Investigative and enforcement actions

(a) In general In carrying out the investigative and enforcement actions of section 3451(b)(2) of the Public Health Service Act, as added by section 9003 of this Act, the Director for Civil Rights and Health Equity (referred to in this section as the Director) shall pursue such investigative and enforcement actions pursuant to this section. (b) Administrative complaint and conciliation process (1) Complaints and answers (A) In general An aggrieved person may, not later than 1 year after an alleged violation of subsection (a) has occurred or concluded, file a complaint with the Director alleging inequitable provision of health care by a provider described in subsection (a). (B) Complaint A complaint submitted pursuant to subparagraph (A) shall be in writing and shall contain such information and be in such form as the Director requires. (C) Oath or affirmation The complaint and any answer made under this subsection shall be made under oath or affirmation, and may be reasonably and fairly modified at any time. (2) Response to complaints (A) In general Upon the filing of a complaint under this subsection, the following procedures shall apply: (i) Complainant notice The Director shall serve notice upon the complainant acknowledging receipt of such filing and advising the complainant of the time limits and procedures provided under this section. (ii) Respondent notice The Director shall, not later than 30 days after receipt of such filing— (I) serve on the respondent a notice of the complaint, together with a copy of the original complaint; and (II) advise the respondent of the procedural rights and obligations of respondents under this section. (iii) Answer The respondent may file, not later than 60 days after receipt of the notice from the Director, an answer to such complaint. (iv) Investigative duties The Director shall— (I) make an investigation of the alleged inequitable provision of health care; and (II) complete such investigation within 180 days (unless it is impracticable to complete such investigation within 180 days) after the filing of the complaint. (B) Investigations (i) Pattern or practice In the course of investigating the complaint, the Director may seek records of care provided to patients other than the complainant if necessary to demonstrate or disprove an allegation of inequitable provision of health care or to determine whether there is a pattern or practice of such care. (ii) Accounting for social determinants of health In investigating the complaint and reaching a determination on the validity of the complaint, the Director shall account for social determinants of health and the effect of such social determinants on health care outcomes. (iii) Inability to complete investigation If the Director is unable to complete (or finds it is impracticable to complete) the investigation within 180 days after the filing of the complaint (or, if the Secretary takes further action under paragraph (6)(B) with respect to a complaint, within 180 days after the commencement of such further action), the Director shall notify the complainant and respondent in writing of the reasons involved. (C) Report (i) Final report On completing each investigation under this paragraph, the Director shall prepare a final investigative report. (ii) Modification of report A final report under this subparagraph may be modified if additional evidence is later discovered. (3) Conciliation (A) In general During the period beginning on the date on which a complaint is filed under this subsection and ending on the date of final disposition of such complaint (including during an investigation under paragraph (2)(B)), the Director shall, to the extent feasible, engage in conciliation with respect to such complaint. (B) Conciliation agreement A conciliation agreement arising out of such conciliation shall be an agreement between the respondent and the complainant, and shall be subject to approval by the Director. (C) Rights protected The Director shall approve a conciliation agreement only if the agreement protects the rights of the complainant and other persons similarly situated. (D) Publicly available agreement (i) In general Subject to clause (ii), the Secretary shall make available to the public a copy of a conciliation agreement entered into pursuant to this subsection unless the complainant and respondent otherwise agree, and the Secretary determines, that disclosure is not required to further the purposes of this subsection. (ii) Limitation A conciliation agreement that is made available to the public pursuant to clause (i) may not disclose individually identifiable health information. (4) Failure to comply with conciliation agreement Whenever the Director has reasonable cause to believe that a respondent has breached a conciliation agreement, the Director shall refer the matter to the Attorney General to consider filing a civil action to enforce such agreement. (5) Written consent for disclosure of information Nothing said or done in the course of conciliation under this subsection may be made public, or used as evidence in a subsequent proceeding under this subsection, without the written consent of the parties to the conciliation. (6) Prompt judicial action (A) In general If the Director determines at any time following the filing of a complaint under this subsection that prompt judicial action is necessary to carry out the purposes of this subsection, the Director may recommend that the Attorney General promptly commence a civil action under subsection (d). (B) Immediate suit If the Director determines at any time following the filing of a complaint under this subsection that the public interest would be served by allowing the complainant to bring a civil action under subsection (c) in a State or Federal court immediately, the Director