
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1320a-7]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
   SUBCHAPTER XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE 
                             SIMPLIFICATION
 
                       Part A--General Provisions
 
Sec. 1320a-7. Exclusion of certain individuals and entities from 
        participation in Medicare and State health care programs
        

(a) Mandatory exclusion

    The Secretary shall exclude the following individuals and entities 
from participation in any Federal health care program (as defined in 
section 1320a-7b(f) of this title):

              (1) Conviction of program-related crimes

        Any individual or entity that has been convicted of a criminal 
    offense related to the delivery of an item or service under 
    subchapter XVIII of this chapter or under any State health care 
    program.

              (2) Conviction relating to patient abuse

        Any individual or entity that has been convicted, under Federal 
    or State law, of a criminal offense relating to neglect or abuse of 
    patients in connection with the delivery of a health care item or 
    service.

         (3) Felony conviction relating to health care fraud

        Any individual or entity that has been convicted for an offense 
    which occurred after August 21, 1996, under Federal or State law, in 
    connection with the delivery of a health care item or service or 
    with respect to any act or omission in a health care program (other 
    than those specifically described in paragraph (1)) operated by or 
    financed in whole or in part by any Federal, State, or local 
    government agency, of a criminal offense consisting of a felony 
    relating to fraud, theft, embezzlement, breach of fiduciary 
    responsibility, or other financial misconduct.

       (4) Felony conviction relating to controlled substance

        Any individual or entity that has been convicted for an offense 
    which occurred after August 21, 1996, under Federal or State law, of 
    a criminal offense consisting of a felony relating to the unlawful 
    manufacture, distribution, prescription, or dispensing of a 
    controlled substance.

(b) Permissive exclusion

    The Secretary may exclude the following individuals and entities 
from participation in any Federal health care program (as defined in 
section 1320a-7b(f) of this title):

                  (1) Conviction relating to fraud

        Any individual or entity that has been convicted for an offense 
    which occurred after August 21, 1996, under Federal or State law--
            (A) of a criminal offense consisting of a misdemeanor 
        relating to fraud, theft, embezzlement, breach of fiduciary 
        responsibility, or other financial misconduct--
                (i) in connection with the delivery of a health care 
            item or service, or
                (ii) with respect to any act or omission in a health 
            care program (other than those specifically described in 
            subsection (a)(1) of this section) operated by or financed 
            in whole or in part by any Federal, State, or local 
            government agency; or

            (B) of a criminal offense relating to fraud, theft, 
        embezzlement, breach of fiduciary responsibility, or other 
        financial misconduct with respect to any act or omission in a 
        program (other than a health care program) operated by or 
        financed in whole or in part by any Federal, State, or local 
        government agency.

     (2) Conviction relating to obstruction of an investigation

        Any individual or entity that has been convicted, under Federal 
    or State law, in connection with the interference with or 
    obstruction of any investigation into any criminal offense described 
    in paragraph (1) or in subsection (a) of this section.

     (3) Misdemeanor conviction relating to controlled substance

        Any individual or entity that has been convicted, under Federal 
    or State law, of a criminal offense consisting of a misdemeanor 
    relating to the unlawful manufacture, distribution, prescription, or 
    dispensing of a controlled substance.

                (4) License revocation or suspension

        Any individual or entity--
            (A) whose license to provide health care has been revoked or 
        suspended by any State licensing authority, or who otherwise 
        lost such a license or the right to apply for or renew such a 
        license, for reasons bearing on the individual's or entity's 
        professional competence, professional performance, or financial 
        integrity, or
            (B) who surrendered such a license while a formal 
        disciplinary proceeding was pending before such an authority and 
        the proceeding concerned the individual's or entity's 
        professional competence, professional performance, or financial 
        integrity.

     (5) Exclusion or suspension under Federal or State health 
                                care program

        Any individual or entity which has been suspended or excluded 
    from participation, or otherwise sanctioned, under--
            (A) any Federal program, including programs of the 
        Department of Defense or the Department of Veterans Affairs, 
        involving the provision of health care, or
            (B) a State health care program,

    for reasons bearing on the individual's or entity's professional 
    competence, professional performance, or financial integrity.

    (6) Claims for excessive charges or unnecessary services and 
                failure of certain organizations to furnish 
                        medically necessary services

