
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[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-7a]

 
                 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-7a. Civil monetary penalties


(a) Improperly filed claims

    Any person (including an organization, agency, or other entity, but 
excluding a beneficiary, as defined in subsection (i)(5) of this 
section) that--
        (1) knowingly presents or causes to be presented to an officer, 
    employee, or agent of the United States, or of any department or 
    agency thereof, or of any State agency (as defined in subsection 
    (i)(1) of this section), a claim (as defined in subsection (i)(2) of 
    this section) that the Secretary determines--
            (A) is for a medical or other item or service that the 
        person knows or should know was not provided as claimed, 
        including any person who engages in a pattern or practice of 
        presenting or causing to be presented a claim for an item or 
        service that is based on a code that the person knows or should 
        know will result in a greater payment to the person than the 
        code the person knows or should know is applicable to the item 
        or service actually provided,
            (B) is for a medical or other item or service and the person 
        knows or should know the claim is false or fraudulent,
            (C) is presented for a physician's service (or an item or 
        service incident to a physician's service) by a person who knows 
        or should know that the individual who furnished (or supervised 
        the furnishing of) the service--
                (i) was not licensed as a physician,
                (ii) was licensed as a physician, but such license had 
            been obtained through a misrepresentation of material fact 
            (including cheating on an examination required for 
            licensing), or
                (iii) represented to the patient at the time the service 
            was furnished that the physician was certified in a medical 
            specialty by a medical specialty board when the individual 
            was not so certified,

            (D) is for a medical or other item or service furnished 
        during a period in which the person was excluded from the 
        program under which the claim was made pursuant to a 
        determination by the Secretary under this section or under 
        section 1320a-7, 1320c-5, 1320c-9(b) (as in effect on September 
        2, 1982), 1395y(d) (as in effect on August 18, 1987), or 
        1395cc(b) of this title or as a result of the application of the 
        provisions of section 1395u(j)(2) of this title, or
            (E) is for a pattern of medical or other items or services 
        that a person knows or should know are not medically necessary;

        (2) knowingly presents or causes to be presented to any person a 
    request for payment which is in violation of the terms of (A) an 
    assignment under section 1395u(b)(3)(B)(ii) of this title, or (B) an 
    agreement with a State agency (or other requirement of a State plan 
    under subchapter XIX of this chapter) not to charge a person for an 
    item or service in excess of the amount permitted to be charged, or 
    (C) an agreement to be a participating physician or supplier under 
    section 1395u(h)(1) of this title, or (D) an agreement pursuant to 
    section 1395cc(a)(1)(G) of this title;
        (3) knowingly gives or causes to be given to any person, with 
    respect to coverage under subchapter XVIII of this chapter of 
    inpatient hospital services subject to the provisions of section 
    1395ww of this title, information that he knows or should know is 
    false or misleading, and that could reasonably be expected to 
    influence the decision when to discharge such person or another 
    individual from the hospital;
        (4) in the case of a person who is not an organization, agency, 
    or other entity, is excluded from participating in a program under 
    subchapter XVIII of this chapter or a State health care program in 
    accordance with this subsection or under section 1320a-7 of this 
    title and who, at the time of a violation of this subsection--
            (A) retains a direct or indirect ownership or control 
        interest in an entity that is participating in a program under 
        subchapter XVIII of this chapter or a State health care program, 
        and who knows or should know of the action constituting the 
        basis for the exclusion; or
            (B) is an officer or managing employee (as defined in 
        section 1320a-5(b) of this title) of such an entity;

        (5) offers to or transfers remuneration to any individual 
    eligible for benefits under subchapter XVIII of this chapter, or 
    under a State health care program (as defined in section 1320a-7(h) 
    of this title) that such person knows or should know is likely to 
    influence such individual to order or receive from a particular 
    provider, practitioner, or supplier any item or service for which 
    payment may be made, in whole or in part, under subchapter XVIII of 
    this chapter, or a State health care program (as so defined);
        (6) arranges or contracts (by employment or otherwise) with an 
    individual or entity that the person knows or should know is 
    excluded from participation in a Federal health care program (as 
    defined in section 1320a-7b(f) of this title), for the provision of 
    items or services for which payment may be made under such a 
    program; or
        (7) commits an act described in paragraph (1) or (2) of section 
    1320a-7b(b) of this title;

shall be subject, in addition to any other penalties that may be 
prescribed by law, to a civil money penalty of not more than $10,000 for 
each item or service (or, in cases under paragraph (3), $15,000 for each 
individual with respect to whom false or misleading information was 
given; in cases under paragraph (4), $10,000 for each day the prohibited 
relationship occurs; or in cases under paragraph (7), $50,000 for each 
such act). In addition, such a person shall be subject to an assessment 
of not more than 3 times the amount claimed for each such item or 
service in lieu of damages sustained by the United States or a State 
agency because of such claim (or, in cases under paragraph (7), damages 
of not more than 3 times the total amount of remuneration offered, paid, 
solicited, or received, without regard to whether a portion of such 
remuneration was offered, paid, solicited, or received for a lawful 
purpose). In addition the Secretary may make a determination in the same 
proceeding to exclude the person from participation in the Federal 
health care programs (as defined in section 1320a-7b(f)(1) of this 
title) and to direct the appropriate State agency to exclude the person 
from participation in any State health care program.

(b) Payments to induce reduction or limitation of services

    (1) If a hospital or a critical access hospital knowingly makes a 
payment, directly or indirectly, to a physician as an inducement to 
reduce or limit services provided with respect to individuals who--
        (A) are entitled to benefits under part A or part B of 
    subchapter XVIII of this chapter or to medical assistance under a 
    State plan approved under subchapter XIX of this chapter, and
        (B) are under the direct care of the physician,

the hospital or a critical access hospital shall be subject, in addition 
to any other penalties that may be prescribed by law, to a civil money 
penalty of not more than $2,000 for each such individual with respect to 
whom the payment is made.
    (2) Any physician who knowingly accepts receipt of a payment 
described in paragraph (1) shall be subject, in addition to any other 
penalties that may be prescribed by law, to a civil money penalty of not 
more than $2,000 for each individual described in such paragraph with 
respect to whom the payment is made.
    (3)(A) Any physician who executes a document described in 
subparagraph (B) with respect to an individual knowing that all of the 
requirements referred to in such subparagraph are not met with respect 
to the individual shall be subject to a civil monetary penalty of not 
more than the greater of--
        (i) $5,000, or
        (ii) three times the amount of the payments under subchapter 
    XVIII of this chapter for home health services which are made 
    pursuant to such certification.

    (B) A document described in this subparagraph is any document that 
certifies, for purposes of subchapter XVIII of this chapter, that an 
individual meets the requirements of section 1395f(a)(2)(C) or 
1395n(a)(2)(A) of this title in the case of home health services 
furnished to the individual.

