
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: 42USC1320b-6]

 
                 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. 1320b-6. Exclusion of representatives and health care 
        providers convicted of violations from participation in social 
        security programs
        

(a) In general

    The Commissioner of Social Security shall exclude from participation 
in the social security programs any representative or health care 
provider--
        (1) who is convicted of a violation of section 408 or 1383a of 
    this title;
        (2) who is convicted of any violation under title 18 relating to 
    an initial application for or continuing entitlement to, or amount 
    of, benefits under subchapter II of this chapter, or an initial 
    application for or continuing eligibility for, or amount of, 
    benefits under subchapter XVI of this chapter; or
        (3) who the Commissioner determines has committed an offense 
    described in section 1320a-8(a)(1) of this title.

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

    (1) An exclusion under this section shall be effective at such time, 
for such period, and upon such reasonable notice to the public and to 
the individual excluded as may be specified in regulations consistent 
with paragraph (2).
    (2) Such an exclusion shall be effective with respect to services 
furnished to any individual on or after the effective date of the 
exclusion. Nothing in this section may be construed to preclude, in 
determining disability under subchapter II of this chapter or subchapter 
XVI of this chapter, consideration of any medical evidence derived from 
services provided by a health care provider before the effective date of 
the exclusion of the health care provider under this section.
    (3)(A) The Commissioner shall specify, in the notice of exclusion 
under paragraph (1), the period of the exclusion.
    (B) Subject to subparagraph (C), in the case of an exclusion under 
subsection (a) of this section, the minimum period of exclusion shall be 
5 years, except that the Commissioner may waive the exclusion in the 
case of an individual who is the sole source of essential services in a 
community. The Commissioner's decision whether to waive the exclusion 
shall not be reviewable.
    (C) In the case of an exclusion of an individual under subsection 
(a) of this section based on a conviction or a determination described 
in subsection (a)(3) of this section occurring on or after December 14, 
1999, if the individual has (before, on, or after December 14, 1999) 
been convicted, or if such a determination has been made with respect to 
the individual--
        (i) on one previous occasion of one or more offenses for which 
    an exclusion may be effected under such subsection, the period of 
    the exclusion shall be not less than 10 years; or
        (ii) on two or more previous occasions of one or more offenses 
    for which an exclusion may be effected under such subsection, the 
    period of the exclusion shall be permanent.

(c) Notice to State agencies

    The Commissioner shall promptly notify each appropriate State agency 
employed for the purpose of making disability determinations under 
section 421 or 1383b(a) of this title--
        (1) of the fact and circumstances of each exclusion effected 
    against an individual under this section; and
        (2) of the period (described in subsection (b)(3) of this 
    section) for which the State agency is directed to exclude the 
    individual from participation in the activities of the State agency 
    in the course of its employment.

(d) Notice to State licensing agencies

    The Commissioner shall--
        (1) promptly notify the appropriate State or local agency or 
    authority having responsibility for the licensing or certification 
    of an individual excluded from participation under this section of 
    the fact and circumstances of the exclusion;
        (2) request that appropriate investigations be made and 
    sanctions invoked in accordance with applicable State law and 
    policy; and
        (3) request that the State or local agency or authority keep the 
    Commissioner and the Inspector General of the Social Security 
    Administration fully and currently informed with respect to any 
    actions taken in response to the request.

(e) Notice, hearing, and judicial review

    (1) Any individual who is excluded (or directed to be excluded) from 
participation under this section is entitled to reasonable notice and 
opportunity for a hearing thereon by the Commissioner to the same extent 
as is provided in section 405(b) of this title, and to judicial review 
of the Commissioner's final decision after such hearing as is provided 
in section 405(g) of this title.
    (2) The provisions of section 405(h) of this title shall apply with 
respect to this section to the same extent as it is applicable with 
respect to subchapter II of this chapter.

(f) Application for termination of exclusion

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

    (3) The Commissioner shall promptly notify each State agency 
employed for the purpose of making disability determinations under 
section 421 or 1383b(a) of this title of the fact and circumstances of 
each termination of exclusion made under this subsection.