        Any individual or entity that the Secretary determines--
            (A) has submitted or caused to be submitted bills or 
        requests for payment (where such bills or requests are based on 
        charges or cost) under subchapter XVIII of this chapter or a 
        State health care program containing charges (or, in applicable 
        cases, requests for payment of costs) for items or services 
        furnished substantially in excess of such individual's or 
        entity's usual charges (or, in applicable cases, substantially 
        in excess of such individual's or entity's costs) for such items 
        or services, unless the Secretary finds there is good cause for 
        such bills or requests containing such charges or costs;
            (B) has furnished or caused to be furnished items or 
        services to patients (whether or not eligible for benefits under 
        subchapter XVIII of this chapter or under a State health care 
        program) substantially in excess of the needs of such patients 
        or of a quality which fails to meet professionally recognized 
        standards of health care;
            (C) is--
                (i) a health maintenance organization (as defined in 
            section 1396b(m) of this title) providing items and services 
            under a State plan approved under subchapter XIX of this 
            chapter, or
                (ii) an entity furnishing services under a waiver 
            approved under section 1396n(b)(1) of this title,

        and has failed substantially to provide medically necessary 
        items and services that are required (under law or the contract 
        with the State under subchapter XIX of this chapter) to be 
        provided to individuals covered under that plan or waiver, if 
        the failure has adversely affected (or has a substantial 
        likelihood of adversely affecting) these individuals; or
            (D) is an entity providing items and services as an eligible 
        organization under a risk-sharing contract under section 1395mm 
        of this title and has failed substantially to provide medically 
        necessary items and services that are required (under law or 
        such contract) to be provided to individuals covered under the 
        risk-sharing contract, if the failure has adversely affected (or 
        has a substantial likelihood of adversely affecting) these 
        individuals.

        (7) Fraud, kickbacks, and other prohibited activities

        Any individual or entity that the Secretary determines has 
    committed an act which is described in section 1320a-7a, 1320a-7b, 
    or 1320a-8 of this title.

         (8) Entities controlled by a sanctioned individual

        Any entity with respect to which the Secretary determines that a 
    person--
            (A)(i) who has a direct or indirect ownership or control 
        interest of 5 percent or more in the entity or with an ownership 
        or control interest (as defined in section 1320a-3(a)(3) of this 
        title) in that entity,
            (ii) who is an officer, director, agent, or managing 
        employee (as defined in section 1320a-5(b) of this title) of 
        that entity; or
            (iii) who was described in clause (i) but is no longer so 
        described because of a transfer of ownership or control 
        interest, in anticipation of (or following) a conviction, 
        assessment, or exclusion described in subparagraph (B) against 
        the person, to an immediate family member (as defined in 
        subsection (j)(1) of this section) or a member of the household 
        of the person (as defined in subsection (j)(2) of this section) 
        who continues to maintain an interest described in such clause--

    is a person--
            (B)(i) who has been convicted of any offense described in 
        subsection (a) of this section or in paragraph (1), (2), or (3) 
        of this subsection;
            (ii) against whom a civil monetary penalty has been assessed 
        under section 1320a-7a or 1320a-8 of this title; or
            (iii) who has been excluded from participation under a 
        program under subchapter XVIII of this chapter or under a State 
        health care program.

            (9) Failure to disclose required information

        Any entity that did not fully and accurately make any disclosure 
    required by section 1320a-3 of this title, section 1320a-3a of this 
    title, or section 1320a-5 of this title.

          (10) Failure to supply requested information on 
                        subcontractors and suppliers

        Any disclosing entity (as defined in section 1320a-3(a)(2) of 
    this title) that fails to supply (within such period as may be 
    specified by the Secretary in regulations) upon request specifically 
    addressed to the entity by the Secretary or by the State agency 
    administering or supervising the administration of a State health 
    care program--
            (A) full and complete information as to the ownership of a 
        subcontractor (as defined by the Secretary in regulations) with 
        whom the entity has had, during the previous 12 months, business 
        transactions in an aggregate amount in excess of $25,000, or
            (B) full and complete information as to any significant 
        business transactions (as defined by the Secretary in 
        regulations), occurring during the five-year period ending on 
        the date of such request, between the entity and any wholly 
        owned supplier or between the entity and any subcontractor.

             (11) Failure to supply payment information

        Any individual or entity furnishing items or services for which 
    payment may be made under subchapter XVIII of this chapter or a 
    State health care program that fails to provide such information as 
    the Secretary or the appropriate State agency finds necessary to 
    determine whether such payments are or were due and the amounts 
    thereof, or has refused to permit such examination of its records by 
    or on behalf of the Secretary or that agency as may be necessary to 
    verify such information.

               (12) Failure to grant immediate access

        Any individual or entity that fails to grant immediate access, 
    upon reasonable request (as defined by the Secretary in regulations) 
    to any of the following:
            (A) To the Secretary, or to the agency used by the 
        Secretary, for the purpose specified in the first sentence of 
        section 1395aa(a) of this title (relating to compliance with 
        conditions of participation or payment).
            (B) To the Secretary or the State agency, to perform the 
        reviews and surveys required under State plans under paragraphs 
        (26), (31), and (33) of section 1396a(a) of this title and under 
        section 1396b(g) of this title.
            (C) To the Inspector General of the Department of Health and 
        Human Services, for the purpose of reviewing records, documents, 
        and other data necessary to the performance of the statutory 
        functions of the Inspector General.
            (D) To a State medicaid fraud control unit (as defined in 
        section 1396b(q) of this title), for the purpose of conducting 
        activities described in that section.

