
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-7b]

 
                 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-7b. Criminal penalties for acts involving Federal 
        health care programs
        

(a) Making or causing to be made false statements or representations

    Whoever--
        (1) knowingly and willfully makes or causes to be made any false 
    statement or representation of a material fact in any application 
    for any benefit or payment under a Federal health care program (as 
    defined in subsection (f) of this section),
        (2) at any time knowingly and willfully makes or causes to be 
    made any false statement or representation of a material fact for 
    use in determining rights to such benefit or payment,
        (3) having knowledge of the occurrence of any event affecting 
    (A) his initial or continued right to any such benefit or payment, 
    or (B) the initial or continued right to any such benefit or payment 
    of any other individual in whose behalf he has applied for or is 
    receiving such benefit or payment, conceals or fails to disclose 
    such event with an intent fraudulently to secure such benefit or 
    payment either in a greater amount or quantity than is due or when 
    no such benefit or payment is authorized,
        (4) having made application to receive any such benefit or 
    payment for the use and benefit of another and having received it, 
    knowingly and willfully converts such benefit or payment or any part 
    thereof to a use other than for the use and benefit of such other 
    person,
        (5) presents or causes to be presented a claim for a physician's 
    service for which payment may be made under a Federal health care 
    program and knows that the individual who furnished the service was 
    not licensed as a physician, or
        (6) for a fee knowingly and willfully counsels or assists an 
    individual to dispose of assets (including by any transfer in trust) 
    in order for the individual to become eligible for medical 
    assistance under a State plan under subchapter XIX of this chapter, 
    if disposing of the assets results in the imposition of a period of 
    ineligibility for such assistance under section 1396p(c) of this 
    title,

shall (i) in the case of such a statement, representation, concealment, 
failure, or conversion by any person in connection with the furnishing 
(by that person) of items or services for which payment is or may be 
made under the program, be guilty of a felony and upon conviction 
thereof fined not more than $25,000 or imprisoned for not more than five 
years or both, or (ii) in the case of such a statement, representation, 
concealment, failure, conversion, or provision of counsel or assistance 
by any other person, be guilty of a misdemeanor and upon conviction 
thereof fined not more than $10,000 or imprisoned for not more than one 
year, or both. In addition, in any case where an individual who is 
otherwise eligible for assistance under a Federal health care program is 
convicted of an offense under the preceding provisions of this 
subsection, the administrator of such program may at its option 
(notwithstanding any other provision of such program) limit, restrict, 
or suspend the eligibility of that individual for such period (not 
exceeding one year) as it deems appropriate; but the imposition of a 
limitation, restriction, or suspension with respect to the eligibility 
of any individual under this sentence shall not affect the eligibility 
of any other person for assistance under the plan, regardless of the 
relationship between that individual and such other person.

(b) Illegal remunerations

    (1) Whoever knowingly and willfully solicits or receives any 
remuneration (including any kickback, bribe, or rebate) directly or 
indirectly, overtly or covertly, in cash or in kind--
        (A) in return for referring an individual to a person for the 
    furnishing or arranging for the furnishing of any item or service 
    for which payment may be made in whole or in part under a Federal 
    health care program, or
        (B) in return for purchasing, leasing, ordering, or arranging 
    for or recommending purchasing, leasing, or ordering any good, 
    facility, service, or item for which payment may be made in whole or 
    in part under a Federal health care program,

shall be guilty of a felony and upon conviction thereof, shall be fined 
not more than $25,000 or imprisoned for not more than five years, or 
both.
    (2) Whoever knowingly and willfully offers or pays any remuneration 
(including any kickback, bribe, or rebate) directly or indirectly, 
overtly or covertly, in cash or in kind to any person to induce such 
person--
        (A) to refer an individual to a person for the furnishing or 
    arranging for the furnishing of any item or service for which 
    payment may be made in whole or in part under a Federal health care 
    program, or
        (B) to purchase, lease, order, or arrange for or recommend 
    purchasing, leasing, or ordering any good, facility, service, or 
    item for which payment may be made in whole or in part under a 
    Federal health care program,