(g) Availability of records of excluded representatives and health care 
        providers

    Nothing in this section shall be construed to have the effect of 
limiting access by any applicant or beneficiary under subchapter II or 
XVI of this chapter, any State agency acting under section 421 or 
1383b(a) of this title, or the Commissioner to records maintained by any 
representative or health care provider in connection with services 
provided to the applicant or beneficiary prior to the exclusion of such 
representative or health care provider under this section.

(h) Reporting requirement

    Any representative or health care provider participating in, or 
seeking to participate in, a social security program shall inform the 
Commissioner, in such form and manner as the Commissioner shall 
prescribe by regulation, whether such representative or health care 
provider has been convicted of a violation described in subsection (a) 
of this section.

(i) Delegation of authority

    The Commissioner may delegate authority granted by this section to 
the Inspector General.

(j) Definitions

    For purposes of this section:

                             (1) Exclude

        The term ``exclude'' from participation means--
            (A) in connection with a representative, to prohibit from 
        engaging in representation of an applicant for, or recipient of, 
        benefits, as a representative payee under section 405(j) or 
        section 1383(a)(2)(A)(ii) of this title, or otherwise as a 
        representative, in any hearing or other proceeding relating to 
        entitlement to benefits; and
            (B) in connection with a health care provider, to prohibit 
        from providing items or services to an applicant for, or 
        recipient of, benefits for the purpose of assisting such 
        applicant or recipient in demonstrating disability.

                     (2) Social security program

        The term ``social security programs'' means the program 
    providing for monthly insurance benefits under subchapter II of this 
    chapter, and the program providing for monthly supplemental security 
    income benefits to individuals under subchapter XVI of this chapter 
    (including State supplementary payments made by the Commissioner 
    pursuant to an agreement under section 1382e(a) of this title or 
    section 212(b) of Public Law 93-66).

                            (3) Convicted

        An individual is considered to have been ``convicted'' of a 
    violation--
            (A) when a judgment of conviction has been entered against 
        the individual by a Federal, State, or local court, except if 
        the judgment of conviction has been set aside or expunged;
            (B) when there has been a finding of guilt against the 
        individual by a Federal, State, or local court;
            (C) when a plea of guilty or nolo contendere by the 
        individual has been accepted by a Federal, State, or local 
        court; or
            (D) when the individual has entered into participation in a 
        first offender, deferred adjudication, or other arrangement or 
        program where judgment of conviction has been withheld.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1136, as added Pub. L. 106-169, 
title II, Sec. 208(a), Dec. 14, 1999, 113 Stat. 1839.)

                       References in Text

    Section 212(b) of Public Law 93-66, referred to in subsec. (j)(2), 
is section 212(b) of Pub. L. 93-66, title II, July 9, 1973, 87 Stat. 
155, as amended, which is set out as a note under section 1382 of this 
title.


                            Prior Provisions

    A prior section 1320b-6, act Aug. 14, 1935, ch. 531, title XI, 
Sec. 1136, as added Pub. L. 98-369, div. B, title VI, Sec. 2630, July 
18, 1984, 98 Stat. 1137; amended Pub. L. 99-514, title XVIII, 
Sec. 1883(c)(2), Oct. 22, 1986, 100 Stat. 2918, related to pilot 
projects to demonstrate use of integrated service delivery systems for 
human services programs, prior to repeal by Pub. L. 104-193, title I, 
Secs. 108(q)(7), 116, Aug. 22, 1996, 110 Stat. 2168, 2181, effective 
July 1, 1997, with certain transition rules.


                             Effective Date

    Pub. L. 106-169, title II, Sec. 208(b), Dec. 14, 1999, 113 Stat. 
1842, provided that: ``The amendment made by this section [enacting this 
section] shall apply with respect to convictions of violations described 
in paragraphs (1) and (2) of section 1136(a) of the Social Security Act 
[subsec. (a) of this section] and determinations described in paragraph 
(3) of such section occurring on or after the date of the enactment of 
this Act [Dec. 14, 1999].''