               (13) Failure to take corrective action

        Any hospital that fails to comply substantially with a 
    corrective action required under section 1395ww(f)(2)(B) of this 
    title.

        (14) Default on health education loan or scholarship 
                                 obligations

        Any individual who the Secretary determines is in default on 
    repayments of scholarship obligations or loans in connection with 
    health professions education made or secured, in whole or in part, 
    by the Secretary and with respect to whom the Secretary has taken 
    all reasonable steps available to the Secretary to secure repayment 
    of such obligations or loans, except that (A) the Secretary shall 
    not exclude pursuant to this paragraph a physician who is the sole 
    community physician or sole source of essential specialized services 
    in a community if a State requests that the physician not be 
    excluded, and (B) the Secretary shall take into account, in 
    determining whether to exclude any other physician pursuant to this 
    paragraph, access of beneficiaries to physician services for which 
    payment may be made under subchapter XVIII or XIX of this chapter.

          (15) Individuals controlling a sanctioned entity

        (A) Any individual--
            (i) who has a direct or indirect ownership or control 
        interest in a sanctioned entity and who knows or should know (as 
        defined in section 1320a-7a(i)(6) \1\ of this title) of the 
        action constituting the basis for the conviction or exclusion 
        described in subparagraph (B); or
---------------------------------------------------------------------------
    \1\ So in original. Probably should be section ``1320a-7a(i)(7)''.
---------------------------------------------------------------------------
            (ii) who is an officer or managing employee (as defined in 
        section 1320a-5(b) of this title) of such an entity.

        (B) For purposes of subparagraph (A), the term ``sanctioned 
    entity'' means an entity--
            (i) that has been convicted of any offense described in 
        subsection (a) of this section or in paragraph (1), (2), or (3) 
        of this subsection; or
            (ii) that has been excluded from participation under a 
        program under subchapter XVIII of this chapter or under a State 
        health care program.

(c) Notice, effective date, and period of exclusion

    (1) An exclusion under this section or under section 1320a-7a of 
this title shall be effective at such time and upon such reasonable 
notice to the public and to the individual or entity excluded as may be 
specified in regulations consistent with paragraph (2).
    (2)(A) Except as provided in subparagraph (B), such an exclusion 
shall be effective with respect to services furnished to an individual 
on or after the effective date of the exclusion.
    (B) Unless the Secretary determines that the health and safety of 
individuals receiving services warrants the exclusion taking effect 
earlier, an exclusion shall not apply to payments made under subchapter 
XVIII of this chapter or under a State health care program for--
        (i) inpatient institutional services furnished to an individual 
    who was admitted to such institution before the date of the 
    exclusion, or
        (ii) home health services and hospice care furnished to an 
    individual under a plan of care established before the date of the 
    exclusion,

until the passage of 30 days after the effective date of the exclusion.
    (3)(A) The Secretary shall specify, in the notice of exclusion under 
paragraph (1) and the written notice under section 1320a-7a of this 
title, the minimum period (or, in the case of an exclusion of an 
individual under subsection (b)(12) of this section or in the case 
described in subparagraph (G), the period) of the exclusion.
    (B) Subject to subparagraph (G), in the case of an exclusion under 
subsection (a) of this section, the minimum period of exclusion shall be 
not less than five years, except that, upon the request of a State, the 
Secretary may waive the exclusion under subsection (a)(1) of this 
section in the case of an individual or entity that is the sole 
community physician or sole source of essential specialized services in 
a community. The Secretary's decision whether to waive the exclusion 
shall not be reviewable.
    (C) In the case of an exclusion of an individual under subsection 
(b)(12) of this section, the period of the exclusion shall be equal to 
the sum of--
        (i) the length of the period in which the individual failed to 
    grant the immediate access described in that subsection, and
        (ii) an additional period, not to exceed 90 days, set by the 
    Secretary.

    (D) Subject to subparagraph (G), in the case of an exclusion of an 
individual or entity under paragraph (1), (2), or (3) of subsection (b) 
of this section, the period of the exclusion shall be 3 years, unless 
the Secretary determines in accordance with published regulations that a 
shorter period is appropriate because of mitigating circumstances or 
that a longer period is appropriate because of aggravating 
circumstances.
    (E) In the case of an exclusion of an individual or entity under 
subsection (b)(4) or (b)(5) of this section, 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) of this section, the period of the exclusion shall 
be not less than 1 year.
    (G) In the case of an exclusion of an individual under subsection 
(a) of this section based on a conviction occurring on or after August 
5, 1997, if the individual has (before, on, or after August 5, 1997) 
been convicted--
        (i) on one previous occasion of one or more offenses for which 
    an exclusion may be effected under such subsection, the period of 
    the exclusion shall be not less than 10 years, or
        (ii) on 2 or more previous occasions of one or more offenses for 
    which an exclusion may be effected under such subsection, the period 
    of the exclusion shall be permanent.

