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42 U.S.C. § 1320a–7e — Health care fraud and abuse data collection program
Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** The Secretary shall maintain a national health care fraud and abuse data collection program under this section for the reporting of certain final adverse actions (not including settlements in which no findings of liability have been made) against health care providers, suppliers, or practitioners as required by subsection (b), with access as set forth in subsection (d), and shall furnish the information collected under this section to the National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 ([42 U.S.C. 11101](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section11101&num=0&edition=prelim) et seq.).
**(b) Reporting of information**
(1) **In general** — Each Government agency and health plan shall report any final adverse action (not including settlements in which no findings of liability have been made) taken against a health care provider, supplier, or practitioner.
(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 se
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1320a–7e
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Source file: Laws/federal/codes/united-states-code/title-42/section-1320a7e-health-care-fraud-and-abuse-data-collection-program--fb4f5145d5.md
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Source location: Title 42, Chapter 7, § 1320a–7e; chapter-007-social-security.md
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**(a) In general** The Secretary shall maintain a national health care fraud and abuse data collection program under this section for the reporting of certain final adverse actions (not including settlements in which no findings of liability have been made) against health care providers, suppliers, or practitioners as required by subsection (b), with access as set forth in subsection (d), and shall furnish the information collected under this section to the National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 ([42 U.S.C. 11101](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section11101&num=0&edition=prelim) et seq.).
**(b) Reporting of information**
(1) **In general** — Each Government agency and health plan shall report any final adverse action (not including settlements in which no findings of liability have been made) taken against a health care provider, supplier, or practitioner.
(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** — In determining what information is required, the Secretary shall include procedures to assure that the privacy of individuals receiving health care services is appropriately protected.
(4) **Timing and form of reporting** — The information required to be reported under this subsection shall be reported regularly (but not less often than monthly) and in such form and manner as the Secretary prescribes. Such information shall first be required to be reported on a date specified by the Secretary.
(5) **To whom reported** — The information required to be reported under this subsection shall be reported to the Secretary.
(6) **Sanctions for failure to report**
(A) *Health plans* — Any health plan that fails to report information on an adverse action required to be reported under this subsection shall be subject to a civil money penalty of not more than $25,000 for each such adverse action not reported. 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a-7a&num=0&edition=prelim) are imposed and collected under that section.
(B) *Governmental agencies* — The Secretary shall provide for a publication of a public report that identifies those Government agencies that have failed to report information on adverse actions as required to be reported under this subsection.
**(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** — Each Government agency and health plan shall report corrections of information already reported about any final adverse action taken against a health care provider, supplier, or practitioner, in such form and manner that the Secretary prescribes by regulation.
**(d) Access to reported information**
(1) **Availability** — The information collected under this section shall be available from the National Practitioner Data Bank to the agencies, authorities, and officials which are provided under [section 1396r–2(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r–2/b&num=0&edition=prelim) information reported under [section 1396r–2(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r–2/a&num=0&edition=prelim).
(2) **Fees for disclosure** — The Secretary may establish or approve reasonable fees for the disclosure of information under this section. The amount of such a fee may not exceed the costs of processing the requests for disclosure and of providing such information. Such fees shall be available to the Secretary to cover such costs.
**(e) Protection from liability for reporting** No person or entity, including the agency designated by the Secretary in subsection (b)(5) shall be held liable in any civil action with respect to any report made as required by this section, without knowledge of the falsity of the information contained in the report.
**(f) Appropriate coordination** In implementing this section, the Secretary shall provide for the maximum appropriate coordination with part B of the Health Care Quality Improvement Act of 1986 ([42 U.S.C. 11131](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section11131&num=0&edition=prelim) et seq.) and [section 1396r–2 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r-2&num=0&edition=prelim).
**(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 11 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a–7b/f&num=0&edition=prelim)).
(v) Any other adjudicated actions or decisions that the Secretary shall establish by regulation.
(B) *Exception* — The term does not include any action with respect to a malpractice claim.
(2) **Practitioner** — The terms “licensed health care practitioner”, “licensed practitioner”, and “practitioner” mean, with respect to a State, an individual who is licensed or otherwise authorized by the State to provide health care services (or any individual who, without authority holds himself or herself out to be so licensed or authorized).
(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** — The term “health plan” has the meaning given such term by [section 1320a–7c(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a–7c/c&num=0&edition=prelim).
(5) **Determination of conviction** — For purposes of paragraph (1), the existence of a conviction shall be determined under paragraphs (1) through (4) of [section 1320a–7(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a–7/i&num=0&edition=prelim).
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Annual reports to Congress** The Secretary shall report to Congress, annually during the three years after November 14, 1986, on the implementation of this chapter.
**(b) Memoranda of understanding** The Secretary of Health and Human Services shall seek to enter into memoranda of understanding with the Secretary of Defense and the Administrator of Veterans’ Affairs to apply the provisions of subchapter II of this chapter to hospitals and other facilities and health care providers under the jurisdiction of the Secretary or Administrator, respectively. The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memoranda and on the cooperation among such officials in establishing such memoranda.
