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42 U.S.C. § 1396h — State false claims act requirements for increased State share of recoveries

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

42 U.S.C. § 1396h — State false claims act requirements for increased State share of recoveries

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Stable record: federal_law:legal_authorities:record_usc_8352a54efa27f6d039c1a295
Source file: Laws/federal/codes/united-states-code/title-42/section-1396h-state-false-claims-act-requirements-for-increased-state-share-of-recover--431d9f6335.md
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Source location: Title 42, Chapter 7, § 1396h; chapter-007-social-security.md

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**(a) In general** Notwithstanding [section 1396d(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/b&num=0&edition=prelim), if a State has in effect a law relating to false or fraudulent claims that meets the requirements of subsection (b), the Federal medical assistance percentage with respect to any amounts recovered under a State action brought under such law, shall be decreased by 10 percentage points. **(b) Requirements** For purposes of subsection (a), the requirements of this subsection are that the Inspector General of the Department of Health and Human Services, in consultation with the Attorney General, determines that the State has in effect a law that meets the following requirements: (1) The law establishes liability to the State for false or fraudulent claims described in [section 3729 of title 31](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section3729&num=0&edition=prelim) with respect to any expenditure described in [section 1396b(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396b/a&num=0&edition=prelim). (2) The law contains provisions that are at least as effective in rewarding and facilitating qui tam actions for false or fraudulent claims as those described in sections 3730 through 3732 of title 31. (3) The law contains a requirement for filing an action under seal for 60 days with review by the State Attorney General. (4) The law contains a civil penalty that is not less than the amount of the civil penalty authorized under [section 3729 of title 31](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section3729&num=0&edition=prelim). **(c) Deemed compliance** A State that, as of January 1, 2007, has a law in effect that meets the requirements of subsection (b) shall be deemed to be in compliance with such requirements for so long as the law continues to meet such requirements. **(d) No preclusion of broader laws** Nothing in this section shall be construed as prohibiting a State that has in effect a law that establishes liability to the State for false or fraudulent claims described in [section 3729 of title 31](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section3729&num=0&edition=prelim), with respect to programs in addition to the State program under this subchapter, or with respect to expenditures in addition to expenditures described in [section 1396b(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396b/a&num=0&edition=prelim), from being considered to be in compliance with the requirements of subsection (a) so long as the law meets such requirements.

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

31 U.S.C. § 3729 — False claims

**(a) Liability for Certain Acts.—** (1) **In general.—** — Subject to paragraph (2), any person who— (A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval; (B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim; (C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G); (D) has possession, custody, or control of property or money used, or to be used, by the Government and knowingly delivers, or causes to be delivered, less than all of that money or property; (E) is authorized to make or deliver a document certifying receipt of property used, or to be used, by the Government and, intending to defraud the Government, makes or delivers the receipt without completely knowing that the information on the receipt is true; (F) knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the Government, or a member of the Armed Forces, who lawfully may not sell or pledge property; or (G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government, is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 ([28 U.S.C. 2461](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title28-section2461&num=0&edition=prelim) note; Public Law 104–410 11 So in original. Probably should be “101–410”.

Source: Supplied U.S. Code snapshot — release unconfirmed · 31 U.S.C. § 3729

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

42 U.S.C. § 1396a — State plans for medical assistance

**(a) Contents** A State plan for medical assistance must— (1) provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them; (2) provide for financial participation by the State equal to not less than 40 per centum of the non-Federal share of the expenditures under the plan with respect to which payments under [section 1396b of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396b&num=0&edition=prelim) are authorized by this subchapter; and, effective July 1, 1969, provide for financial participation by the State equal to all of such non-Federal share or provide for distribution of funds from Federal or State sources, for carrying out the State plan, on an equalization or other basis which will assure that the lack of adequate funds from local sources will not result in lowering the amount, duration, scope, or quality of care and services available under the plan; (3) provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness; (4) provide (A) such methods of administration (including methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods, including provision for utilization of professional medical personnel in the administration and, where administered locally, supervision of administration of the plan, and, subject to [section 1396b(i) of this title](https://uscode.house.gov/view.xhtml?req=granulei

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396a

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

42 U.S.C. § 1305 — Short title of chapter

This chapter may be cited as the “Social Security Act”.

