H.R. 5433 — POP Act

This section prohibits any person from directly or indirectly owning, operating, or controlling both (1) an applicable provider or a management services organization with a management services agreement with an applicable provider and (2) a health insurance issuer. It requires any person in violation to divest either the applicable provider (or management services organization) or the health insurance issuer within two years after enactment for pre-enactment acquisitions or within one year of acquisition for post-enactment acquisitions. It authorizes the HHS Inspector General, DOJ Antitrust Assistant Attorney General, FTC, or a state attorney general to bring civil actions in federal district court for injunctive relief, divestiture, and disgorgement of revenues from health care services during the violation, with disgorged funds deposited in an FTC-managed fund for health care needs in affected communities. It requires reporting of such divestitures under the Hart-Scott-Rodino Act (15 U.S.C. 18a) without regard to monetary thresholds in subsection (a)(2), tolls divestiture periods during any HSR waiting period, and directs the FTC and DOJ Antitrust Division to additionally review effects on competition, financial viability, and public interest of the divestiture and any subsequent acquisition. It directs the FTC to promulgate implementing rules. It amends Section 1857(j) of the Social Security Act (42 U.S.C. 1395w-27) to bar Medicare Advantage contracts or payments, for plan years beginning on or after January 1, 2026, with organizations that directly or indirectly own/control prohibited entities or are owned/controlled by persons who do; requires annual compliance certifications to CMS; and deems claims from violating entities false claims under the False Claims Act (31 U.S.C. 3729 et seq.).