42 USC 1320a-7e - Health care fraud and abuse data collection program

U.S Code last checked for updates: May 02, 2024

§ 1320a–7e.

Health care fraud and abuse data collection program

(a)

In general

(b)

Reporting of information

(1)

In general

(2)

Information to be reported

The information to be reported under paragraph (1) includes:

(A)

The name and TIN (as defined in section 7701(a)(41) of the Internal Revenue Code of 1986) of any health care provider, supplier, or practitioner who is the subject of a final adverse action.

(B)

The name (if known) of any health care entity with which a health care provider, supplier, or practitioner, who is the subject of a final adverse action, is affiliated or associated.

(C)

The nature of the final adverse action and whether such action is on appeal.

(D)

A description of the acts or omissions and injuries upon which the final adverse action was based, and such other information as the Secretary determines by regulation is required for appropriate interpretation of information reported under this section.

(3)

Confidentiality

(4)

Timing and form of reporting

(5)

To whom reported

(6)

Sanctions for failure to report

(A)

Health plans

(B)

Governmental agencies

(c)

Disclosure and correction of information

(1)

Disclosure

With respect to the information about final adverse actions (not including settlements in which no findings of liability have been made) reported to the Secretary under this section with respect to a health care provider, supplier, or practitioner, the Secretary shall, by regulation, provide for—

(A)

disclosure of the information, upon request, to the health care provider, supplier, or licensed practitioner, and

(B)

procedures in the case of disputed accuracy of the information.

(2)

Corrections

(d)

Access to reported information

(1)

Availability

(2)

Fees for disclosure

(e)

Protection from liability for reporting

(f)

Appropriate coordination

(g)

Definitions and special rules

For purposes of this section:

(1)

Final adverse action

(A)

In general

The term “final adverse action” includes:

(i)

Civil judgments against a health care provider, supplier, or practitioner in Federal or State court related to the delivery of a health care item or service.

(ii)

Federal or State criminal convictions related to the delivery of a health care item or service.

(iii)

Actions by Federal agencies responsible for the licensing and certification of health care providers, suppliers, and licensed health care practitioners, including—

(I)

formal or official actions, such as revocation or suspension of a license (and the length of any such suspension), reprimand, censure or probation,

(II)

any dismissal or closure of the proceedings by reason of the provider, supplier, or practitioner surrendering their license or leaving the State or jurisdiction 1

 So in original. Probably should be followed by a comma.

(III)

any other loss of license or the right to apply for, or renew, a license of the provider, supplier, or practitioner, whether by operation of law, voluntary surrender, non-renewability, or otherwise, or

(IV)

any other negative action or finding by such Federal agency that is publicly available information.

(iv)

Exclusion from participation in a Federal health care program (as defined in section 1320a–7b(f) of this title).

(v)

Any other adjudicated actions or decisions that the Secretary shall establish by regulation.

(B)

Exception

(2)

Practitioner

(3)

Government agency

The term “Government agency” shall include:

(A)

The Department of Justice.

(B)

The Department of Health and Human Services.

(C)

Any other Federal agency that either administers or provides payment for the delivery of health care services, including, but not limited to the Department of Defense and the Department of Veterans Affairs.

(D)

Federal agencies responsible for the licensing and certification of health care providers and licensed health care practitioners.

(4)

Health plan

(5)

Determination of conviction

(Aug. 14, 1935, ch. 531, title XI, § 1128E, as added Pub. L. 104–191, title II, § 221(a), Aug. 21, 1996, 110 Stat. 2009; amended Pub. L. 105–33, title IV, § 4331(a)(2), (b), (d), Aug. 5, 1997, 111 Stat. 395, 396; Pub. L. 111–148, title VI, § 6403(a), Mar. 23, 2010, 124 Stat. 763.)

cite as: 42 USC 1320a-7e