Adds a new paragraph (5) to 42 U.S.C. 1320a–7(a) creating a mandatory exclusion for individuals or entities that sell assets to, or newly pledge assets as collateral for a loan with, a real estate investment trust, with a grandfathering exception for pledges agreed to prior to enactment.

Adds a new section (1150D) to Part A of title XI of the Social Security Act requiring specified entities to submit annual reports to the Secretary of HHS containing detailed ownership, financial, and related information; requires HHS to publish reported information annually (with confidentiality protections), conduct annual audits, and authorizes civil monetary penalties for violations; and exempts these information collections from the Paperwork Reduction Act.

Adds new section 671 to title 18 establishing definitions (by reference to section 674(b)) and prohibiting covered-party conduct that contributes to a triggering event causing death or injury to patients under the care of a target firm; violations are subject to penalties under sections 672 and 673.

Adds new section 672 to title 18 establishing criminal penalties for violations of section 671(b).

Adds new section 673 to title 18 establishing civil penalties and deposit rules for violations of section 671(b).

Adds new section 674 to title 18 establishing clawback authority, enforcement mechanisms (Attorney General and State attorneys general), deposit and distribution rules, an affirmative defense, and detailed definitions used in the new provisions.

Amends the table of sections for title 18 by adding entries for the new chapter 31 sections (671–674).

Replaces paragraph (1) of section 199A(b) with new text defining the combined qualified business income amount.

Strikes the last sentence of section 199A(c)(1).

Strikes paragraph (3) of section 199A(e) and redesignates paragraph (4) as paragraph (3).