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1305

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

42 U.S.C. § 1320a–7 — Exclusion of certain individuals and entities from participation in Medicare and State health care programs

**(a) Mandatory exclusion** The Secretary shall exclude the following individuals and entities from participation in any 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)): (1) **Conviction of program-related crimes** — Any individual or entity that has been convicted of a criminal offense related to the delivery of an item or service under subchapter XVIII or under any State health care program. (2) **Conviction relating to patient abuse** — Any individual or entity that has been convicted, under Federal or State law, of a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care item or service. (3) **Felony conviction relating to health care fraud** — Any individual or entity that has been convicted for an offense which occurred after August 21, 1996, under Federal or State law, in connection with the delivery of a health care item or service or with respect to any act or omission in a health care program (other than those specifically described in paragraph (1)) operated by or financed in whole or in part by any Federal, State, or local government agency, of a criminal offense consisting of a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct. (4) **Felony conviction relating to controlled substance** — Any individual or entity that has been convicted for an offense which occurred after August 21, 1996, under Federal or State law, of a criminal offense consisting of a felony relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance. **(b) Permissive exclusion** The Secr

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

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

42 U.S.C. § 1320a–7b — Criminal penalties for acts involving Federal health care programs

**(a) Making or causing to be made false statements or representations** Whoever— (1) knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any application for any benefit or payment under a Federal health care program (as defined in subsection (f)), (2) at any time knowingly and willfully makes or causes to be made any false statement or representation of a material fact for use in determining rights to such benefit or payment, (3) having knowledge of the occurrence of any event affecting (A) his initial or continued right to any such benefit or payment, or (B) the initial or continued right to any such benefit or payment of any other individual in whose behalf he has applied for or is receiving such benefit or payment, conceals or fails to disclose such event with an intent fraudulently to secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized, (4) having made application to receive any such benefit or payment for the use and benefit of another and having received it, knowingly and willfully converts such benefit or payment or any part thereof to a use other than for the use and benefit of such other person, (5) presents or causes to be presented a claim for a physician’s service for which payment may be made under a Federal health care program and knows that the individual who furnished the service was not licensed as a physician, or (6) for a fee knowingly and willfully counsels or assists an individual to dispose of assets (including by any transfer in trust) in order for the individual to become eligible for medical assistance under a State plan under subchapter XIX, if disposing of the assets results in the imposition of a per

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

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

42 U.S.C. § 1396h — State false claims act requirements for

Page 4217 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396i (Aug. 14, 1935, ch. 531, title XIX, § 1908A, formerly § 1908, as added Pub. L. 103–66, title XIII, § 13623(b), Aug. 10, 1993, 107 Stat. 633, renumbered § 1908A, Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 608(y)(1)], Nov. 29, 1999, 113 Stat. 1536, 1501A–398.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Pub. L. 103–66, title XIII, § 13623(c), Aug. 10, 1993, 107 Stat. 635, provided that: ‘‘(1) Except as provided in paragraph (2), the amend- ments made by this section [enacting this section and amending section 1396a of this title] apply to calendar quarters beginning on or after April 1, 1994, without re- gard to whether or not final regulations to carry out such amendments have been promulgated by such date. ‘‘(2) In the case of a State plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] which the Secretary of Health and Human Services determines re- quires State legislation in order for the plan to meet the additional requirements imposed by the amend- ments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act [Aug. 10, 1993]. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a sepa- rate regular session of the State legislature.’’ § 1396h. State false claims act requirements for increased State share of recoveries (a) In general Notwi

Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1396h

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