shall be guilty of a felony and upon conviction thereof, shall be fined 
not more than $25,000 or imprisoned for not more than five years, or 
both.
    (3) Paragraphs (1) and (2) shall not apply to--
        (A) a discount or other reduction in price obtained by a 
    provider of services or other entity under a Federal health care 
    program if the reduction in price is properly disclosed and 
    appropriately reflected in the costs claimed or charges made by the 
    provider or entity under a Federal health care program;
        (B) any amount paid by an employer to an employee (who has a 
    bona fide employment relationship with such employer) for employment 
    in the provision of covered items or services;
        (C) any amount paid by a vendor of goods or services to a person 
    authorized to act as a purchasing agent for a group of individuals 
    or entities who are furnishing services reimbursed under a Federal 
    health care program if--
            (i) the person has a written contract, with each such 
        individual or entity, which specifies the amount to be paid the 
        person, which amount may be a fixed amount or a fixed percentage 
        of the value of the purchases made by each such individual or 
        entity under the contract, and
            (ii) in the case of an entity that is a provider of services 
        (as defined in section 1395x(u) of this title), the person 
        discloses (in such form and manner as the Secretary requires) to 
        the entity and, upon request, to the Secretary the amount 
        received from each such vendor with respect to purchases made by 
        or on behalf of the entity;

        (D) a waiver of any coinsurance under part B of subchapter XVIII 
    of this chapter by a Federally qualified health care center with 
    respect to an individual who qualifies for subsidized services under 
    a provision of the Public Health Service Act [42 U.S.C. 201 et 
    seq.];
        (E) any payment practice specified by the Secretary in 
    regulations promulgated pursuant to section 14(a) of the Medicare 
    and Medicaid Patient and Program Protection Act of 1987; and
        (F) any remuneration between an organization and an individual 
    or entity providing items or services, or a combination thereof, 
    pursuant to a written agreement between the organization and the 
    individual or entity if the organization is an eligible organization 
    under section 1395mm of this title or if the written agreement, 
    through a risk-sharing arrangement, places the individual or entity 
    at substantial financial risk for the cost or utilization of the 
    items or services, or a combination thereof, which the individual or 
    entity is obligated to provide.

(c) False statements or representations with respect to condition or 
        operation of institutions

    Whoever knowingly and willfully makes or causes to be made, or 
induces or seeks to induce the making of, any false statement or 
representation of a material fact with respect to the conditions or 
operation of any institution, facility, or entity in order that such 
institution, facility, or entity may qualify (either upon initial 
certification or upon recertification) as a hospital, critical access 
hospital, skilled nursing facility, nursing facility, intermediate care 
facility for the mentally retarded, home health agency, or other entity 
(including an eligible organization under section 1395mm(b) of this 
title) for which certification is required under subchapter XVIII of 
this chapter or a State health care program (as defined in section 
1320a-7(h) of this title), or with respect to information required to be 
provided under section 1320a-3a of this title, shall be guilty of a 
felony and upon conviction thereof shall be fined not more than $25,000 
or imprisoned for not more than five years, or both.

(d) Illegal patient admittance and retention practices

    Whoever knowingly and willfully--
        (1) charges, for any service provided to a patient under a State 
    plan approved under subchapter XIX of this chapter, money or other 
    consideration at a rate in excess of the rates established by the 
    State (or, in the case of services provided to an individual 
    enrolled with a medicaid managed care organization under subchapter 
    XIX of this chapter under a contract under section 1396b(m) of this 
    title or under a contractual, referral, or other arrangement under 
    such contract, at a rate in excess of the rate permitted under such 
    contract), or
        (2) charges, solicits, accepts, or receives, in addition to any 
    amount otherwise required to be paid under a State plan approved 
    under subchapter XIX of this chapter, any gift, money, donation, or 
    other consideration (other than a charitable, religious, or 
    philanthropic contribution from an organization or from a person 
    unrelated to the patient)--
            (A) as a precondition of admitting a patient to a hospital, 
        nursing facility, or intermediate care facility for the mentally 
        retarded, or
            (B) as a requirement for the patient's continued stay in 
        such a facility,

    when the cost of the services provided therein to the patient is 
    paid for (in whole or in part) under the State plan,

shall be guilty of a felony and upon conviction thereof shall be fined 
not more than $25,000 or imprisoned for not more than five years, or 
both.

