Title IV, SEC. 4044. EXCLUSIONS FROM PROGRAM PARTICIPATION. (a) Mandatory Exclusion for Individual Convicted of Criminal Offense Related to Health Care Fraud. Section 1128 (42 U.S.C. 1320a-7) is amended (1) by amending paragraph (1) of subsection (a) to read as follows: ``(1) Convictions of program-related crimes and health care fraud. ``(A) Any individual or entity that has been convicted of a criminal offense related to the delivery of an item or service under title XVIII or under any State health care program; or ``(B) Any individual or entity that has been convicted, under Federal or State law, in connection with the delivery of a health care item or service of a criminal offense relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct.''; and (2) in subsection (b)(1), by striking ``in connection with the delivery of a health care item or service or''. (b) Establishment of Minimum Period of Exclusion for Certain Individuals and Entities Subject to Permissive Exclusion From Medicare and State Health Care Programs. Section 1128(c)(3) (42 U.S.C. 1320a 7(c)(3)) is amended by adding at the end the following new subparagraphs: ``(D) In the case of an exclusion of an individual or entity under paragraphs (1), (2), or (3) of subsection (b), the period of exclusion shall be a minimum of 3 years, unless the Secretary determines that a longer period is appropriate because of aggravating circumstances. ``(E) In the case of an exclusion of an individual or entity under paragraph (4) or (5) of subsection (b), the period of the exclusion shall not be less than the period during which the individual's or entity's license to provide health care is revoked, suspended, or surrendered, or the individual or the entity is excluded or suspended from a Federal or State health care program. ``(F) In the case of an exclusion of an individual or entity under subsection (b)(6)(B), the period of the exclusion shall be not less than 1 year.''. (c) Revision to Exclusion for Default on Health Education Loan or Scholarship Obligations. Section 1128(b)(14) (42 U.S.C. 1320a 7(b)(14)) is amended by striking ``all reasonable steps'' and inserting ``reasonable steps''. (d) Permissive Exclusion of Individuals With Ownership or Control Interest in Sanctioned Entities. Section 1128(b) (42 U.S.C. 1320a-7(b)), is amended by adding at the end the following new paragraph: ``(15) Individuals controlling a sanctioned entity. Any individual who has a direct or indirect ownership or control interest of 5 percent or more, or an ownership or control interest (as defined in section 1124(a)(3)) in, or who is an officer, director, agent, or managing employee (as defined in section 1126(b)) of, an entity ``(A) that has been convicted of any offense described in subsection (a) or in paragraph (1), (2), or (3) of this subsection; ``(B) against which a civil monetary penalty has been assessed under section 1128A; or ``(C) that has been excluded from participation under a program under title XVIII or under a State health care program.''. (e) Exclusions Based on Actions Under Alliance System. Section 1128(b) (42 U.S.C. 1320a 7(b)), as amended by subsections (a) and (d), is amended (1) in paragraph (1), by striking ``XVIII or under a State health care program'' and inserting ``XVIII, a State health care program, or under an applicable health plan (as defined in section 1902(6) of the Health Security Act)''; (2) in paragraph (7), by striking the period at the end and inserting ``, or in section 5412 of the Health Security Act.''; (3) in paragraph (8)(B) (A) in clause (ii), by striking ``1128A'' and inserting ``1128A or under section 5412 of the Health Security Act'', and (B) in clause (iii), by striking ``XVIII or under a State health care program'' and inserting ``XVIII, a State health care program, or under an applicable health plan (as defined in section 1902(6) of the Health Security Act)''; (4) in paragraph (9), by striking the period at the end and inserting ``, or any information requested by the Inspector General of the Department of Health and Human Services to carry out the All-Payer Health Care Fraud and Abuse Control Program established under section 5401 of the Health Security Act.''; (5) in paragraph (11) (A) by striking ``title XVIII or a State health care program'' and inserting ``title XVIII, a State health care program, or an applicable health plan (as defined in section 1902(6) of the Health Security Act)'', (B) by striking ``Secretary or the appropriate State agency'' and inserting ``Secretary, the appropriate State agency, or plan sponsor'', and (C) by striking ``Secretary or that agency'' and inserting ``Secretary, that agency, or that sponsor''; (6) in paragraph (12), by adding at the end the following new subparagraph: ``(E) Any entity authorized by law to (i) conduct on-site health, safety or patient care reviews and surveys or (ii) to investigate whether any actions have occurred that would subject an individual or entity to the imposition of any sanctions under this section, section 1128A, section 1128B, or part 2 of subtitle E of title V of the Health Security Act.''; and (7) in paragraph (15) (A) in subparagraph (B), by striking ``1128A'' and inserting ``1128A or section 54.. of the Health Security Act'', and (B) in subparagraph (C), by striking ``title XVIII or under a State health care program'' and inserting ``title XVIII, a State health care program, or an applicable health plan (as defined in section 1902(6) of the Health Security Act''. (f) Appeal of Exclusions to Court of Appeals. Section 1128(f)(1) (42 U.S.C. 1320a 7(f)(1)) is amended by striking the period at the end and inserting the following: ``, except that any action brought to appeal such decision shall be brought in the United States Court of Appeals for the judicial circuit in which the individual or entity resides or has a principal place of business (or, if the individual or entity does not reside or have a principal place of business within any such judicial circuit, in the United States Court of Appeals for the District of Columbia Circuit).''.