(d) Notice to State agencies and exclusion under State health care 
        programs

    (1) Subject to paragraph (3), the Secretary shall exercise the 
authority under this section and section 1320a-7a of this title in a 
manner that results in an individual's or entity's exclusion from all 
the programs under subchapter XVIII of this chapter and all the State 
health care programs in which the individual or entity may otherwise 
participate.
    (2) The Secretary shall promptly notify each appropriate State 
agency administering or supervising the administration of each State 
health care program (and, in the case of an exclusion effected pursuant 
to subsection (a) of this section and to which section 824(a)(5) of 
title 21 may apply, the Attorney General)--
        (A) of the fact and circumstances of each exclusion effected 
    against an individual or entity under this section or section 1320a-
    7a of this title, and
        (B) of the period (described in paragraph (3)) for which the 
    State agency is directed to exclude the individual or entity from 
    participation in the State health care program.

    (3)(A) Except as provided in subparagraph (B), the period of the 
exclusion under a State health care program under paragraph (2) shall be 
the same as any period of exclusion under subchapter XVIII of this 
chapter.
    (B)(i) The Secretary may waive an individual's or entity's exclusion 
under a State health care program under paragraph (2) if the Secretary 
receives and approves a request for the waiver with respect to the 
individual or entity from the State agency administering or supervising 
the administration of the program.
    (ii) A State health care program may provide for a period of 
exclusion which is longer than the period of exclusion under subchapter 
XVIII of this chapter.

(e) Notice to State licensing agencies

    The Secretary shall--
        (1) promptly notify the appropriate State or local agency or 
    authority having responsibility for the licensing or certification 
    of an individual or entity excluded (or directed to be excluded) 
    from participation under this section or section 1320a-7a of this 
    title, of the fact and circumstances of the exclusion,
        (2) request that appropriate investigations be made and 
    sanctions invoked in accordance with applicable State law and 
    policy, and
        (3) request that the State or local agency or authority keep the 
    Secretary and the Inspector General of the Department of Health and 
    Human Services fully and currently informed with respect to any 
    actions taken in response to the request.

(f) Notice, hearing, and judicial review

    (1) Subject to paragraph (2), any individual or entity that is 
excluded (or directed to be excluded) from participation under this 
section is entitled to reasonable notice and opportunity for a hearing 
thereon by the Secretary to the same extent as is provided in section 
405(b) of this title, and to judicial review of the Secretary's final 
decision after such hearing as is provided in section 405(g) of this 
title, except that, in so applying such sections and section 405(l) of 
this title, any reference therein to the Commissioner of Social Security 
or the Social Security Administration shall be considered a reference to 
the Secretary or the Department of Health and Human Services, 
respectively.
    (2) Unless the Secretary determines that the health or safety of 
individuals receiving services warrants the exclusion taking effect 
earlier, any individual or entity that is the subject of an adverse 
determination under subsection (b)(7) of this section shall be entitled 
to a hearing by an administrative law judge (as provided under section 
405(b) of this title) on the determination under subsection (b)(7) of 
this section before any exclusion based upon the determination takes 
effect.
    (3) The provisions of section 405(h) of this title shall apply with 
respect to this section and sections 1320a-7a, 1320a-8, and 1320c-5 of 
this title to the same extent as it is applicable with respect to 
subchapter II of this chapter, except that, in so applying such section 
and section 405(l) of this title, any reference therein to the 
Commissioner of Social Security shall be considered a reference to the 
Secretary.

(g) Application for termination of exclusion

    (1) An individual or entity excluded (or directed to be excluded) 
from participation under this section or section 1320a-7a of this title 
may apply to the Secretary, in the manner specified by the Secretary in 
regulations and at the end of the minimum period of exclusion provided 
under subsection (c)(3) of this section and at such other times as the 
Secretary may provide, for termination of the exclusion effected under 
this section or section 1320a-7a of this title.
    (2) The Secretary may terminate the exclusion if the Secretary 
determines, on the basis of the conduct of the applicant which occurred 
after the date of the notice of exclusion or which was unknown to the 
Secretary at the time of the exclusion, that--
        (A) there is no basis under subsection (a) or (b) of this 
    section or section 1320a-7a(a) of this title for a continuation of 
    the exclusion, and
        (B) there are reasonable assurances that the types of actions 
    which formed the basis for the original exclusion have not recurred 
    and will not recur.

    (3) The Secretary shall promptly notify each appropriate State 
agency administering or supervising the administration of each State 
health care program (and, in the case of an exclusion effected pursuant 
to subsection (a) of this section and to which section 824(a)(5) of 
title 21 may apply, the Attorney General) of the fact and circumstances 
of each termination of exclusion made under this subsection.

(h) ``State health care program'' defined

    For purposes of this section and sections 1320a-7a and 1320a-7b of 
this title, the term ``State health care program'' means--
        (1) a State plan approved under subchapter XIX of this chapter,
        (2) any program receiving funds under subchapter V of this 
    chapter or from an allotment to a State under such subchapter,
        (3) any program receiving funds under subchapter XX of this 
    chapter or from an allotment to a State under such subchapter, or
        (4) a State child health plan approved under subchapter XXI of 
    this chapter.