(e) Violation of assignment terms

    Whoever accepts assignments described in section 1395u(b)(3)(B)(ii) 
of this title or agrees to be a participating physician or supplier 
under section 1395u(h)(1) of this title and knowingly, willfully, and 
repeatedly violates the term of such assignments or agreement, shall be 
guilty of a misdemeanor and upon conviction thereof shall be fined not 
more than $2,000 or imprisoned for not more than six months, or both.

(f) ``Federal health care program'' defined

    For purposes of this section, the term ``Federal health care 
program'' means--
        (1) any plan or program that provides health benefits, whether 
    directly, through insurance, or otherwise, which is funded directly, 
    in whole or in part, by the United States Government (other than the 
    health insurance program under chapter 89 of title 5); or
        (2) any State health care program, as defined in section 1320a-
    7(h) of this title.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128B, formerly title XVIII, 
Sec. 1877(d), and title XIX, Sec. 1909, as added and amended Pub. L. 92-
603, title II, Secs. 242(c), 278(b)(9), Oct. 30, 1972, 86 Stat. 1419, 
1454; Pub. L. 95-142, Sec. 4(a), (b), Oct. 25, 1977, 91 Stat. 1179, 
1181; Pub. L. 96-499, title IX, Sec. 917, Dec. 5, 1980, 94 Stat. 2625; 
Pub. L. 98-369, div. B, title III, Sec. 2306(f)(2), July 18, 1984, 98 
Stat. 1073; renumbered title XI, Sec. 1128B, and amended Pub. L. 100-93, 
Secs. 4(a)-(d), 14(b), Aug. 18, 1987, 101 Stat. 688, 689, 697; Pub. L. 
100-203, title IV, Secs. 4039(a), 4211(h)(7), Dec. 22, 1987, 101 Stat. 
1330-81, 1330-206; Pub. L. 100-360, title IV, Sec. 411(a)(3)(A), (B)(i), 
July 1, 1988, 102 Stat. 768; Pub. L. 101-239, title VI, 
Sec. 6003(g)(3)(D)(ii), Dec. 19, 1989, 103 Stat. 2153; Pub. L. 101-508, 
title IV, Secs. 4161(a)(4), 4164(b)(2), Nov. 5, 1990, 104 Stat. 1388-94, 
1388-102; Pub. L. 103-432, title I, Sec. 133(a)(2), Oct. 31, 1994, 108 
Stat. 4421; Pub. L. 104-191, title II, Secs. 204(a), 216(a), 217, Aug. 
21, 1996, 110 Stat. 1999, 2007, 2008; Pub. L. 105-33, title IV, 
Secs. 4201(c)(1), 4704(b), 4734, Aug. 5, 1997, 111 Stat. 373, 498, 522.)

                       References in Text

    Part B of subchapter XVIII of this chapter, referred to in subsec. 
(b)(3)(D), is classified to section 1395j et seq. of this title.
    The Public Health Service Act, referred to in subsec. (b)(3)(D), is 
act July 1, 1944, ch. 373, 58 Stat. 682, as amended, which is classified 
generally to chapter 6A (Sec. 201 et seq.) of this title. For complete 
classification of this Act to the Code, see Short Title note set out 
under section 201 of this title and Tables.
    Section 14(a) of the Medicare and Medicaid Patient and Program 
Protection Act of 1987, referred to in subsec. (b)(3)(E), is section 
14(a) of Pub. L. 100-93, which is set out below.

                          Codification

    Prior to redesignation by Pub. L. 100-93, subsecs. (a) to (d) of 
this section were subsecs. (a) to (d) of section 1909 of act Aug. 14, 
1935, which was classified to section 1396h of this title, and subsec. 
(e) of this section was subsec. (d) of section 1877 of act Aug. 14, 
1935, which was classified to section 1395nn of this title.