shall certify that the administrative process has concluded and that the complainant may file such a suit immediately. (7) Annual report Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Director shall make publicly available a report detailing the activities of the Office for Civil Rights and Health Equity under this subsection, including— (A) the number of complaints filed and the basis on which the complaints were filed; (B) the number of investigations undertaken as a result of such complaints; and (C) the disposition of all such investigations. (c) Enforcement by private persons (1) In general (A) Civil action (i) In suit A complainant under subsection (b) may commence a civil action to obtain appropriate relief with respect to an alleged violation of subsection (a), or for breach of a conciliation agreement under subsection (b), in an appropriate district court of the United States or State court— (I) not sooner than the earliest of— (aa) the date a conciliation agreement is reached under subsection (b); (bb) the date of a final disposition of a complaint under subsection (b); or (cc) 180 days after the first day of the alleged violation; and (II) not later than 2 years after the final day of the alleged violation. (ii) Statute of limitations The computation of such 2-year period shall not include any time during which an administrative proceeding (including investigation or conciliation) under subsection (b) was pending with respect to a complaint under such subsection. (B) Barring suit If the Director has obtained a conciliation agreement under subsection (b) regarding an alleged violation of subsection (a), no action may be filed under this paragraph by the complainant involved with respect to the alleged violation except for the purpose of enforcing the terms of such an agreement. (2) Relief which may be granted (A) In general In a civil action under paragraph (1), if the court finds that a violation of subsection (a) or breach of a conciliation agreement has occurred, the court may award to the plaintiff actual and punitive damages, and may grant as relief, as the court determines to be appropriate, any permanent or temporary injunction, temporary restraining order, or other order (including an order enjoining the defendant from engaging in a practice violating subsection (a) or ordering such affirmative action as may be appropriate). (B) Fees and costs In a civil action under paragraph (1), the court, in its discretion, may allow the prevailing party, other than the United States, a reasonable attorney’s fee and costs. The United States shall be liable for such fees and costs to the same extent as a private person. (3) Intervention by Attorney General Upon timely application, the Attorney General may intervene in a civil action under paragraph (1), if the Attorney General certifies that the case is of general public importance. (d) Enforcement by the Attorney General (1) Commencement of actions (A) Pattern or practice cases The Attorney General may commence a civil action in any appropriate district court of the United States if the Attorney General has reasonable cause to believe that any health care provider covered by subsection (a)— (i) is engaged in a pattern or practice that violates such subsection; or (ii) is engaged in a violation of such subsection that raises an issue of significant public importance. (B) Cases by referral The Director may determine, based on a pattern of complaints, a pattern of violations, a review of data reported by a health care provider covered by subsection (a), or any other means, that there is reasonable cause to believe a health care provider is engaged in a pattern or practice that violates subsection (a). If the Director makes such a determination, the Director shall refer the related findings to the Attorney General. If the Attorney General finds that such reasonable cause exists, the Attorney General may commence a civil action in any appropriate district court of the United States. (2) Enforcement of subpoenas The Attorney General, on behalf of the Director, or another party at whose request a subpoena is issued under this subsection, may enforce such subpoena in appropriate proceedings in the district court of the United States for the district in which the person to whom the subpoena was addressed resides, was served, or transacts business. (3) Relief which may be granted in civil actions (A) In general In a civil action under paragraph (1), the court— (i) may award such preventive relief, including a permanent or temporary injunction, temporary restraining order, or other order against the person responsible for a violation of subsection (a) as is necessary to assure the full enjoyment of the rights granted by this subsection; (ii) may award such other relief as the court determines to be appropriate, including monetary damages, to aggrieved persons; and (iii) may, to vindicate the public interest, assess punitive damages against the respondent— (I) in an amount not exceeding $500,000, for a first violation; and (II) in an amount not exceeding $1,000,000, for any subsequent violation. (B) Fees and costs In a civil action under this subsection, the court, in its discretion, may allow the prevailing party, other than the United States, a reasonable attorney’s fee and costs. The United States shall be liable for such fees and costs to the extent provided by section 2412 of title 28, United States Code. (4) Intervention in civil actions Upon timely application, any person may intervene in a civil action commenced by the Attorney General under paragraphs (1) and (2) if the action involves an alleged violation of subsection (a) with respect to which such person is an aggrieved person (including a person who is a complainant under subsection (b)) or a conciliation agreement to which such person is a party.