 1320a 7b(b)), as amended by subsection (a)(4), is further amended by adding at the end the following new paragraph: ``(5) In this subsection, the term `referral' includes the referral by an employee to his or her employer of any item or service for which payment may be made in whole or in part under title XVIII or a State health care program.'' (d) Authorization for the Secretary To Issue Regulations. Section 1128B(b) (42 U.S.C. 1320a 7b(b)), as amended by subsections (a)(4) and (c), is further amended by adding at the end the following new paragraph ``(6) The Secretary is authorized to impose by regulation such other requirements as needed to protect against program or patient abuse with respect to any of the exceptions described in paragraph (3).''. (e) Clarification of Other Elements of Offense. Section 1128B(b) (42 U.S.C. 1320a 7b(b)) is amended (1) in paragraph (1) in the matter preceding subparagraph (A), by striking ``kind '' and inserting ``kind with intent to be influenced ''; (2) in paragraph (1)(A), by striking ``in return for referring'' and inserting ``to refer''; (3) in paragraph (1)(B), by striking ``in return for purchasing, leasing, ordering, or arranging for or recommending'' and inserting ``to purchase, lease, order, or arrange for or recommend''; and (4) in paragraph (2) in the matter preceding subparagraph (A), by striking ``to induce such person'' and inserting ``with intent to influence such person''.