(c) Initiation of proceeding; authorization by Attorney General, notice, 
        etc., estoppel, failure to comply with order or procedure

    (1) The Secretary may initiate a proceeding to determine whether to 
impose a civil money penalty, assessment, or exclusion under subsection 
(a) or (b) of this section only as authorized by the Attorney General 
pursuant to procedures agreed upon by them. The Secretary may not 
initiate an action under this section with respect to any claim, request 
for payment, or other occurrence described in this section later than 
six years after the date the claim was presented, the request for 
payment was made, or the occurrence took place. The Secretary may 
initiate an action under this section by serving notice of the action in 
any manner authorized by Rule 4 of the Federal Rules of Civil Procedure.
    (2) The Secretary shall not make a determination adverse to any 
person under subsection (a) or (b) of this section until the person has 
been given written notice and an opportunity for the determination to be 
made on the record after a hearing at which the person is entitled to be 
represented by counsel, to present witnesses, and to cross-examine 
witnesses against the person.
    (3) In a proceeding under subsection (a) or (b) of this section 
which--
        (A) is against a person who has been convicted (whether upon a 
    verdict after trial or upon a plea of guilty or nolo contendere) of 
    a Federal crime charging fraud or false statements, and
        (B) involves the same transaction as in the criminal action,

the person is estopped from denying the essential elements of the 
criminal offense.
    (4) The official conducting a hearing under this section may 
sanction a person, including any party or attorney, for failing to 
comply with an order or procedure, failing to defend an action, or other 
misconduct as would interfere with the speedy, orderly, or fair conduct 
of the hearing. Such sanction shall reasonably relate to the severity 
and nature of the failure or misconduct. Such sanction may include--
        (A) in the case of refusal to provide or permit discovery, 
    drawing negative factual inferences or treating such refusal as an 
    admission by deeming the matter, or certain facts, to be 
    established,
        (B) prohibiting a party from introducing certain evidence or 
    otherwise supporting a particular claim or defense,
        (C) striking pleadings, in whole or in part,
        (D) staying the proceedings,
        (E) dismissal of the action,
        (F) entering a default judgment,
        (G) ordering the party or attorney to pay attorneys' fees and 
    other costs caused by the failure or misconduct, and
        (H) refusing to consider any motion or other action which is not 
    filed in a timely manner.

(d) Amount or scope of penalty, assessment, or exclusion

    In determining the amount or scope of any penalty, assessment, or 
exclusion imposed pursuant to subsection (a) or (b) of this section, the 
Secretary shall take into account--
        (1) the nature of claims and the circumstances under which they 
    were presented,
        (2) the degree of culpability, history of prior offenses, and 
    financial condition of the person presenting the claims, and
        (3) such other matters as justice may require.

(e) Review by courts of appeals

    Any person adversely affected by a determination of the Secretary 
under this section may obtain a review of such determination in the 
United States Court of Appeals for the circuit in which the person 
resides, or in which the claim was presented, by filing in such court 
(within sixty days following the date the person is notified of the 
Secretary's determination) a written petition requesting that the 
determination be modified or set aside. A copy of the petition shall be 
forthwith transmitted by the clerk of the court to the Secretary, and 
thereupon the Secretary shall file in the Court \1\ the record in the 
proceeding as provided in section 2112 of title 28. Upon such filing, 
the court shall have jurisdiction of the proceeding and of the question 
determined therein, and shall have the power to make and enter upon the 
pleadings, testimony, and proceedings set forth in such record a decree 
affirming, modifying, remanding for further consideration, or setting 
aside, in whole or in part, the determination of the Secretary and 
enforcing the same to the extent that such order is affirmed or 
modified. No objection that has not been urged before the Secretary 
shall be considered by the court, unless the failure or neglect to urge 
such objection shall be excused because of extraordinary circumstances. 
The findings of the Secretary with respect to questions of fact, if 
supported by substantial evidence on the record considered as a whole, 
shall be conclusive. If any party shall apply to the court for leave to 
adduce additional evidence and shall show to the satisfaction of the 
court that such additional evidence is material and that there were 
reasonable grounds for the failure to adduce such evidence in the 
hearing before the Secretary, the court may order such additional 
evidence to be taken before the Secretary and to be made a part of the 
record. The Secretary may modify his findings as to the facts, or make 
new findings, by reason of additional evidence so taken and filed, and 
he shall file with the court such modified or new findings, which 
findings with respect to questions of fact, if supported by substantial 
evidence on the record considered as a whole, shall be conclusive, and 
his recommendations, if any, for the modification or setting aside of 
his original order. Upon the filing of the record with it, the 
jurisdiction of the court shall be exclusive and its judgment and decree 
shall be final, except that the same shall be subject to review by the 
Supreme Court of the United States, as provided in section 1254 of title 
28.
---------------------------------------------------------------------------
    \1\ So in original. Probably should not be capitalized.
---------------------------------------------------------------------------

(f) Compromise of penalties and assessments; recovery; use of funds 
        recovered

    Civil money penalties and assessments imposed under this section may 
be compromised by the Secretary and may be recovered in a civil action 
in the name of the United States brought in United States district court 
for the district where the claim was presented, or where the claimant 
resides, as determined by the Secretary. Amounts recovered under this 
section shall be paid to the Secretary and disposed of as follows:
        (1)(A) In the case of amounts recovered arising out of a claim 
    under subchapter XIX of this chapter, there shall be paid to the 
    State agency an amount bearing the same proportion to the total 
    amount recovered as the State's share of the amount paid by the 
    State agency for such claim bears to the total amount paid for such 
    claim.
        (B) In the case of amounts recovered arising out of a claim 
    under an allotment to a State under subchapter V of this chapter, 
    there shall be paid to the State agency an amount equal to three-
    sevenths of the amount recovered.
        (2) Such portion of the amounts recovered as is determined to 
    have been paid out of the trust funds under sections 1395i and 1395t 
    of this title shall be repaid to such trust funds.
        (3) With respect to amounts recovered arising out of a claim 
    under a Federal health care program (as defined in section 1320a-
    7b(f) of this title), the portion of such amounts as is determined 
    to have been paid by the program shall be repaid to the program, and 
    the portion of such amounts attributable to the amounts recovered 
    under this section by reason of the amendments made by the Health 
    Insurance Portability and Accountability Act of 1996 (as estimated 
    by the Secretary) shall be deposited into the Federal Hospital 
    Insurance Trust Fund pursuant to section 1395i(k)(2)(C) of this 
    title.
        (4) The remainder of the amounts recovered shall be deposited as 
    miscellaneous receipts of the Treasury of the United States.

The amount of such penalty or assessment, when finally determined, or 
the amount agreed upon in compromise, may be deducted from any sum then 
or later owing by the United States or a State agency to the person 
against whom the penalty or assessment has been assessed.