                               Amendments

    1997--Subsec. (a). Pub. L. 105-33, Sec. 4734(2), in cl. (ii) of 
concluding provisions, substituted ``failure, conversion, or provision 
of counsel or assistance by any other person'' for ``failure, or 
conversion by any other person''.
    Subsec. (a)(6). Pub. L. 105-33, Sec. 4734(1), added par. (6) and 
struck out former par. (6) which read as follows: ``knowingly and 
willfully disposes of assets (including by any transfer in trust) in 
order for an individual to become eligible for medical assistance under 
a State plan under subchapter XIX of this chapter, if disposing of the 
assets results in the imposition of a period of ineligibility for such 
assistance under section 1396p(c) of this title,''.
    Subsec. (c). Pub. L. 105-33, Sec. 4201(c)(1), substituted ``critical 
access'' for ``rural primary care''.
    Subsec. (d)(1). Pub. L. 105-33, Sec. 4704(b), inserted ``(or, in the 
case of services provided to an individual enrolled with a medicaid 
managed care organization under subchapter XIX of this chapter under a 
contract under section 1396b(m) of this title or under a contractual, 
referral, or other arrangement under such contract, at a rate in excess 
of the rate permitted under such contract)'' after ``by the State''.
    1996--Pub. L. 104-191, Sec. 204(a)(1), substituted ``Federal'' for 
``Medicare or State'' in section catchline.
    Subsec. (a). Pub. L. 104-191, Sec. 204(a)(4), in concluding 
provisions, substituted ``a Federal health care program'' for ``a State 
plan approved under subchapter XIX of this chapter'' and ``the 
administrator of such program may at its option (notwithstanding any 
other provision of such program)'' for ``the State may at its option 
(notwithstanding any other provision of that subchapter or of such 
plan)''.
    Subsec. (a)(1). Pub. L. 104-191, Sec. 204(a)(2), substituted ``a 
Federal health care program (as defined in subsection (f) of this 
section)'' for ``a program under subchapter XVIII of this chapter or a 
State health care program (as defined in section 1320a-7(h) of this 
title)''.
    Subsec. (a)(5). Pub. L. 104-191, Sec. 204(a)(3), substituted ``a 
Federal'' for ``a program under subchapter XVIII of this chapter or a 
State''.
    Subsec. (a)(6). Pub. L. 104-191, Sec. 217, added par. (6).
    Subsec. (b). Pub. L. 104-191, Sec. 204(a)(5), substituted ``a 
Federal health care program'' for ``subchapter XVIII of this chapter or 
a State health care program'' wherever appearing.
    Subsec. (b)(3)(F). Pub. L. 104-191, Sec. 216(a), added subpar. (F).
    Subsec. (c). Pub. L. 104-191, Sec. 204(a)(6), inserted ``(as defined 
in section 1320a-7(h) of this title)'' after ``a State health care 
program''.
    Subsec. (f). Pub. L. 104-191, Sec. 204(a)(7), added subsec. (f).
    1994--Subsec. (b)(3)(B). Pub. L. 103-432, which directed 
substitution of ``1395m(j)(5)'' for ``1395m(j)(4)'' in subpar. (B) as 
amended by section 134(a) of Pub. L. 103-432, could not be executed 
because ``1395m(j)(4)'' does not appear in subpar. (B) and section 
134(a) of Pub. L. 103-432 did not amend this section.
    1990--Subsec. (b)(3)(D), (E). Pub. L. 101-508, Sec. 4161(a)(4), 
added subpar. (D) and redesignated former subpar. (D) as (E).
    Subsec. (c). Pub. L. 101-508, Sec. 4164(b)(2), substituted ``health 
care program, or with respect to information required to be provided 
under section 1320a-3a of this title,'' for ``health care program''.
    1989--Subsec. (c). Pub. L. 101-239 inserted ``rural primary care 
hospital,'' after ``hospital,''.
    1988--Subsec. (c). Pub. L. 100-360 made technical correction to 
directory language of Pub. L. 100-203, Sec. 4039(a), see 1987 Amendment 
note below.
    Pub. L. 100-203, Sec. 4211(h)(7)(A), substituted ``nursing facility, 
intermediate care facility for the mentally retarded'' for 
``intermediate care facility''.
    Subsec. (d)(2)(A). Pub. L. 100-203, Sec. 4211(h)(7)(B), substituted 
``nursing facility, or intermediate care facility for the mentally 
retarded'' for ``skilled nursing facility, or intermediate care 
facility''.
    1987--Pub. L. 100-93, Sec. 4(a)(1), substituted ``Criminal penalties 
for acts involving Medicare or State health care programs'' for 
