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18 U.S.C. § 220 — Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories
Federal law — U.S. Code and appendices · legal_authorities
**(a) Offense.—** Except as provided in subsection (b), whoever, with respect to services covered by a health care benefit program, in or affecting interstate or foreign commerce, knowingly and willfully—
(1) solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind, in return for referring a patient or patronage to a recovery home, clinical treatment facility, or laboratory; or
(2) pays or offers any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind—
(A) to induce a referral of an individual to a recovery home, clinical treatment facility, or laboratory; or
(B) in exchange for an individual using the services of that recovery home, clinical treatment facility, or laboratory,
shall be fined not more than $200,000, imprisoned not more than 10 years, or both, for each occurrence.
**(b) Applicability.—** Subsection (a) shall not apply to—
(1) a discount or other reduction in price obtained by a provider of services or other entity under a health care benefit program if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity;
(2) a payment made by an employer to an employee or independent contractor (who has a bona fide employment or contractual relationship with such employer) for employment, if the employee’s payment is not determined by or does not vary by—
(A) the number of individuals referred to a particular recovery home, clinical treatment facility, or laboratory;
(B) the number of tests or procedures performed; or
(C) the amount billed to or received from, in part or in whole, the health care benefit program from
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Source location: Title 18, Chapter 11, § 220; chapter-011-bribery-graft-and-conflicts-of-interest.md
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**(a) Offense.—** Except as provided in subsection (b), whoever, with respect to services covered by a health care benefit program, in or affecting interstate or foreign commerce, knowingly and willfully—
(1) solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind, in return for referring a patient or patronage to a recovery home, clinical treatment facility, or laboratory; or
(2) pays or offers any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind—
(A) to induce a referral of an individual to a recovery home, clinical treatment facility, or laboratory; or
(B) in exchange for an individual using the services of that recovery home, clinical treatment facility, or laboratory,
shall be fined not more than $200,000, imprisoned not more than 10 years, or both, for each occurrence.
**(b) Applicability.—** Subsection (a) shall not apply to—
(1) a discount or other reduction in price obtained by a provider of services or other entity under a health care benefit program if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity;
(2) a payment made by an employer to an employee or independent contractor (who has a bona fide employment or contractual relationship with such employer) for employment, if the employee’s payment is not determined by or does not vary by—
(A) the number of individuals referred to a particular recovery home, clinical treatment facility, or laboratory;
(B) the number of tests or procedures performed; or
(C) the amount billed to or received from, in part or in whole, the health care benefit program from the individuals referred to a particular recovery home, clinical treatment facility, or laboratory;
(3) a discount in the price of an applicable drug of a manufacturer that is furnished to an applicable beneficiary under the Medicare coverage gap discount program under section 1860D–14A(g) of the Social Security Act ([42 U.S.C. 1395w–114a(g)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–114a/g&num=0&edition=prelim));
(4) a payment made by a principal to an agent as compensation for the services of the agent under a personal services and management contract that meets the requirements of section 1001.952(d) of title 42, Code of Federal Regulations, as in effect on the date of enactment of this section;
(5) a waiver or discount (as defined in section 1001.952(h)(5) of title 42, Code of Federal Regulations, or any successor regulation) of any coinsurance or copayment by a health care benefit program if—
(A) the waiver or discount is not routinely provided; and
(B) the waiver or discount is provided in good faith;
(6) a remuneration described in section 1128B(b)(3)(I) of the Social Security Act ([42 U.S.C. 1320a–7b(b)(3)(I)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a–7b/b/3/I&num=0&edition=prelim));
(7) a remuneration made pursuant to an alternative payment model (as defined in section 1833(z)(3)(C) of the Social Security Act) or pursuant to a payment arrangement used by a State, health insurance issuer, or group health plan if the Secretary of Health and Human Services has determined that such arrangement is necessary for care coordination or value-based care; or
(8) any other payment, remuneration, discount, or reduction as determined by the Attorney General, in consultation with the Secretary of Health and Human Services, by regulation.
