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10 U.S.C. § 1073f — Health care fraud and abuse prevention program

Federal law — U.S. Code and appendices · legal_authorities

10 U.S.C. § 1073f — Health care fraud and abuse prevention program

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Stable record: federal_law:legal_authorities:record_usc_4a3765eaec1ec5416eaaff2b
Source file: Laws/federal/codes/united-states-code/title-10/section-1073f-health-care-fraud-and-abuse-prevention-program--7800780d66.md
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Source location: Title 10, Chapter 55, § 1073f; chapter-055-medical-and-dental-care.md

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**(a) Program Authorized.—** (1) The Secretary of Defense may carry out a program under this section to prevent and remedy fraud and abuse in the health care programs of the Department of Defense. (2) At the discretion of the Secretary, such program may be administered jointly by the Inspector General of the Department of Defense and the Director of the Defense Health Agency. (3) In carrying out such program, the authorities granted to the Secretary of Defense and the Inspector General of the Department of Defense under section 1128A(m) of the Social Security Act ([42 U.S.C. 1320a–7a(m)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a–7a/m&num=0&edition=prelim)) shall be available to the Secretary and the Inspector General. **(b) Civil Monetary Penalties.—** (1) Except as provided in paragraph (2), the provisions of section 1128A of the Social Security Act ([42 U.S.C. 1320a–7a](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a–7a&num=0&edition=prelim)) shall apply with respect to any civil monetary penalty imposed in carrying out the program authorized under subsection (a). (2) Consistent with [section 1079a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079a&num=0&edition=prelim), amounts recovered in connection with any such civil monetary penalty imposed— (A) shall be credited to appropriations available as of the time of the collection for expenses of the health care program of the Department of Defense affected by the fraud and abuse for which such penalty was imposed; and (B) may be used to support the administration of the program authorized under subsection (a), including to support any interagency agreements entered into under subsection (d). **(c) Interagency Agreements.—** The Secretary of Defense may enter into agreements with the Secretary of Health and Human Services, the Attorney General, or the heads of other Federal agencies, for the effective and efficient implementation of the program authorized under subsection (a). **(d) Rule of Construction.—** Joint administration of the program authorized under subsection (a) may not be construed as limiting the authority of the Inspector General of the Department of Defense under any other provision of law. **(e) Fraud and Abuse Defined.—** In this section, the term “fraud and abuse” means any conduct specified in subsection (a) or (b) of section 1128A of the Social Security Act ([42 U.S.C. 1320a–7a](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a–7a&num=0&edition=prelim)).

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1320a–7a — Civil monetary penalties

**(a) Improperly filed claims** Any person (including an organization, agency, or other entity, but excluding a beneficiary, as defined in subsection (i)(5)) that— (1) knowingly presents or causes to be presented to an officer, employee, or agent of the United States, or of any department or agency thereof, or of any State agency (as defined in subsection (i)(1)), a claim (as defined in subsection (i)(2)) that the Secretary determines— (A) is for a medical or other item or service that the person knows or should know was not provided as claimed, including any person who engages in a pattern or practice of presenting or causing to be presented a claim for an item or service that is based on a code that the person knows or should know will result in a greater payment to the person than the code the person knows or should know is applicable to the item or service actually provided, (B) is for a medical or other item or service and the person knows or should know the claim is false or fraudulent, (C) is presented for a physician’s service (or an item or service incident to a physician’s service) by a person who knows or should know that the individual who furnished (or supervised the furnishing of) the service— (i) was not licensed as a physician, (ii) was licensed as a physician, but such license had been obtained through a misrepresentation of material fact (including cheating on an examination required for licensing), or (iii) represented to the patient at the time the service was furnished that the physician was certified in a medical specialty by a medical specialty board when the individual was not so certified, (D) is for a medical or other item or service furnished during a period in which the person was excluded from the Federal health c

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1320a–7a

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Federal law — U.S. Code and appendices · legal_authorities

10 U.S.C. § 1079a — TRICARE program: treatment of refunds and other amounts collected

All refunds and other amounts collected in the administration of the TRICARE program shall be credited to the appropriation available for that program for the fiscal year in which the refund or amount is collected.