**(c) Memorandum of understanding with Drug Enforcement Administration** The Secretary of Health and Human Services shall seek to enter into a memorandum of understanding with the Administrator of Drug Enforcement relating to providing for the reporting by the Administrator to the Secretary of information respecting physicians and other practitioners whose registration to dispense controlled substances has been suspended or revoked under [section 824 of title 21](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section824&num=0&edition=prelim). The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memorandum and on the cooperation between the Secretary and the Administrator in establishing such a memorandum.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 11101
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** Except as specifically provided in this subchapter, nothing in this subchapter shall be construed as changing the liabilities or immunities under law or as preempting or overriding any State law which provides incentives, immunities, or protection for those engaged in a professional review action that is in addition to or greater than that provided by this subchapter.
**(b) Scope of clinical privileges** Nothing in this subchapter shall be construed as requiring health care entities to provide clinical privileges to any or all classes or types of physicians or other licensed health care practitioners.
**(c) Treatment of nurses and other practitioners** Nothing in this subchapter shall be construed as affecting, or modifying any provision of Federal or State law, with respect to activities of professional review bodies regarding nurses, other licensed health care practitioners, or other health professionals who are not physicians.
**(d) Treatment of patient malpractice claims** Nothing in this chapter shall be construed as affecting in any manner the rights and remedies afforded patients under any provision of Federal or State law to seek redress for any harm or injury suffered as a result of negligent treatment or care by any physician, health care practitioner, or health care entity, or as limiting any defenses or immunities available to any physician, health care practitioner, or health care entity.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 11131
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Federal law — U.S. Code and appendices · legal_authorities
Page 8114
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 11101
1 So in original. Probably should be ‘‘for purposes of subpara-
graph (A),’’.
Sec.
11115.
Construction.
SUBCHAPTER II—REPORTING OF INFORMATION
11131.
Requiring reports on medical malpractice
payments.
11132.
Reporting of sanctions taken by Boards of
Medical Examiners.
11133.
Reporting of certain professional review ac-
tions taken by health care entities.
11134.
Form of reporting.
11135.
Duty of hospitals to obtain information.
11136.
Disclosure and correction of information.
11137.
Miscellaneous provisions.
SUBCHAPTER III—DEFINITIONS AND REPORTS
11151.
Definitions.
11152.
Reports and memoranda of understanding.
§ 11101. Findings
The Congress finds the following:
(1) The increasing occurrence of medical
malpractice and the need to improve the qual-
ity of medical care have become nationwide
problems that warrant greater efforts than
those that can be undertaken by any indi-
vidual State.
(2) There is a national need to restrict the
ability of incompetent physicians to move
from State to State without disclosure or dis-
covery of the physician’s previous damaging
or incompetent performance.
(3) This nationwide problem can be remedied
through effective professional peer review.
(4) The threat of private money damage li-
ability under Federal laws, including treble
damage liability under Federal antitrust law,
unreasonably discourages physicians from par-
ticipating in effective professional peer re-
view.
(5) There is an overriding national need to
provide incentive and protection for physi-
cians engaging in effective professional peer
review.
(Pub. L. 99–660, title IV, § 402, Nov. 14, 1986, 100
Stat. 3784.)
Statutory Notes and Related Subsidiaries
SHORT TITLE
Pub. L.
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 11101
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 11101. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 8116
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 11113
(D) upon completion of the hearing, the
physician involved has the right—
(i) to receive the written recommenda-
tion of the arbitrator, officer, or panel, in-
cluding a statement of the basis for the
recommendations, and
(ii) to receive a written decision of the
health care entity, including a statement
of the basis for the decision.
A professional review body’s failure to meet the
conditions described in this subsection shall not,
in itself, constitute failure to meet the stand-
ards of subsection (a)(3).
(c) Adequate procedures in investigations or
health emergencies
For purposes of section 11111(a) of this title,
nothing in this section shall be construed as—
(1) requiring the procedures referred to in
subsection (a)(3)—
(A) where there is no adverse professional
review action taken, or
(B) in the case of a suspension or restric-
tion of clinical privileges, for a period of not
longer than 14 days, during which an inves-
tigation is being conducted to determine the
need for a professional review action; or
(2) precluding an immediate suspension or
restriction of clinical privileges, subject to
subsequent notice and hearing or other ade-
quate procedures, where the failure to take
such an action may result in an imminent
danger to the health of any individual.
(Pub. L. 99–660, title IV, § 412, Nov. 14, 1986, 100
Stat. 3785.)
§ 11113. Payment of reasonable attorneys’ fees
and costs in defense of suit
In any suit brought against a defendant, to the
extent that a defendant has met the standards
set forth under section 11112(a) of this title and
the defendant substantially prevails, the court
shall, at the conclusion of the action, award to
a
substantially
prevailing
party
defendin
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 11131
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 11131. This identifies an authority to review, not proof of applicability.