(i) ``Convicted'' defined

    For purposes of subsections (a) and (b) of this section, an 
individual or entity is considered to have been ``convicted'' of a 
criminal offense--
        (1) when a judgment of conviction has been entered against the 
    individual or entity by a Federal, State, or local court, regardless 
    of whether there is an appeal pending or whether the judgment of 
    conviction or other record relating to criminal conduct has been 
    expunged;
        (2) when there has been a finding of guilt against the 
    individual or entity by a Federal, State, or local court;
        (3) when a plea of guilty or nolo contendere by the individual 
    or entity has been accepted by a Federal, State, or local court; or
        (4) when the individual or entity has entered into participation 
    in a first offender, deferred adjudication, or other arrangement or 
    program where judgment of conviction has been withheld.

(j) Definition of immediate family member and member of household

    For purposes of subsection (b)(8)(A)(iii) of this section:
        (1) The term ``immediate family member'' means, with respect to 
    a person--
            (A) the husband or wife of the person;
            (B) the natural or adoptive parent, child, or sibling of the 
        person;
            (C) the stepparent, stepchild, stepbrother, or stepsister of 
        the person;
            (D) the father-, mother-, daughter-, son-, brother-, or 
        sister-in-law of the person;
            (E) the grandparent or grandchild of the person; and
            (F) the spouse of a grandparent or grandchild of the person.

        (2) The term ``member of the household'' means, with respect to 
    any person, any individual sharing a common abode as part of a 
    single family unit with the person, including domestic employees and 
    others who live together as a family unit, but not including a 
    roomer or boarder.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128, as added Pub. L. 96-499, 
title IX, Sec. 913(a), Dec. 5, 1980, 94 Stat. 2619; amended Pub. L. 97-
35, title XXI, Sec. 2105(b), title XXIII, Sec. 2353(k), Aug. 13, 1981, 
95 Stat. 791, 873; Pub. L. 98-369, div. B, title III, Sec. 2333(a), (b), 
July 18, 1984, 98 Stat. 1089; Pub. L. 99-509, title IX, Sec. 9317(c), 
Oct. 21, 1986, 100 Stat. 2008; Pub. L. 100-93, Sec. 2, Aug. 18, 1987, 
101 Stat. 680; Pub. L. 100-203, title IV, Sec. 4118(e)(2)-(5), Dec. 22, 
1987, 101 Stat. 1330-155, as amended Pub. L. 100-360, title IV, 
Sec. 411(k)(10)(D), July 1, 1988, 102 Stat. 795; Pub. L. 100-360, title 
IV, Sec. 411(k)(10)(C), July 1, 1988, 102 Stat. 795; Pub. L. 101-239, 
title VI, Sec. 6411(d)(1), Dec. 19, 1989, 103 Stat. 2270; Pub. L. 101-
508, title IV, Sec. 4164(b)(3), Nov. 5, 1990, 104 Stat. 1388-102; Pub. 
L. 102-54, Sec. 13(q)(3)(A)(ii), June 13, 1991, 105 Stat. 279; Pub. L. 
103-296, title I, Sec. 108(b)(9), title II, Sec. 206(b)(2), Aug. 15, 
1994, 108 Stat. 1483, 1513; Pub. L. 104-191, title II, Secs. 211-213, 
Aug. 21, 1996, 110 Stat. 2003-2005; Pub. L. 105-33, title IV, 
Secs. 4301, 4303(a), 4331(c), 4901(b)(2), Aug. 5, 1997, 111 Stat. 382, 
396, 570.)