(g) Finality of determination respecting penalty, assessment, or 
        exclusion

    A determination by the Secretary to impose a penalty, assessment, or 
exclusion under subsection (a) or (b) of this section shall be final 
upon the expiration of the sixty-day period referred to in subsection 
(e) of this section. Matters that were raised or that could have been 
raised in a hearing before the Secretary or in an appeal pursuant to 
subsection (e) of this section may not be raised as a defense to a civil 
action by the United States to collect a penalty, assessment, or 
exclusion assessed under this section.

(h) Notification of appropriate entities of finality of determination

    Whenever the Secretary's determination to impose a penalty, 
assessment, or exclusion under subsection (a) or (b) of this section 
becomes final, he shall notify the appropriate State or local medical or 
professional organization, the appropriate State agency or agencies 
administering or supervising the administration of State health care 
programs (as defined in section 1320a-7(h) of this title), and the 
appropriate utilization and quality control peer review organization, 
and the appropriate State or local licensing agency or organization 
(including the agency specified in section 1395aa(a) and 1396a(a)(33) of 
this title) that such a penalty, assessment, or exclusion has become 
final and the reasons therefor.

(i) Definitions

    For the purposes of this section:
        (1) The term ``State agency'' means the agency established or 
    designated to administer or supervise the administration of the 
    State plan under subchapter XIX of this chapter or designated to 
    administer the State's program under subchapter V of this chapter or 
    subchapter XX of this chapter.
        (2) The term ``claim'' means an application for payments for 
    items and services under a Federal health care program (as defined 
    in section 1320a-7b(f) of this title).
        (3) The term ``item or service'' includes (A) any particular 
    item, device, medical supply, or service claimed to have been 
    provided to a patient and listed in an itemized claim for payment, 
    and (B) in the case of a claim based on costs, any entry in the cost 
    report, books of account or other documents supporting such claim.
        (4) The term ``agency of the United States'' includes any 
    contractor acting as a fiscal intermediary, carrier, or fiscal agent 
    or any other claims processing agent for a Federal health care 
    program (as so defined).
        (5) The term ``beneficiary'' means an individual who is eligible 
    to receive items or services for which payment may be made under a 
    Federal health care program (as so defined) but does not include a 
    provider, supplier, or practitioner.
        (6) The term ``remuneration'' includes the waiver of coinsurance 
    and deductible amounts (or any part thereof), and transfers of items 
    or services for free or for other than fair market value. The term 
    ``remuneration'' does not include--
            (A) the waiver of coinsurance and deductible amounts by a 
        person, if--
                (i) the waiver is not offered as part of any 
            advertisement or solicitation;
                (ii) the person does not routinely waive coinsurance or 
            deductible amounts; and
                (iii) the person--
                    (I) waives the coinsurance and deductible amounts 
                after determining in good faith that the individual is 
                in financial need; or
                    (II) fails to collect coinsurance or deductible 
                amounts after making reasonable collection efforts;

            (B) subject to subsection (n) of this section, any 
        permissible practice described in any subparagraph of section 
        1320a-7b(b)(3) of this title or in regulations issued by the 
        Secretary;
            (C) differentials in coinsurance and deductible amounts as 
        part of a benefit plan design as long as the differentials have 
        been disclosed in writing to all beneficiaries, third party 
        payers, and providers, to whom claims are presented and as long 
        as the differentials meet the standards as defined in 
        regulations promulgated by the Secretary not later than 180 days 
        after August 21, 1996; or
            (D) \2\ incentives given to individuals to promote the 
        delivery of preventive care as determined by the Secretary in 
        regulations so promulgated.
---------------------------------------------------------------------------
    \2\ So in original. Two subpars. (D) have been enacted.
---------------------------------------------------------------------------
            (D) \2\ a reduction in the copayment amount for covered OPD 
        services under section 1395l(t)(5)(B) \3\ of this title.
---------------------------------------------------------------------------
    \3\ See References in Text note below.

        (7) The term ``should know'' means that a person, with respect 
    to information--
            (A) acts in deliberate ignorance of the truth or falsity of 
        the information; or
            (B) acts in reckless disregard of the truth or falsity of 
        the information,

    and no proof of specific intent to defraud is required.

(j) Subpoenas

    (1) The provisions of subsections (d) and (e) of section 405 of this 
title shall apply with respect to this section to the same extent as 
they are applicable with respect to subchapter II of this chapter. The 
Secretary may delegate the authority granted by section 405(d) of this 
title (as made applicable to this section) to the Inspector General of 
the Department of Health and Human Services for purposes of any 
investigation under this section.
    (2) The Secretary may delegate authority granted under this section 
and under section 1320a-7 of this title to the Inspector General of the 
Department of Health and Human Services.

(k) Injunctions

    Whenever the Secretary has reason to believe that any person has 
engaged, is engaging, or is about to engage in any activity which makes 
the person subject to a civil monetary penalty under this section, the 
Secretary may bring an action in an appropriate district court of the 
United States (or, if applicable, a United States court of any 
territory) to enjoin such activity, or to enjoin the person from 
concealing, removing, encumbering, or disposing of assets which may be 
required in order to pay a civil monetary penalty if any such penalty 
were to be imposed or to seek other appropriate relief.

(l) Liability of principal for acts of agent

    A principal is liable for penalties, assessments, and an exclusion 
under this section for the actions of the principal's agent acting 
within the scope of the agency.

(m) Claims within jurisdiction of other departments or agencies

    (1) For purposes of this section, with respect to a Federal health 
care program not contained in this chapter, references to the Secretary 
in this section shall be deemed to be references to the Secretary or 
Administrator of the department or agency with jurisdiction over such 
program and references to the Inspector General of the Department of 
Health and Human Services in this section shall be deemed to be 
references to the Inspector General of the applicable department or 
agency.
    (2)(A) The Secretary and Administrator of the departments and 
agencies referred to in paragraph (1) may include in any action pursuant 
to this section, claims within the jurisdiction of other Federal 
departments or agencies as long as the following conditions are 
satisfied:
        (i) The case involves primarily claims submitted to the Federal 
    health care programs of the department or agency initiating the 
    action.
        (ii) The Secretary or Administrator of the department or agency 
    initiating the action gives notice and an opportunity to participate 
    in the investigation to the Inspector General of the department or 
    agency with primary jurisdiction over the Federal health care 
    programs to which the claims were submitted.

    (B) If the conditions specified in subparagraph (A) are fulfilled, 
the Inspector General of the department or agency initiating the action 
is authorized to exercise all powers granted under the Inspector General 
Act of 1978 (5 U.S.C. App.) with respect to the claims submitted to the 
other departments or agencies to the same manner and extent as provided 
in that Act with respect to claims submitted to such departments or 
agencies.

(n) Safe harbor for payment of medigap premiums

    (1) Subparagraph (B) of subsection (i)(6) of this section shall not 
apply to a practice described in paragraph (2) unless--
        (A) the Secretary, through the Inspector General of the 
    Department of Health and Human Services, promulgates a rule 
    authorizing such a practice as an exception to remuneration; and
        (B) the remuneration is offered or transferred by a person under 
    such rule during the 2-year period beginning on the date the rule is 
    first promulgated.