``Offenses and penalties'' in section catchline.
    Subsec. (a). Pub. L. 100-93, Sec. 4(a)(3), (4), in concluding 
provisions, substituted ``made under the program'' for ``made under this 
subchapter'', ``approved under subchapter XIX of this chapter'' for 
``approved under this subchapter'', and ``provision of that subchapter'' 
for ``provision of this subchapter''.
    Subsec. (a)(1). Pub. L. 100-93, Sec. 4(a)(2), substituted ``a 
program under subchapter XVIII of this chapter or a State health care 
program (as defined in section 1320a-7(h) of this title)'' for ``a State 
plan approved under this subchapter''.
    Subsec. (a)(5). Pub. L. 100-93, Sec. 4(b), added par. (5).
    Subsec. (b)(1)(A), (B), (2)(A), (B). Pub. L. 100-93, Sec. 4(a)(5), 
substituted ``subchapter XVIII of this chapter or a State health care 
program'' for ``this subchapter''.
    Subsec. (b)(3). Pub. L. 100-93, Secs. 4(a)(5), (6), 14(b), 
substituted ``subchapter XVIII of this chapter or a State health care 
program'' for ``this subchapter'' in two places in subpar. (A) and added 
subpars. (C) and (D).
    Subsec. (c). Pub. L. 100-203, Sec. 4039(a), as amended by Pub. L. 
100-360, substituted ``institution, facility, or entity'' for 
``institution or facility'' wherever appearing and inserted ``(including 
an eligible organization under section 1395mm(b) of this title)'' after 
``other entity''.
    Pub. L. 100-93, Sec. 4(a)(7), substituted ``home health agency, or 
other entity for which certification is required under subchapter XVIII 
of this chapter or a State health care program'' for ``or home health 
agency (as those terms are employed in this subchapter)''.
    Subsec. (d)(1), (2). Pub. L. 100-93, Sec. 4(a)(8), substituted 
``subchapter XIX of this chapter'' for ``this subchapter''.
    Subsec. (e). Pub. L. 100-93, Sec. 4(c), redesignated subsec. (d) of 
section 1395nn of this title as subsec. (e) of this section.
    1984--Subsec. (e). Pub. L. 98-369 inserted ``or agrees to be a 
participating physician or supplier under section 1395u(h)(1) of this 
title'' after ``section 1395u(b)(3)(B)(ii) of this title'', and 
substituted ``or agreement'' for ``specified in subclause (I) of such 
section''.
    1980--Subsec. (b)(1), (2). Pub. L. 96-499 inserted ``knowingly and 
willfully'' after ``Whoever''.
    1977--Subsec. (a). Pub. L. 95-142, Sec. 4(b), designated existing 
provisions following par. (4) as cl. (ii) and, as so designated, 
inserted provisions relating to activities of other persons, and 
inserted provisions authorizing the State to limit, restrict, or 
suspend, the eligibility of any convicted persons for benefits, and 
added cl. (i). See Codification note above.
    Subsec. (b). Pub. L. 95-142, Sec. 4(b), redesignated existing 
provisions as par. (1), substituted provisions relating to solicitation 
or receiving of any remuneration in return for referring an individual 
to a person for the furnishing or arranging the furnishing of any item 
or service, or in return for purchasing, leasing, ordering, or arranging 
for or recommending purchasing, etc., as constituting a felony 
punishable by a fine of not more than $25,000 and/or imprisonment for 
not more than five years, for provisions relating to furnishing items or 
services and soliciting, offering or receiving any kickback, bribe, or 
rebate in connection with furnishing, etc. items or services as 
constituting a misdemeanor punishable by a fine of not more than $10,000 
and/or imprisonment for not more than one year, and added pars. (2) and 
(3). See Codification note above.
    Subsec. (c). Pub. L. 95-142, Sec. 4(b), substituted provisions 
setting forth felony nature of criminal activities with a fine of not 
more than $25,000, or imprisonment for not more than five years, or 
both, for provisions setting forth misdemeanor nature of criminal 
activities with a fine of not more than $2,000, or imprisonment for not 
more than six months, or both. See Codification note above.
    Subsec. (d). Pub. L. 95-142, Sec. 4(b), added subsec. (d). See 
Codification note above.
    Subsec. (e). Pub. L. 95-142, Sec. 4(a), added subsec. (e). See 
Codification note above.
    1972--Subsec. (c). Pub. L. 92-603, Sec. 278(b)(9), substituted 
``skilled nursing facility'' for ``skilled nursing home''.