                               Amendments

    1997--Subsec. (a). Pub. L. 105-33, Sec. 4331(c)(1), substituted 
``any Federal health care program (as defined in section 1320a-7b(f) of 
this title)'' for ``any program under subchapter XVIII of this chapter 
and shall direct that the following individuals and entities be excluded 
from participation in any State health care program (as defined in 
subsection (h) of this section)'' in introductory provisions.
    Subsec. (b). Pub. L. 105-33, Sec. 4331(c)(2), substituted ``any 
Federal health care program (as defined in section 1320a-7b(f) of this 
title)'' for ``any program under subchapter XVIII of this chapter and 
may direct that the following individuals and entities be excluded from 
participation in any State health care program'' in introductory 
provisions.
    Subsec. (b)(8)(A)(iii). Pub. L. 105-33, Sec. 4303(a)(1), added cl. 
(iii).
    Subsec. (c)(3)(A). Pub. L. 105-33, Sec. 4301(1), inserted ``or in 
the case described in subparagraph (G)'' after ``subsection (b)(12) of 
this section''.
    Subsec. (c)(3)(B), (D). Pub. L. 105-33, Sec. 4301(2), substituted 
``Subject to subparagraph (G), in the case'' for ``In the case''.
    Subsec. (c)(3)(G). Pub. L. 105-33, Sec. 4301(3), added subpar. (G).
    Subsec. (h)(4). Pub. L. 105-33, Sec. 4901(b)(2), added par. (4).
    Subsec. (j). Pub. L. 105-33, Sec. 4303(a)(2), added subsec. (j).
    1996--Subsec. (a)(3). Pub. L. 104-191, Sec. 211(a)(1), added par. 
(3).
    Subsec. (a)(4). Pub. L. 104-191, Sec. 211(b)(1), added par. (4).
    Subsec. (b)(1). Pub. L. 104-191, Sec. 211(a)(2), reenacted heading 
without change and amended text generally. Prior to amendment, text read 
as follows: ``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 or with respect to any act or omission in a program 
operated by or financed in whole or in part by any Federal, State, or 
local government agency, of a criminal offense relating to fraud, theft, 
embezzlement, breach of fiduciary responsibility, or other financial 
misconduct.''
    Subsec. (b)(3). Pub. L. 104-191, Sec. 211(b)(2), substituted 
``Misdemeanor conviction'' for ``conviction'' in heading and ``criminal 
offense consisting of a misdemeanor'' for ``criminal offense'' in text.
    Subsec. (b)(15). Pub. L. 104-191, Sec. 213, added par. (15).
    Subsec. (c)(3)(D) to (F). Pub. L. 104-191, Sec. 212, added subpars. 
(D) to (F).
    1994--Subsec. (b)(7). Pub. L. 103-296, Sec. 206(b)(2)(A), 
substituted ``section 1320a-7a, 1320a-7b, or 1230a-8 of this title'' for 
``section 1320a-7a of this title or section 1320a-7b of this title''.
    Subsec. (b)(8)(B)(ii). Pub. L. 103-296, Sec. 206(b)(2)(B), inserted 
``or 1320a-8'' after ``section 1320a-7a''.
    Subsec. (f)(1). Pub. L. 103-296, Sec. 108(b)(9)(A), inserted before 
period at end ``, except that, in so applying such sections and section 
405(l) of this title, any reference therein to the Commissioner of 
Social Security or the Social Security Administration shall be 
considered a reference to the Secretary or the Department of Health and 
Human Services, respectively''.
    Subsec. (f)(3). Pub. L. 103-296, Sec. 206(b)(2)(C), inserted ``, 
1320a-8,'' after ``sections 1320a-7a''.
    Pub. L. 103-296, Sec. 108(b)(9)(B), inserted before period at end 
``, except that, in so applying such section and section 405(l) of this 
title, any reference therein to the Commissioner of Social Security 
shall be considered a reference to the Secretary''.
    1991--Subsec. (b)(5)(A). Pub. L. 102-54 substituted ``Department of 
Veterans Affairs'' for ``Veterans' Administration''.
    1990--Subsec. (b)(9). Pub. L. 101-508 substituted ``section 1320a-3 
of this title, section 1320a-3a of this title,'' for ``section 1320a-3 
of this title''.
    1989--Subsec. (b)(4)(A). Pub. L. 101-239 inserted ``or the right to 
apply for or renew such a license'' after ``lost such a license''.
    1988--Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L. 100-203, 
Sec. 4118(e)(3)-(5), which amended subsec. (b)(8)(A)(i), (d)(1), (3)(A), 
and (i). See 1987 Amendment notes below.
    Subsec. (d)(3)(B)(ii). Pub. L. 100-360, Sec. 411(k)(10)(C), struck 
out ``under a program'' after ``longer than the period of exclusion''.
    1987--Pub. L. 100-93 amended section generally, substituting 
subsecs. (a) to (i) for former subsecs. (a) to (f).
    Subsec. (b)(8)(A)(i). Pub. L. 100-203, Sec. 4118(e)(3), as added by 
Pub. L. 100-360, Sec. 411(k)(10)(D), inserted at beginning ``who has a 
direct or indirect ownership or control interest of 5 percent or more in 
the entity or''.
    Subsec. (d)(1). Pub. L. 100-203, Sec. 4118(e)(4)(A), as added by 
Pub. L. 100-360, Sec. 411(k)(10)(D), substituted ``this section and 
section 1320a-7a of this title'' for ``subsection (b) of this section''.
    Subsec. (d)(3)(A). Pub. L. 100-203, Sec. 4118(e)(4)(B), as added by 
Pub. L. 100-360, Sec. 411(k)(10)(D), struck out ``under a program'' 
after ``any period of exclusion''.
    Subsec. (d)(3)(B). Pub. L. 100-203, Sec. 4118(e)(2), designated 
existing provisions as cl. (i) and added cl. (ii).
    Subsec. (i). Pub. L. 100-203, Sec. 4118(e)(5)(A), as added by Pub. 
L. 100-360, Sec. 411(k)(10)(D), substituted ``an individual or entity'' 
for ``a physician or other individual'' in introductory provisions.
    Pub. L. 100-203, Sec. 4118(e)(5)(B), as added by Pub. L. 100-360, 
Sec. 411(k)(10)(D), which directed amendment of pars. (1) to (4) by 
substituting ``individual or entity'' for ``physician or other 
individual'' each place it appears, was executed by substituting 
``individual or entity'' for ``physician or individual'' in pars. (1) to 
(4) as the probable intent of Congress.
    Subsec. (i)(4). Pub. L. 100-203, Sec. 4118(e)(5)(C), as added by 
Pub. L. 100-360, Sec. 411(k)(10)(D), substituted ``first offender, 
deferred adjudication, or other arrangement or program'' for ``first 
offender or other program''.
    1986--Subsec. (f). Pub. L. 99-509 added subsec. (f).
    1984--Subsecs. (b) to (e). Pub. L. 98-369 added subsec. (b), 
redesignated former subsecs. (b) to (d) as (c) to (e), respectively, and 
in subsec. (e) substituted ``Any person or entity'' for ``Any person'' 
and ``(a), (b), or (c)'' for ``(a) or (b)''.
    1981--Subsec. (a)(1). Pub. L. 97-35, Sec. 2105(b)(1), struck out ``, 
for such period as he may deem appropriate,'' after ``subchapter XVIII 
of this chapter''.
    Subsec. (a)(2). Pub. L. 97-35, Sec. 2353(k), substituted in subpar. 
(A) ``subchapter XIX of this chapter'' for ``subchapter XIX or 
subchapter XX of this chapter,'' and in subpar. (B) ``subchapter XIX of 
this chapter'' for ``subchapter XIX or subchapter XX of this chapter''.
    Subsecs. (b) to (d). Pub. L. 97-35, Sec. 2105(b)(2)-(4), added 
subsec. (b), redesignated former subsecs. (b) and (c) as (c) and (d), 
respectively, and in subsec. (d) as so redesignated substituted 
``subsection (a) or (b)'' for ``subsection (a)''.