    (2) A practice described in this paragraph is a practice under which 
a health care provider or facility pays, in whole or in part, premiums 
for medicare supplemental policies for individuals entitled to benefits 
under part A of subchapter XVIII of this chapter pursuant to section 
426-1 of this title.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128A, as added Pub. L. 97-35, 
title XXI, Sec. 2105(a), Aug. 13, 1981, 95 Stat. 789; amended Pub. L. 
97-248, title I, Sec. 137(b)(26), Sept. 3, 1982, 96 Stat. 380; Pub. L. 
98-369, div. B, title III, Secs. 2306(f)(1), 2354(a)(3), July 18, 1984, 
98 Stat. 1073, 1100; Pub. L. 99-509, title IX, Secs. 9313(c)(1), 
9317(a), (b), Oct. 21, 1986, 100 Stat. 2003, 2008; Pub. L. 100-93, 
Sec. 3, Aug. 18, 1987, 101 Stat. 686; Pub. L. 100-203, title IV, 
Secs. 4039(h)(1), 4118(e)(1), (6)-(10), Dec. 22, 1987, 101 Stat. 1330-
155, as amended Pub. L. 100-360, title IV, Sec. 411(e)(3), 
(k)(10)(B)(ii), (D), July 1, 1988, 102 Stat. 775, 794, 795; Pub. L. 100-
360, title II, Sec. 202(c)(2), July 1, 1988, 102 Stat. 715; Pub. L. 100-
485, title VI, Sec. 608(d)(26)(H)-(K)(i), Oct. 13, 1988, 102 Stat. 2422; 
Pub. L. 101-234, title II, Sec. 201(a), Dec. 13, 1989, 103 Stat. 1981; 
Pub. L. 101-239, title VI, Sec. 6003(g)(3)(D)(i), Dec. 19, 1989, 103 
Stat. 2153; Pub. L. 101-508, title IV, Secs. 4204(a)(3), 4207(h), 
formerly 4027(h), 4731(b)(1), 4753, Nov. 5, 1990, 104 Stat. 1388-109, 
1388-123, 1388-195, 1388-208, renumbered Sec. 4207(h), Pub. L. 103-432, 
title I, Sec. 160(d)(4), Oct. 31, 1994, 108 Stat. 4444; Pub. L. 104-191, 
title II, Secs. 231(a)-(e), (h), 232(a), Aug. 21, 1996, 110 Stat. 2012-
2015; Pub. L. 105-33, title IV, Secs. 4201(c)(1), 4304(a), (b), 4331(e), 
4523(c), Aug. 5, 1997, 111 Stat. 373, 383, 396, 449; Pub. L. 105-277, 
div. J, title V, Sec. 5201(a), (b)(1), Oct. 21, 1998, 112 Stat. 2681-
916.)

                       References in Text

    The Federal Rules of Civil Procedure, referred to in subsec. (c)(1), 
are set out in the Appendix to Title 28, Judiciary and Judicial 
Procedure.
    The Health Insurance Portability and Accountability Act of 1996, 
referred to in subsec. (f)(3), is Pub. L. 104-191, Aug. 21, 1996, 110 
Stat. 1936. For complete classification of this Act to the Code, see 
Short Title of 1996 Amendments note set out under section 201 of this 
title and Tables.
    Section 1395l(t)(5)(B) of this title, referred to in subsec. 
(i)(6)(D), was redesignated section 1395l(t)(8)(B) of this title by Pub. 
L. 106-113, div. B, Sec. 1000(a)(6) [title II, Secs. 201(a)(1), 
202(a)(2)], Nov. 29, 1999, 113 Stat. 1536, 1501A-336, 1501A-342.
    The Inspector General Act of 1978, referred to in subsec. (m)(2)(B), 
is Pub. L. 95-452, Oct. 12, 1978, 92 Stat. 1101, as amended, which is 
set out in the Appendix to Title 5, Government Organization and 
Employees.