                    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.
    Amendment by section 4704(b) of Pub. L. 105-33 effective Aug. 5, 
1997, and applicable to contracts entered into or renewed on or after 
Oct. 1, 1997, see section 4710 of Pub. L. 105-33, set out as a note 
under section 1396b of this title.


                    Effective Date of 1996 Amendment

    Section 204(b) of Pub. L. 104-191 provided that: ``The amendments 
made by this section [amending this section] shall take effect on 
January 1, 1997.''
    Section 216(c) of Pub. L. 104-191 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply to written 
agreements entered into on or after January 1, 1997, without regard to 
whether regulations have been issued to implement such amendments.''
    Amendment by section 217 of Pub. L. 104-191 effective Jan. 1, 1997, 
except as otherwise provided, see section 218 of Pub. L. 104-191, set 
out as a note under section 1320a-7 of this title.


                    Effective Date of 1994 Amendment

    Amendment by section 133(a)(2) of Pub. L. 103-432 applicable to 
items or services furnished on or after Jan. 1, 1995, see section 133(c) 
of Pub. L. 103-432, set out as a note under section 1395m of this title.


                    Effective Date of 1990 Amendment

    Amendment by section 4161(a)(4) of Pub. L. 101-508 applicable to 
services furnished on or after Oct. 1, 1991, see section 4161(a)(8) of 
Pub. L. 101-508, set out as a note under section 1395k of this title.
    Amendment by section 4164(b)(2) of 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 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 Amendments

    Amendment by section 4211(h)(7) of Pub. L. 100-203 applicable to 
nursing facility services furnished on or after Oct. 1, 1990, without 
regard to whether regulations implementing such amendment are 
promulgated by such date, except as otherwise specifically provided in 
section 1396r of this title, with transitional rule, see section 
4214(a), (b)(2) of Pub. L. 100-203, as amended, set out as an Effective 
Date note under section 1396r of this title.
    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, see section 15(a) of Pub. L. 100-
93, set out as a note under section 1320a-7 of this title.


                    Effective Date of 1977 Amendment

    Section 4(d) of Pub. L. 95-142 provided that: ``The amendments made 
by subsections (a) and (b) [amending this section] shall apply with 
respect to acts occurring and statements or representations made on or 
after the date of the enactment of this Act [Oct. 25, 1977].''


                             Effective Date

    Section 242(d) of Pub. L. 92-603 provided that: ``The provisions of 
amendments made by this section [enacting this section and section 1396h 
of this title and amending section 1395ii of this title] shall not be 
applicable to any acts, statements, or representations made or committed 
prior to the enactment of this Act [Oct. 30, 1972].''