                    Effective Date of 1997 Amendment

    Section 4303(b) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section] shall take effect on the 
date that is 45 days after the date of the enactment of this Act [Aug. 
5, 1997].''
    Amendments by section 4331(c) of Pub. L. 105-33 effective Aug. 5, 
1997, see section 4331(f)(2) of Pub. L. 105-33, set out as a note under 
section 1320a-7e of this title.


                    Effective Date of 1996 Amendment

    Section 218 of Pub. L. 104-191 provided that: ``Except as otherwise 
provided, the amendments made by this subtitle [subtitle B, Secs. 211-
218, of title II of Pub. L. 104-191, amending this section and sections 
1320a-7b, 1320c-5, and 1395mm of this title] shall take effect January 
1, 1997.''


                    Effective Date of 1994 Amendment

    Amendment by section 108(b)(9) of Pub. L. 103-296 effective Mar. 31, 
1995, see section 110(a) of Pub. L. 103-296, set out as a note under 
section 401 of this title.
    Section 206(b)(3) of Pub. L. 103-296 provided that: ``The amendments 
made by this subsection [enacting section 1320a-8 of this title and 
amending this section] shall apply to conduct occurring on or after 
October 1, 1994.''


                    Effective Date of 1990 Amendment

    Amendment by Pub. L. 101-508 applicable with respect to items or 
services furnished on or after Jan. 1, 1993, in the case of items or 
services furnished by a provider who, on or before Nov. 5, 1990, has 
furnished items or services for which payment may be made under part B 
of subchapter XVIII of this chapter, or Jan. 1, 1992, in the case of 
items or services furnished by any other provider, see section 
4164(b)(4) of Pub. L. 101-508, set out as an Effective Date note under 
section 1320a-3a of this title.


                    Effective Date of 1989 Amendment

    Section 6411(d)(4)[(A)] of Pub. L. 101-239 provided that: ``The 
amendments made by paragraphs (1) and (2) [amending this section and 
sections 1395y and 1396b of this title] shall take effect on the date of 
the enactment of this Act [Dec. 19, 1989].''


                    Effective Date of 1988 Amendment

    Except as specifically provided in section 411 of Pub. L. 100-360, 
amendment by Pub. L. 100-360, as it relates to a provision in the 
Omnibus Budget Reconciliation Act of 1987, Pub. L. 100-203, effective as 
if included in the enactment of that provision in Pub. L. 100-203, see 
section 411(a) of Pub. L. 100-360 set out as a Reference to OBRA; 
Effective Date note under section 106 of Title 1, General Provisions.