                               Amendments

    1998--Subsec. (i)(6)(B). Pub. L. 105-277, Sec. 5201(a), amended 
subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: 
``any permissible waiver as specified in section 1320a-7b(b)(3) of this 
title or in regulations issued by the Secretary;''.
    Subsec. (n). Pub. L. 105-277, Sec. 5201(b)(1), added subsec. (n).
    1997--Subsec. (a). Pub. L. 105-33, Sec. 4304(b)(2), in concluding 
provisions, substituted ``occurs; or in cases under paragraph (7), 
$50,000 for each such act).'' for ``occurs).'' and inserted ``(or, in 
cases under paragraph (7), damages of not more than 3 times the total 
amount of remuneration offered, paid, solicited, or received, without 
regard to whether a portion of such remuneration was offered, paid, 
solicited, or received for a lawful purpose)'' after ``of such claim''.
    Subsec. (a)(6). Pub. L. 105-33, Sec. 4304(a), added par. (6).
    Subsec. (a)(7). Pub. L. 105-33, Sec. 4304(b)(1), added par. (7).
    Subsec. (b)(1). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care'' in introductory and 
concluding provisions.
    Subsec. (i)(6)(A)(iii). Pub. L. 105-33, Sec. 4331(e)(1), inserted 
``or'' at end of subcl. (I), struck out ``or'' at end of subcl. (II), 
and struck out subcl. (III) which read as follows: ``provides for any 
permissible waiver as specified in section 1320a-7b(b)(3) of this title 
or in regulations issued by the Secretary;''.
    Subsec. (i)(6)(B). Pub. L. 105-33, Sec. 4523(c)(1), which directed 
amendment of par. (6) by striking ``or'' at end of subpar. (B), could 
not be executed because the word ``or'' did not appear at end of subpar. 
(B) subsequent to amendment by Pub. L. 105-33, Sec. 4331(e)(2), (3). See 
below.
    Pub. L. 105-33, Sec. 4331(e)(3), added subpar. (B). Former subpar. 
(B) redesignated (C).
    Subsec. (i)(6)(C). Pub. L. 105-33, Sec. 4523(c)(2), which directed 
amendment of par. (6) by substituting ``; or'' for the period at end of 
subpar. (C), could not be executed because there was not a period at the 
end of subpar. (C) subsequent to amendment by Pub. L. 105-33, 
Sec. 4331(e)(2). See below.
    Pub. L. 105-33, Sec. 4331(e)(2), redesignated subpar. (B) as (C). 
Former subpar. (C) redesignated (D).
    Subsec. (i)(6)(D). Pub. L. 105-33, Sec. 4523(c), added subpar. (D) 
relating to a reduction in copayment amount for covered OPD services.
    Pub. L. 105-33, Sec. 4331(e)(2), redesignated subpar. (C), relating 
to incentives given to individuals to promote delivery, as (D).
    1996--Subsec. (a). Pub. L. 104-191, Sec. 231(c), in concluding 
provisions, substituted ``$10,000'' for ``$2,000'', inserted ``; in 
cases under paragraph (4), $10,000 for each day the prohibited 
relationship occurs'' after ``false or misleading information was 
given'', and substituted ``3 times the amount'' for ``twice the 
amount''.
    Pub. L. 104-191, Sec. 231(a)(1), in concluding provisions, 
substituted ``Federal health care programs (as defined in section 1320a-
7b(f)(1) of this title)'' for ``programs under subchapter XVIII of this 
chapter''.
    Subsec. (a)(1). Pub. L. 104-191, Sec. 231(d)(1)(A), inserted 
``knowingly'' before ``presents'' in introductory provisions.
    Subsec. (a)(1)(A). Pub. L. 104-191, Sec. 231(e)(1), substituted 
``claimed, including any person who engages in a pattern or practice of 
presenting or causing to be presented a claim for an item or service 
that is based on a code that the person knows or should know will result 
in a greater payment to the person than the code the person knows or 
should know is applicable to the item or service actually provided,'' 
for ``claimed,''.
    Subsec. (a)(1)(E). Pub. L. 104-191, Sec. 231(e)(2)-(4), added 
subpar. (E).
    Subsec. (a)(2). Pub. L. 104-191, Sec. 231(d)(1)(A), inserted 
``knowingly'' before ``presents''.
    Subsec. (a)(3). Pub. L. 104-191, Sec. 231(d)(1)(B), substituted 
``knowingly gives or causes to be given'' for ``gives''.
    Subsec. (a)(4). Pub. L. 104-191, Sec. 231(b), added par. (4).
    Subsec. (a)(5). Pub. L. 104-191, Sec. 231(h)(1), added par. (5).
    Subsec. (b)(3). Pub. L. 104-191, Sec. 232(a), added par. (3).
    Subsec. (f)(3), (4). Pub. L. 104-191, Sec. 231(a)(2), added par. (3) 
and redesignated former par. (3) as (4).
    Subsec. (i)(2). Pub. L. 104-191, Sec. 231(a)(3)(A), substituted ``a 
Federal health care program (as defined in section 1320a-7b(f) of this 
title)'' for ``subchapter V, XVIII, XIX, or XX of this chapter''.
    Subsec. (i)(4). Pub. L. 104-191, Sec. 231(a)(3)(B), substituted ``a 
Federal health care program (as so defined)'' for ``a health insurance 
or medical services program under subchapter XVIII or XIX of this 
chapter''.
    Subsec. (i)(5). Pub. L. 104-191, Sec. 231(a)(3)(C), substituted ``a 
Federal health care program (as so defined)'' for ``subchapter V, XVIII, 
XIX, or XX of this chapter''.
    Subsec. (i)(6). Pub. L. 104-191, Sec. 231(h)(2), added par. (6).
    Subsec. (i)(7). Pub. L. 104-191, Sec. 231(d)(2), added par. (7).
    Subsec. (m). Pub. L. 104-191, Sec. 231(a)(4), added subsec. (m).
    1990--Subsec. (b)(1). Pub. L. 101-508, Sec. 4731(b)(1), struck out 
``or an entity with a contract under section 1396b(m) of this title'' 
before ``knowingly makes a payment'' in introductory provisions.
    Pub. L. 101-508, Sec. 4204(a)(3), struck out ``, an eligible 
organization with a risk-sharing contract under section 1395mm of this 
title,'' after ``primary care hospital'' in introductory provisions, 
struck out ``or organization'' after ``primary care hospital'' in 
concluding provisions, redesignated subpar. (C) as (B), and struck out 
former subpar. (B) which read as follows: ``in the case of an eligible 
organization or an entity, are enrolled with the organization or entity, 
and''.
    Subsec. (j). Pub. L. 101-508, Sec. 4753, made an amendment to 
subsec. (j) identically to that of Pub. L. 101-508, Sec. 4207(h). See 
below.
    Pub. L. 101-508, Sec. 4207(h), formerly Sec. 4027(h), as renumbered 
by Pub. L. 103-432, designated existing provisions as par. (1) and added 
par. (2).
    1989--Subsec. (a)(1)(D), (2)(C), (4). Pub. L. 101-234 repealed Pub. 
L. 100-360, Sec. 202(c), and provided that the provisions of law amended 
or repealed by such section are restored or revived as if such section 
had not been enacted, see 1988 Amendment note below.
    Subsec. (b)(1). Pub. L. 101-239 substituted ``hospital or a rural 
primary care hospital'' for ``hospital'' in introductory and concluding 
provisions.
    1988--Subsec. (a). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. 
L. 100-203, Sec. 4118(e)(10)(A), see 1987 Amendment note below.
    Subsec. (a)(1). Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(I), (II), as 
amended by Pub. L. 100-485, Sec. 608(d)(26)(H), amended directory 
language of Pub. L. 100-203, Sec. 4118(e)(1), see 1987 Amendment note 
below.
    Subsec. (a)(1)(D). Pub. L. 100-360, Sec. 411(k)(10)(D), as amended 
by Pub. L. 100-485, Sec. 608(d)(26)(K)(i), added Pub. L. 100-203, 
Sec. 4118(e)(6), see 1987 Amendment note below.
    Pub. L. 100-360, Sec. 202(c)(2)(A), struck out ``or'' after 
semicolon.
    Subsec. (a)(2)(C). Pub. L. 100-360, Sec. 202(c)(2)(B), inserted ``or 
to be a participating pharmacy under section 1395u(o) of this title'' 
after ``section 1395u(h)(1) of this title''.
    Subsec. (a)(3). Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(I), (II), as 
amended by Pub. L. 100-485, Sec. 608(d)(26)(H), made technical amendment 
to directory language of Pub. L. 100-203, Sec. 4118(e)(1)(A), see 1987 
Amendment note below.
    Subsec. (a)(4). Pub. L. 100-360, Sec. 202(c)(2)(C)-(E), added par. 
(4) relating to participating or nonparticipating pharmacies.
    Subsec. (b)(1)(A). Pub. L. 100-360, Sec. 411(e)(3), added Pub. L. 
100-203, Sec. 4039(h)(1)(A), see 1987 Amendment note below.
    Subsec. (b)(2). Pub. L. 100-360, Sec. 411(e)(3), added Pub. L. 100-
203, Sec. 4039(h)(1)(B), see 1987 Amendment note below.
    Subsec. (c)(1). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L. 
100-203, Sec. 4118(e)(7), see 1987 Amendment note below.
    Subsec. (i). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L. 100-
203, Sec. 4118(e)(8), see 1987 Amendment note below.
    Subsec. (i)(1). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L. 
100-203, Sec. 4118(e)(9), see 1987 Amendment note below.
    Subsec. (i)(2). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L. 
100-203, Sec. 4118(e)(10)(B), see 1987 Amendment note below.
    Subsec. (i)(5). Pub. L. 100-485, Sec. 608(d)(26)(J), amended 
directory language of Pub. L. 100-203, Sec. 4118(e)(10)(C), see 1987 
Amendment note below.
    Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L. 100-203, 
Sec. 4118(e)(10)(C), see 1987 Amendment note below.
    Subsec. (l). Pub. L. 100-485, Sec. 608(d)(26)(I), inserted ``for 
penalties, assessments, and an exclusion'' after ``liable''.
    Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(III), added Pub. L. 100-203, 
Sec. 4118(e)(1)(B), see 1987 Amendment note below.
    1987--Subsec. (a). Pub. L. 100-203, Sec. 4118(e)(10)(A), as added by 
Pub. L. 100-360, Sec. 411(k)(10)(D), inserted ``, but excluding a 
beneficiary, as defined in subsection (i)(5) of this section'' in 
introductory provisions.
    Pub. L. 100-93, Sec. 3(a)(3)(B), in concluding provisions, inserted 
``(or, in cases under paragraph (3), $15,000 for each individual with 
respect to whom false or misleading information was given)'' before 
period at end of first sentence, and inserted at end ``In addition the 
Secretary may make a determination in the same proceeding to exclude the 
person from participation in the programs under subchapter XVIII of this 
chapter and to direct the appropriate State agency to exclude the person 
from participation in any State health care program.''
    Subsec. (a)(1). Pub. L. 100-203, Sec. 4118(e)(1)(A), formerly 
Sec. 4118(e)(1), as amended by Pub. L. 100-360, 
Sec. 411(k)(10)(B)(ii)(I), (II), as amended by Pub. L. 100-485, 
Sec. 608(d)(26)(H), substituted ``or should know'' for ``or has reason 
to know'' in subpars. (A) to (C).
    Pub. L. 100-93, Sec. 3(a)(1), substituted ``the Secretary 
determines'' for ``the Secretary determines is for a medical or other 
item or service'' in introductory provisions and substituted subpars. 
(A) to (D) for former subpars. (A) and (B) which read as follows:
    ``(A) that the person knows or has reason to know was not provided 
as claimed, or
    ``(B) payment for which may not be made under the program under 
which such claim was made, pursuant to a determination by the Secretary 
under section 1320a-7, 1320c-9(b), or 1395y(d) of this title, or 
pursuant to a determination by the Secretary under section 1395cc(b)(2) 
of this title with respect to which the Secretary has initiated 
termination proceedings; or''.
    Subsec. (a)(1)(D). Pub. L. 100-203, Sec. 4118(e)(6), as added by 
Pub. L. 100-360, Sec. 411(k)(10)(D), as amended by Pub. L. 100-485, 
Sec. 608(d)(26)(K)(i), substituted ``excluded from'' for ``excluded 
under'' and inserted ``or as a result of the application of the 
provisions of section 1395u(j)(2) of this title''.
    Subsec. (a)(2). Pub. L. 100-93, Sec. 3(a)(2), inserted ``(or other 
requirement of a State plan under subchapter XIX of this chapter)'' 
after ``State agency'' in subpar. (B) and added subpar. (D).
    Subsec. (a)(3). Pub. L. 100-203, Sec. 4118(e)(1)(A), as amended by 
Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(I), (II), as amended by Pub. L. 
100-485, Sec. 608(d)(26)(H), substituted ``or should know'' for ``or has 
reason to know''.
    Pub. L. 100-93, Sec. 3(a)(3)(A), added par. (3).
    Subsec. (b)(1)(A). Pub. L. 100-203, Sec. 4039(h)(1)(A), as added by 
Pub. L. 100-360, Sec. 411(e)(3), substituted ``subchapter XVIII'' for 
``subchapter XVII''.
    Subsec. (b)(2). Pub. L. 100-203, Sec. 4039(h)(1)(B), as added by 
Pub. L. 100-360, Sec. 411(e)(3), substituted ``$2,000 for each'' for 
``$2,000 for''.
    Subsec. (c)(1). Pub. L. 100-203, Sec. 4118(e)(7), as added by Pub. 
L. 100-360, Sec. 411(k)(10)(D), inserted ``, request for payment, or 
other occurrence described in this section'' and ``, the request for 
payment was made, or the occurrence took place''.
    Pub. L. 100-93, Sec. 3(b), (c), substituted ``penalty, assessment, 
or exclusion'' for ``penalty or assessment'' and inserted provision that 
the Secretary not initiate an action under this section with respect to 
a claim later than six years after the claim was presented and that the 
Secretary initiate an action in the manner authorized by Rule 4 of the 
Federal Rules of Civil Procedure.
    Subsec. (d). Pub. L. 100-93, Sec. 3(c), substituted ``penalty, 
assessment, or exclusion'' for ``penalty or assessment'' in introductory 
provisions.
    Subsec. (f)(1)(A). Pub. L. 100-93, Sec. 3(d), substituted ``bearing 
the same proportion to the total amount recovered as the State's share 
of the amount paid by the State agency for such claim bears to the total 
amount paid'' for ``equal to the State's share of the amount paid by the 
State agency''.
    Subsec. (g). Pub. L. 100-93, Sec. 3(c), substituted ``penalty, 
assessment, or exclusion'' for ``penalty or assessment'' in two places.
    Subsec. (h). Pub. L. 100-93, Sec. 3(c), (e), substituted ``penalty, 
assessment, or exclusion'' for ``penalty or assessment'' in two places 
and inserted ``the appropriate State agency or agencies administering or 
supervising the administration of State health care programs (as defined 
in section 1320a-7(h) of this title),'' after ``professional 
organization,''.
    Subsec. (i). Pub. L. 100-203, Sec. 4118(e)(8), as added by Pub. L. 
100-360, Sec. 411(k)(10)(D), substituted ``this section'' for ``this 
subsection'' in introductory provisions.
    Subsec. (i)(1). Pub. L. 100-203, Sec. 4118(e)(9), as added by Pub. 
L. 100-360, Sec. 411(k)(10)(D), inserted ``or subchapter XX of this 
chapter''.
    Subsec. (i)(2). Pub. L. 100-203, Sec. 4118(e)(10)(B), as added by 
Pub. L. 100-360, Sec. 411(k)(10)(D), substituted ``for payments for 
items and services under subchapter V, XVIII, XIX, or XX of this 
chapter'' for ``submitted by--
        ``(A) a provider of services or other person, agency, or 
    organization that furnishes an item or service under subchapter 
    XVIII of this chapter, or
        ``(B) a person, agency, or organization that furnishes an item 
    or service for which medical assistance is provided under subchapter 
    XIX of this chapter, or
        ``(C) a person, agency, or organization that provides an item or 
    service for which payment is made under subchapter V of this chapter 
    or from an allotment to a State under such subchapter,
to the United States or a State agency, or agent thereof, for payment 
for health care services under subchapter XVIII or XIX of this chapter 
or for any item or service under subchapter V of this chapter''.
    Subsec. (i)(5). Pub. L. 100-203, Sec. 4118(e)(10)(C), as added by 
Pub. L. 100-360, Sec. 411(k)(10)(D), and amended by Pub. L. 100-485, 
Sec. 608(d)(26)(J), added par. (5).
    Subsecs. (j), (k). Pub. L. 100-93, Sec. 3(f), added subsecs. (j) and 
(k).
    Subsec. (l). Pub. L. 100-203, Sec. 4118(e)(1)(B), as added by Pub. 
L. 100-360, Sec. 411(k)(10)(B)(ii)(III), added subsec. (l).
    1986--Subsec. (a)(1). Pub. L. 99-509, Sec. 9313(c)(1)(B), 
substituted ``(i)(1)'' and ``(i)(2)'' for ``(h)(1)'' and ``(h)(2)'', 
respectively.
    Subsec. (b). Pub. L. 99-509, Sec. 9313(c)(1)(D), (E), added subsec. 
(b). Former subsec. (b) redesignated (c).
    Subsec. (c). Pub. L. 99-509, Sec. 9313(c)(1)(A), (D), redesignated 
subsec. (b) as (c) and substituted ``subsection (a) or (b)'' for 
``subsection (a)'' in pars. (1) and (2). Former subsec. (c) redesignated 
(d).
    Subsec. (c)(3). Pub. L. 99-509, Sec. 9317(a), added par. (3).
    Subsec. (c)(4). Pub. L. 99-509, Sec. 9317(b), added par. (4).
    Subsec. (d). Pub. L. 99-509, Sec. 9313(c)(1)(A), (D), redesignated 
subsec. (c) as (d) and substituted ``subsection (a) or (b)'' for 
``subsection (a)'' in introductory provisions. Former subsec. (d) 
redesignated (e).
    Subsecs. (e), (f). Pub. L. 99-509, Sec. 9313(c)(1)(D), redesignated 
subsecs. (d) and (e) as (e) and (f), respectively. Former subsec. (f) 
redesignated (g).
    Subsec. (g). Pub. L. 99-509, Sec. 9313(c)(1)(A), (C), (D), 
redesignated subsec. (f) as (g) and substituted ``subsection (a) or 
(b)'' for ``subsection (a)'' and ``subsection (e)'' for ``subsection 
(d)''. Former subsec. (g) redesignated (h).
    Subsec. (h). Pub. L. 99-509, Sec. 9313(c)(1)(A), (D), redesignated 
subsec. (g) as (h) and substituted ``subsection (a) or (b)'' for 
``subsection (a)''. Former subsec. (h) redesignated (i).
    Subsec. (i). Pub. L. 99-509, Sec. 9313(c)(1)(D), redesignated 
subsec. (h) as (i).
    1984--Subsec. (a)(2)(C). Pub. L. 98-369, Sec. 2306(f)(1), added cl. 
(C).
    Subsec. (g). Pub. L. 98-369, Sec. 2354(a)(3), substituted 
``utilization and quality control peer review organization'' for 
``Professional Standards Review Organization''.
    1982--Subsec. (a). Pub. L. 97-248 redesignated as part of par. (1) 
preceding subpar. (A) provisions formerly preceding par. (1), in subpar. 
(B) substituted ``or pursuant to a determination by the Secretary under 
section 1395cc(b)(2) of this title with respect to which the Secretary 
has initiated termination proceedings;'' for ``or 1395cc(b)(2) of this 
title,'', and in par. (2) substituted ``presents or causes to be 
presented to any person a request for payment which is in violation of 
the terms of (A) an assignment under section 1842(b)(3)(B)(ii), or (B) 
an agreement with a State agency not to charge a person for an item or 
service in excess of the amount permitted to be charged'' for ``is 
submitted in violation of an agreement between the person and the United 
States or a State agency''.