            Negotiated Rulemaking for Risk-Sharing Exception

    Section 216(b) of Pub. L. 104-191 provided that:
    ``(1) Establishment.--
        ``(A) In general.--The Secretary of Health and Human Services 
    (in this subsection referred to as the `Secretary') shall establish, 
    on an expedited basis and using a negotiated rulemaking process 
    under subchapter 3 [III] of chapter 5 of title 5, United States 
    Code, standards relating to the exception for risk-sharing 
    arrangements to the anti-kickback penalties described in section 
    1128B(b)(3)(F) of the Social Security Act [subsec. (b)(3)(F) of this 
    section], as added by subsection (a).
        ``(B) Factors to consider.--In establishing standards relating 
    to the exception for risk-sharing arrangements to the anti-kickback 
    penalties under subparagraph (A), the Secretary--
            ``(i) shall consult with the Attorney General and 
        representatives of the hospital, physician, other health 
        practitioner, and health plan communities, and other interested 
        parties; and
            ``(ii) shall take into account--
                ``(I) the level of risk appropriate to the size and type 
            of arrangement;
                ``(II) the frequency of assessment and distribution of 
            incentives;
                ``(III) the level of capital contribution; and
                ``(IV) the extent to which the risk-sharing arrangement 
            provides incentives to control the cost and quality of 
            health care services.
    ``(2) Publication of notice.--In carrying out the rulemaking process 
under this subsection, the Secretary shall publish the notice provided 
for under section 564(a) of title 5, United States Code, by not later 
than 45 days after the date of the enactment of this Act [Aug. 21, 
1996].
    ``(3) Target date for publication of rule.--As part of the notice 
under paragraph (2), and for purposes of this subsection, the `target 
date for publication' (referred to in section 564(a)(5) of such title) 
shall be January 1, 1997.
    ``(4) Abbreviated period for submission of comments.--In applying 
section 564(c) of such title under this subsection, `15 days' shall be 
substituted for `30 days'.
    ``(5) Appointment of negotiated rulemaking committee and 
facilitator.--The Secretary shall provide for--
        ``(A) the appointment of a negotiated rulemaking committee under 
    section 565(a) of such title by not later than 30 days after the end 
    of the comment period provided for under section 564(c) of such 
    title (as shortened under paragraph (4)), and
        ``(B) the nomination of a facilitator under section 566(c) of 
    such title by not later than 10 days after the date of appointment 
    of the committee.
    ``(6) Preliminary committee report.--The negotiated rulemaking 
committee appointed under paragraph (5) shall report to the Secretary, 
by not later than October 1, 1996, regarding the committee's progress on 
achieving a consensus with regard to the rulemaking proceeding and 
whether such consensus is likely to occur before one month before the 
target date for publication of the rule. If the committee reports that 
the committee has failed to make significant progress toward such 
consensus or is unlikely to reach such consensus by the target date, the 
Secretary may terminate such process and provide for the publication of 
a rule under this subsection through such other methods as the Secretary 
may provide.
    ``(7) Final committee report.--If the committee is not terminated 
under paragraph (6), the rulemaking committee shall submit a report 
containing a proposed rule by not later than one month before the target 
publication date.
    ``(8) Interim, final effect.--The Secretary shall publish a rule 
under this subsection in the Federal Register by not later than the 
target publication date. Such rule shall be effective and final 
immediately on an interim basis, but is subject to change and revision 
after public notice and opportunity for a period (of not less than 60 
days) for public comment. In connection with such rule, the Secretary 
shall specify the process for the timely review and approval of 
applications of entities to be certified as provider-sponsored 
organizations pursuant to such rules and consistent with this 
subsection.
    ``(9) Publication of rule after public comment.--The Secretary shall 
provide for consideration of such comments and republication of such 
rule by not later than 1 year after the target publication date.''


                        Anti-Kickback Regulations

    Section 14(a) of Pub. L. 100-93 provided that: ``The Secretary of 
Health and Human Services, in consultation with the Attorney General, 
not later than 1 year after the date of the enactment of this Act [Aug. 
18, 1987] shall publish proposed regulations, and not later than 2 years 
after the date of the enactment of this Act shall promulgate final 
regulations, specifying payment practices that shall not be treated as a 
criminal offense under section 1128B(b) of the Social Security Act 
[subsec. (b) of this section] and shall not serve as the basis for an 
exclusion under section 1128(b)(7) of such Act. Any practices specified 
in regulations pursuant to the preceding sentence shall be in addition 
to the practices described in subparagraphs (A) through (C) of section 
1128B(b)(3).''

                  Section Referred to in Other Sections

    This section is referred to in sections 1320a-3a, 1320a-7, 1320a-7a, 
1320a-7c, 1320a-7d, 1320a-7e, 1395b-5, 1396b, 1396r-6, 1397gg of this 
title.