                    Effective Date of 1987 Amendment

    Section 15 of Pub. L. 100-93 provided that:
    ``(a) In General.--Except as provided in subsections (b), (c), (d), 
and (e), the amendments made by this Act [enacting sections 1395aaa and 
1396r-2 of this title, amending this section, sections 704, 1320a-3, 
1320a-5, 1320a-7a, 1320a-7b, 1320c-5, 1395u, 1395y, 1395cc, 1395ff, 
1395nn, 1395rr, 1395ss, 1395ww, 1396a, 1396b, 1396h, 1396n, 1396s, and 
1397d of this title, and section 824 of Title 21, Food and Drugs, 
transferring section 1396h of this title to section 1320a-7b of this 
title, repealing section 1395nn of this title, enacting provisions set 
out as a note under section 1320a-7b of this title, and amending 
provisions set out as a note under section 1396a of this title] shall 
become effective at the end of the fourteen-day period beginning on the 
date of the enactment of this Act [Aug. 18, 1987] and shall not apply to 
administrative proceedings commenced before the end of such period.
    ``(b) Mandatory Minimum Exclusions Apply Prospectively.--Section 
1128(c)(3)(B) of the Social Security Act [subsec. (c)(3)(B) of this 
section] (as amended by this Act), which requires an exclusion of not 
less than five years in the case of certain exclusions, shall not apply 
to exclusions based on convictions occurring before the date of the 
enactment of this Act [Aug. 18, 1987].
    ``(c) Effective Date for Changes in Medicaid Law.--(1) The 
amendments made by sections 5 and 8(f) [enacting section 1396r-2 of this 
title and amending sections 1396a and 1396s of this title] apply (except 
as provided under paragraph (2)) to payments under title XIX of the 
Social Security Act [subchapter XIX of this chapter] for calendar 
quarters beginning more than thirty days after the date of the enactment 
of this Act [Aug. 18, 1987], without regard to whether or not final 
regulations to carry out such amendment have been published by such 
date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirements imposed by the amendments made by this Act, the State plan 
shall not be regarded as failing to comply with the requirements of such 
title solely on the basis of its failure to meet these additional 
requirements before the first day of the first calendar quarter 
beginning after the close of the first regular session of the State 
legislature that begins after the date of the enactment of this Act.
    ``(3) Subsection (j) of section 1128A of the Social Security Act 
[section 1320a-7a(j) of this title] (as added by section 3(f) of this 
Act) takes effect on the date of the enactment of this Act.
    ``(d) Physician Misrepresentations.--Clauses (ii) and (iii) of 
section 1128A(a)(1)(C) of the Social Security Act [section 1320a-
7a(a)(1)(C)(ii), (iii) of this title], as amended by section 3(a)(1) of 
this Act, apply to claims presented for services performed on or after 
the effective date specified in subsection (a), without regard to the 
date the misrepresentation of fact was made.
    ``(e) Clarification of Medicaid Moratorium.--The amendments made by 
section 9 of this Act [amending provisions set out as a note under 
section 1396a of this title] shall apply as though they were originally 
included in the enactment of section 2373(c) of the Deficit Reduction 
Act of 1984 [set out as a note under section 1396a of this title].
    ``(f) Treatment of Certain Denials of Payment.--For purposes of 
section 1128(b)(8)(B)(iii) of the Social Security Act [subsec. 
(b)(8)(B)(iii) of this section] (as amended by section 2 of this Act), a 
person shall be considered to have been excluded from participation 
under a program under title XVIII [subchapter XVIII of this chapter] if 
payment to the person has been denied under section 1862(d) of the 
Social Security Act [section 1395y(d) of this title], as in effect 
before the effective date specified in subsection (a).''


                    Effective Date of 1986 Amendment

    Section 9317(d)(3) of Pub. L. 99-509 provided that: ``The 
provisions--
        ``(A) of paragraphs (1), (2), and (3) of section 1128(f) of the 
    Social Security Act [subsec. (f)(1)-(3) of this section] (as added 
    by the amendment made by subsection (c)) shall apply to judgments 
    entered, findings made, and pleas entered, before, on, or after the 
    date of the enactment of this Act [Oct. 21, 1986], and
        ``(B) of paragraph (4) of such section [subsec. (f)(4) of this 
    section] shall apply to participation in a program entered into on 
    or after the date of the enactment of this Act.''


                    Effective Date of 1984 Amendment

    Section 2333(c) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [amending this section] become effective on the 
date of the enactment of this Act [July 18, 1984] and shall apply to 
convictions of persons occurring after such date.''


                    Effective Date of 1981 Amendment

    Amendment by section 2353(k) of Pub. L. 97-35 effective Oct. 1, 
1981, except as otherwise explicitly provided, see section 2354 of Pub. 
L. 97-35, set out as an Effective Date note under section 1397 of this 
title.

                  Section Referred to in Other Sections

    This section is referred to in sections 704, 1320a-3a, 1320a-5, 
1320a-7a, 1320a-7b, 1320a-7c, 1320a-7d, 1320a-7e, 1320a-8, 1320c-5, 
1395a, 1395b-5, 1395l, 1395m, 1395u, 1395w-27, 1395y, 1395cc, 1395mm, 
1395ww, 1395aaa, 1396a, 1396b, 1396r-2, 1396r-6, 1397d of this title; 
title 21 section 824.