                    Effective Date of 1998 Amendment

    Pub. L. 105-277, div. J, title V, Sec. 5201(d), Oct. 21, 1998, 112 
Stat. 2681-917, provided that: ``The amendments made by this section 
[amending this section and section 1320a-7d of this title] shall take 
effect on the date of the enactment of this Act [Oct. 21, 1998].''


                    Effective Date of 1997 Amendment

    Amendment by section 4201(c)(1) of Pub. L. 105-33 applicable to 
services furnished on or after Oct. 1, 1997, see section 4201(d) of Pub. 
L. 105-33, set out as a note under section 1395f of this title.
    Section 4304(c) of Pub. L. 105-33 provided that:
    ``(1) Contracts with excluded persons.--The amendments made by 
subsection (a) [amending this section] shall apply to arrangements and 
contracts entered into after the date of the enactment of this Act [Aug. 
5, 1997].
    ``(2) Kickbacks.--The amendments made by subsection (b) [amending 
this section] shall apply to acts committed after the date of the 
enactment of this Act.''
    Amendment by section 4331(e) of Pub. L. 105-33 effective as if 
included in the enactment of the Health Insurance Portability and 
Accountability Act of 1996, Pub. L. 104-191, see section 4331(f) of Pub. 
L. 105-33, set out as a note under section 1320a-7e of this title.


                    Effective Date of 1996 Amendment

    Section 231(i) of Pub. L. 104-191 provided that: ``The amendments 
made by this section [amending this section and sections 1320c-5 and 
1395mm of this title] shall apply to acts or omissions occurring on or 
after January 1, 1997.''
    Section 232(b) of Pub. L. 104-191 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to 
certifications made on or after the date of the enactment of this Act 
[Aug. 21, 1996].''


                    Effective Date of 1989 Amendment

    Section 201(c) of Pub. L. 101-234 provided that: ``The provisions of 
this section [amending this section and sections 1320c-3, 1395h, 1395k, 
1395l, 1395m, 1395n, 1395u, 1395w-2, 1395x, 1395y, 1395z, 1395aa, 
1395bb, 1395cc, 1395mm, 1396a, 1396b, 1396d, and 1396n of this title, 
repealing section 1395w-3 of this title, and amending or repealing 
provisions set out as notes under sections 1320c-3, 1395b-1, 1395k, 
1395m, 1395u, 1395x, 1395ll, and 1395ww of this title] shall take effect 
January 1, 1990.''


