
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-7c]

 
                 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-7c. Fraud and abuse control program


(a) Establishment of program

                           (1) In general

        Not later than January 1, 1997, the Secretary, acting through 
    the Office of the Inspector General of the Department of Health and 
    Human Services, and the Attorney General shall establish a program--
            (A) to coordinate Federal, State, and local law enforcement 
        programs to control fraud and abuse with respect to health 
        plans,
            (B) to conduct investigations, audits, evaluations, and 
        inspections relating to the delivery of and payment for health 
        care in the United States,
            (C) to facilitate the enforcement of the provisions of 
        sections 1320a-7, 1320a-7a, and 1320a-7b of this title and other 
        statutes applicable to health care fraud and abuse,
            (D) to provide for the modification and establishment of 
        safe harbors and to issue advisory opinions and special fraud 
        alerts pursuant to section 1320a-7d of this title, and
            (E) to provide for the reporting and disclosure of certain 
        final adverse actions against health care providers, suppliers, 
        or practitioners pursuant to the data collection system 
        established under section 1320a-7e of this title.

                 (2) Coordination with health plans

        In carrying out the program established under paragraph (1), the 
    Secretary and the Attorney General shall consult with, and arrange 
    for the sharing of data with representatives of health plans.

                           (3) Guidelines

        (A) In general

            The Secretary and the Attorney General shall issue 
        guidelines to carry out the program under paragraph (1). The 
        provisions of sections 553, 556, and 557 of title 5 shall not 
        apply in the issuance of such guidelines.

        (B) Information guidelines

            (i) In general

                Such guidelines shall include guidelines relating to the 
            furnishing of information by health plans, providers, and 
            others to enable the Secretary and the Attorney General to 
            carry out the program (including coordination with health 
            plans under paragraph (2)).
            (ii) Confidentiality

                Such guidelines shall include procedures to assure that 
            such information is provided and utilized in a manner that 
            appropriately protects the confidentiality of the 
            information and the privacy of individuals receiving health 
            care services and items.
            (iii) Qualified immunity for providing information

                The provisions of section 1320c-6(a) of this title 
            (relating to limitation on liability) shall apply to a 
            person providing information to the Secretary or the 
            Attorney General in conjunction with their performance of 
            duties under this section.

                (4) Ensuring access to documentation

        The Inspector General of the Department of Health and Human 
    Services is authorized to exercise such authority described in 
    paragraphs (3) through (9) of section 6 of the Inspector General Act 
    of 1978 (5 U.S.C. App.) as necessary with respect to the activities 
    under the fraud and abuse control program established under this 
    subsection.

                 (5) Authority of Inspector General

        Nothing in this chapter shall be construed to diminish the 
    authority of any Inspector General, including such authority as 
    provided in the Inspector General Act of 1978 (5 U.S.C. App.).

(b) Additional use of funds by Inspector General

                (1) Reimbursements for investigations

        The Inspector General of the Department of Health and Human 
    Services is authorized to receive and retain for current use 
    reimbursement for the costs of conducting investigations and audits 
    and for monitoring compliance plans when such costs are ordered by a 
    court, voluntarily agreed to by the payor, or otherwise.

                            (2) Crediting

        Funds received by the Inspector General under paragraph (1) as 
    reimbursement for costs of conducting investigations shall be 
    deposited to the credit of the appropriation from which initially 
    paid, or to appropriations for similar purposes currently available 
    at the time of deposit, and shall remain available for obligation 
    for 1 year from the date of the deposit of such funds.

(c) ``Health plan'' defined

    For purposes of this section, the term ``health plan'' means a plan 
or program that provides health benefits, whether directly, through 
insurance, or otherwise, and includes--
        (1) a policy of health insurance;
        (2) a contract of a service benefit organization; and
        (3) a membership agreement with a health maintenance 
    organization or other prepaid health plan.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128C, as added Pub. L. 104-191, 
title II, Sec. 201(a), Aug. 21, 1996, 110 Stat. 1992.)

                       References in Text

    The Inspector General Act of 1978, referred to in subsec. (a)(4), 
(5), 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.

                  Section Referred to in Other Sections

    This section is referred to in sections 1320a-7e, 1395i of this 
title.