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Federal law — U.S. Code and appendices · legal_authorities

10 U.S.C. § 1073f — Health care fraud and abuse prevention

Page 1031 TITLE 10—ARMED FORCES § 1073f 1 See References in Text note below. level required for the enduring medical support of each such center. ‘‘(e) BRIEFING.—Not later than December 31, 2023, the Secretary of Defense shall provide to the Committees on Armed Services of the Senate and the House of Rep- resentatives a briefing that— ‘‘(1) describes the establishment of each center of excellence established under subsection (a), to in- clude the location, capability, and capacity of each such center; ‘‘(2) describes the referral policy published by the Defense Health Agency under subsection (c); ‘‘(3) identifies the medical personnel billets identi- fied under subsection (d); and ‘‘(4) provides a plan for the staffing of personnel at such centers to ensure the enduring medical support of each such center. ‘‘(f) MILITARY MEDICAL CENTER DEFINED.—In this sec- tion, the term ‘military medical center’ means a med- ical center described in section 1073d(b) of title 10, United States Code.’’ SATELLITE CENTERS Pub. L. 114–328, div. A, title VII, § 703(a)(3), Dec. 23, 2016, 130 Stat. 2198, provided that: ‘‘In addition to the centers of excellence designated under section 1073d(b)(4) of title 10, United States Code, as added by paragraph (1), the Secretary of Defense may establish satellite centers of excellence to provide specialty care for certain conditions, including with respect to— ‘‘(A) post-traumatic stress; ‘‘(B) traumatic brain injury; and ‘‘(C) such other conditions as the Secretary con- siders appropriate.’’ LIMITATION ON RESTRUCTURE AND REALIGNMENT OF MILITARY MEDICAL TREATMENT FACILITIES Pub. L. 114–328, div. A, title VII, § 703(b), (e), Dec. 23, 2016, 130 Stat. 2198, 2200, provided that: ‘‘(b) EXCEPTION.—In carrying out section 10

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1320a — Uniform reporting systems for health services facilities and organizations

**(a) Establishment; criteria for regulations; requirements for hospitals** For the purposes of reporting the cost of services provided by, of planning, and of measuring and comparing the efficiency of and effective use of services in, hospitals, skilled nursing facilities, intermediate care facilities, home health agencies, health maintenance organizations, and other types of health services facilities and organizations to which payment may be made under this chapter, the Secretary shall establish by regulation, for each such type of health services facility or organization, a uniform system for the reporting by a facility or organization of that type of the following information: (1) The aggregate cost of operation and the aggregate volume of services. (2) The costs and volume of services for various functional accounts and subaccounts. (3) Rates, by category of patient and class of purchaser. (4) Capital assets, as defined by the Secretary, including (as appropriate) capital funds, debt service, lease agreements used in lieu of capital funds, and the value of land, facilities, and equipment. (5) Discharge and bill data. The uniform reporting system for a type of health services facility or organization shall provide for appropriate variation in the application of the system to different classes of facilities or organizations within that type and shall be established, to the extent practicable, consistent with the cooperative system for producing comparable and uniform health information and statistics described in [section 242k(e)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section242k/e/1&num=0&edition=prelim). In reporting under such a system, hospitals shall employ such chart of accounts, definitions, principles, and

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1320a — Uniform reporting systems for health

Page 2598 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1320 chapter has made a finding (prior to making such expenditure) that (A) such home is so de- fective that continued occupancy is unwar- ranted, (B) unless repairs are made to such home, rental quarters will be necessary for such individual, and (C) the cost of rental quarters to take care of the needs of such indi- vidual (including his spouse living with him in such home and any other individual whose needs were taken into account in determining the need of such individual) would exceed (over such time as the Secretary may specify) the cost of repairs needed to make such home habitable together with other costs attrib- utable to continued occupancy of such home, and (2) no such expenditures were made for re- pairing such home pursuant to any prior find- ing under this section, the amount paid to any such State for any quar- ter under section 303(a), 1203(a), 1353(a), or 1383(a) of this title shall be increased by 50 per centum of such expenditures, except that the ex- cess above $500 expended with respect to any one home shall not be included in determining such expenditures. (Aug. 14, 1935, ch. 531, title XI, § 1119, as added Pub. L. 90–248, title II, § 209(a), Jan. 2, 1968, 81 Stat. 894; amended Pub. L. 104–193, title I, § 108(g)(5), Aug. 22, 1996, 110 Stat. 2168.) Editorial Notes REFERENCES IN TEXT Section 1383(a) of this title, referred to in text, is a reference to section 1383(a) of this title as it existed prior to the general revision of this subchapter by Pub. L. 92–603, title III, § 301, Oct. 30, 1972, 86 Stat. 1465, eff. Jan. 1, 1974. The prior section (which is set out as a note under section 1383 of this title) continues in effect for Puerto Rico, Guam, and the Virgin Islands

Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1320a

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