                    Effective Date of 1988 Amendments

    Amendment by Pub. L. 100-485 effective as if included in the 
enactment of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 
100-360, see section 608(g)(1) of Pub. L. 100-485, set out as a note 
under section 704 of this title.
    Amendment by section 202(c)(2) of Pub. L. 100-360 applicable to 
items dispensed on or after Jan. 1, 1990, see section 202(m)(1) of Pub. 
L. 100-360, set out as a note under section 1395u of this title.
    Except as specifically provided in section 411 of Pub. L. 100-360, 
amendment by section 411(e)(3), (k)(10)(B)(ii), (D) of 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 Amendments

    Section 4118(e)(14), formerly section 4118(e)(3), of Pub. L. 100-
203, as renumbered and amended by Pub. L. 100-360, title IV, 
Sec. 411(k)(10)(B)(i), (D), July 1, 1988, 102 Stat. 794, 795, provided 
that: ``The amendments made by paragraph (1) [amending this section] 
shall apply to activities occurring before, on, or after the date of the 
enactment of this Act [Dec. 22, 1987].''
    Amendment by Pub. L. 100-93 effective at end of fourteen-day period 
beginning Aug. 18, 1987, and inapplicable to administrative proceedings 
commenced before end of such period, except that amendment by section 
3(a)(1) of Pub. L. 100-93 applicable to claims presented for services 
performed on or after date at end of fourteen-day period beginning Aug. 
18, 1987, without regard to the date the physician's misrepresentation 
of fact was made, and amendment by section 3(f) of Pub. L. 100-93 
effective Aug. 18, 1987, see section 15(a), (c)(3), and (d) of Pub. L. 
100-93, set out as a note under section 1320a-7 of this title.


                    Effective Date of 1986 Amendment

    Section 9313(c)(2) of Pub. L. 99-509, as amended by Pub. L. 100-203, 
title IV, Sec. 4016, Dec. 22, 1987, 101 Stat. 1330-64; Pub. L. 101-239, 
title VI, Sec. 6207(a), Dec. 19, 1989, 103 Stat. 2245, provided that: 
``The amendments made by paragraph (1) [amending this section] shall 
apply to--
        ``(A) payments by hospitals occurring more than 6 months after 
    the date of the enactment of this Act [Oct. 21, 1986], and
        ``(B) payments by eligible organizations or entities occurring 
    on or after April 1, 1991.''
    Section 9317(d)(1), (2) of Pub. L. 99-509 provided that:
    ``(1) The amendment made by subsection (a) [amending this section] 
shall take effect on the date of the enactment of this Act [Oct. 21, 
1986], without regard to when the criminal conviction was obtained, but 
shall only apply to a conviction upon a plea of nolo contendere tendered 
after the date of the enactment of this Act.
    ``(2) The amendment made by subsection (b) [amending this section] 
shall apply to failures or misconduct occurring on or after the date of 
the enactment of this Act.''


                    Effective Date of 1984 Amendment

    Amendment by section 2354(a)(3) of Pub. L. 98-369 effective July 18, 
1984, but not to be construed as changing or affecting any right, 
liability, status, or interpretation which existed (under the provisions 
of law involved) before that date, see section 2354(e)(1) of Pub. L. 98-
369, set out as a note under section 1320a-1 of this title.


                    Effective Date of 1982 Amendment

    Amendment by Pub. L. 97-248 effective as if originally included as 
part of this section as this section was amended by the Omnibus Budget 
Reconciliation Act of 1981, Pub. L. 97-35, see section 137(d)(2) of Pub. 
L. 97-248, set out as a note under section 1396a of this title.


                               Regulations

    Pub. L. 105-277, div. J, title V, Sec. 5201(e), Oct. 21, 1998, 112 
Stat. 2681-917, provided that: ``The Secretary of Health and Human 
Services may promulgate regulations that take effect on an interim 
basis, after notice and pending opportunity for public comment, in order 
to implement the amendments made by this section [amending this section 
and section 1320a-7d of this title] in a timely manner.''


    GAO Study and Report on Impact of Safe Harbor on Medigap Policies

    Pub. L. 105-277, div. J, title V, Sec. 5201(b)(2), Oct. 21, 1998, 
112 Stat. 2681-917, provided that: ``If a permissible practice is 
promulgated under section 1128A(n)(1)(A) of the Social Security Act 
[subsec. (n)(1)(A) of this section] (as added by paragraph (1)), the 
Comptroller General of the United States shall conduct a study that 
compares any disproportionate impact on specific issuers of medicare 
supplemental policies (including the impact on premiums for non-ESRD 
medicare beneficiaries enrolled in such policies) due to adverse 
selection in enrolling medicare ESRD beneficiaries before the enactment 
of the Health Insurance Portability and Accountability Act of 1996 [Pub. 
L. 104-191, Aug. 21, 1996] and 1 year after the date of promulgation of 
such permissible practice under section 1128A(n)(1)(A) of the Social 
Security Act. Not later than 18 months after the date of promulgation of 
such practice, the Comptroller General shall submit a report to Congress 
on such study and shall include in the report recommendations concerning 
whether the time limitation imposed under section 1128A(n)(1)(B) of such 
Act [subsec. (n)(1)(B) of this section] should be extended.''


          Repeal of 1988 Expansion of Medicare Part B Benefits

    Section 201(a) of Pub. L. 101-234 provided that:
    ``(1) General rule.--Except as provided in paragraph (2), sections 
201 through 208 of MCCA [sections 201 to 208 of Pub. L. 100-360, 
enacting section 1395w-3 of this title, amending this section and 
sections 1320c-3, 1395h, 1395k, 1395l, 1395m, 1395n, 1395u, 1395w-2, 
1395x, 1395y, 1395z, 1395aa, 1395bb, 1395cc, 1395mm, 1396a, 1396b, and 
1396n of this title, and enacting provisions set out as notes under 
sections 1320c-3, 1395b-1, 1395k, 1395m, 1395u, 1395x, 1395ll, and 
1395ww of this title] are repealed and the provisions of law amended or 
repealed by such sections are restored or revived as if such sections 
had not been enacted.
    ``(2) Exception.--Paragraph (1) shall not apply to subsections (g) 
and (m)(4) of section 202 of MCCA [amending section 1395u of this title 
and enacting provisions set out as a note under section 1395u of this 
title.]''


    Study and Report on Incentive Arrangements Offered to Physicians

    Section 9313(c)(3) of Pub. L. 99-509 directed Secretary of Health 
and Human Services to report to Congress, not later than Jan. 1, 1988, 
concerning incentive arrangements offered by health maintenance 
organizations and competitive medical plans to physicians.

                  Section Referred to in Other Sections

    This section is referred to in sections 299c-3, 704, 707, 1320a-3a, 
1320a-7, 1320a-7c, 1320a-7d, 1320a-7e, 1320a-8, 1320b-10, 1320d-5, 
1395b-5, 1395b-7, 1395i-3, 1395l, 1395m, 1395u, 1395w-2, 1395w-27, 
1395y, 1395cc, 13955dd, 1395mm, 1395nn, 1395ss, 1395bbb, 1396a, 1396b, 
1396r, 1396r-6, 1396r-8, 1396t, 1396u, 1397d, 1397gg, 11131, 11137 of 
this title; title 5 section 8904; title 10 section 1094.
