
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: 42USC1395b-7]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
Sec. 1395b-7. Explanation of medicare benefits


(a) In general

    The Secretary shall furnish to each individual for whom payment has 
been made under this subchapter (or would be made without regard to any 
deductible) a statement which--
        (1) lists the item or service for which payment has been made 
    and the amount of such payment for each item or service; and
        (2) includes a notice of the individual's right to request an 
    itemized statement (as provided in subsection (b) of this section).

(b) Request for itemized statement for medicare items and services

                           (1) In general

        An individual may submit a written request to any physician, 
    provider, supplier, or any other person (including an organization, 
    agency, or other entity) for an itemized statement for any item or 
    service provided to such individual by such person with respect to 
    which payment has been made under this subchapter.

               (2) 30-day period to furnish statement

        (A) In general

            Not later than 30 days after the date on which a request 
        under paragraph (1) has been made, a person described in such 
        paragraph shall furnish an itemized statement describing each 
        item or service provided to the individual requesting the 
        itemized statement.

        (B) Penalty

            Whoever knowingly fails to furnish an itemized statement in 
        accordance with subparagraph (A) shall be subject to a civil 
        money penalty of not more than $100 for each such failure. Such 
        penalty shall be imposed and collected in the same manner as 
        civil money penalties under subsection (a) of section 1320a-7a 
        of this title are imposed and collected under that section.

                  (3) Review of itemized statement

        (A) In general

            Not later than 90 days after the receipt of an itemized 
        statement furnished under paragraph (1), an individual may 
        submit a written request for a review of the itemized statement 
        to the Secretary.

        (B) Specific allegations

            A request for a review of the itemized statement shall 
        identify--
                (i) specific items or services that the individual 
            believes were not provided as claimed, or
                (ii) any other billing irregularity (including duplicate 
            billing).

                      (4) Findings of Secretary

        The Secretary shall, with respect to each written request 
    submitted under paragraph (3), determine whether the itemized 
    statement identifies specific items or services that were not 
    provided as claimed or any other billing irregularity (including 
    duplicate billing) that has resulted in unnecessary payments under 
    this subchapter.

                       (5) Recovery of amounts

        The Secretary shall take all appropriate measures to recover 
    amounts unnecessarily paid under this subchapter with respect to a 
    statement described in paragraph (4).

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1806, as added Pub. L. 105-
33, title IV, Sec. 4311(b)(1), Aug. 5, 1997, 111 Stat. 385.)


                             Effective Date

    Section 4311(b)(3) of Pub. L. 105-33 provided that:
    ``(A) Statement by secretary.--Paragraph (1) of section 1806(a) of 
the Social Security Act [subsec. (a)(1) of this section], as added by 
paragraph (1), and the repeal made by paragraph (2) [amending section 
1395b-5 of this title] shall take effect on the date of the enactment of 
this Act [Aug. 5, 1997].
    ``(B) Itemized statement.--Paragraph (2) of section 1806(a) and 
section 1806(b) of the Social Security Act [subsecs. (a)(2) and (b) of 
this section], as so added, shall take effect not later than January 1, 
1999.''

                  Section Referred to in Other Sections

    This section is referred to in section 1395b-2 of this title.