**(c) Regulations.—** The Attorney General, in consultation with the Secretary of Health and Human Services, may promulgate regulations to clarify the exceptions described in subsection (b).
**(d) Preemption.—**
(1) **Federal law.—** — This section shall not apply to conduct that is prohibited under section 1128B of the Social Security Act ([42 U.S.C. 1320a–7b](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a–7b&num=0&edition=prelim)).
(2) **State law.—** — Nothing in this section shall be construed to occupy the field in which any provisions of this section operate to the exclusion of State laws on the same subject matter.
**(e) Definitions.—** In this section—
(1) the terms “applicable beneficiary” and “applicable drug” have the meanings given those terms in section 1860D–14A(g) of the Social Security Act ([42 U.S.C. 1395w–114a(g)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–114a/g&num=0&edition=prelim));
(2) the term “clinical treatment facility” means a medical setting, other than a hospital, that provides detoxification, risk reduction, outpatient treatment and care, residential treatment, or rehabilitation for substance use, pursuant to licensure or certification under State law;
(3) the term “health care benefit program” has the meaning given the term in section 24(b);
(4) the term “laboratory” has the meaning given the term in section 353 of the Public Health Service Act ([42 U.S.C. 263a](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section263a&num=0&edition=prelim)); and
(5) the term “recovery home” means a shared living environment that is, or purports to be, free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders.
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Federal law — U.S. Code and appendices · legal_authorities
**(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
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Federal law — U.S. Code and appendices · legal_authorities
**(a) “Laboratory” or “clinical laboratory” defined** As used in this section, the term “laboratory” or “clinical laboratory” means a facility for the biological, microbiological, serological, chemical, immuno-hematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings.
**(b) Certificate requirement** No person may solicit or accept materials derived from the human body for laboratory examination or other procedure unless there is in effect for the laboratory a certificate issued by the Secretary under this section applicable to the category of examinations or procedures which includes such examination or procedure.
**(c) Issuance and renewal of certificates**
(1) **In general** — The Secretary may issue or renew a certificate for a laboratory only if the laboratory meets the requirements of subsection (d).
(2) **Term** — A certificate issued under this section shall be valid for a period of 2 years or such shorter period as the Secretary may establish.
**(d) Requirements for certificates**
(1) **In general** — A laboratory may be issued a certificate or have its certificate renewed if—
(A) the laboratory submits (or if the laboratory is accredited under subsection (e), the accreditation body which accredited the laboratory submits), an application—
(i) in such form and manner as the Secretary shall prescribe,
(ii) that describes the characteristics of the laboratory examinations and other procedures performed by the laboratory including—
(I) the number and types of laboratory examinations and other procedures
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 263a
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Federal law — U.S. Code and appendices · legal_authorities
### Statutory Notes
Section, acts June 25, 1948, ch. 645, 62 Stat. 684; Oct. 30, 1984, Pub. L. 98–596, § 8, 98 Stat. 3138, classified offenses as a felony, misdemeanor, or petty offense.
#### Effective Date of Repeal
Repeal of section effective Nov. 1, 1987, and applicable only to offenses committed after the taking effect of such repeal, see section 235(a)(1) of Pub. L. 98–473, set out as an Effective Date note under [section 3551 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title18-section3551&num=0&edition=prelim).
#### Short Title of 2026 Amendment
Pub. L. 119–73, § 1, Jan. 23, 2026, 139 Stat. 2003, provided that: “This Act [enacting sections 28 and 3771A of this title, amending [section 7102 of Title 22](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title22-section7102&num=0&edition=prelim), Foreign Relations and Intercourse, and enacting provisions set out as notes under [section 28 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title18-section28&num=0&edition=prelim) and [section 10110 of Title 34](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title34-section10110&num=0&edition=prelim), Crime Control and Law Enforcement] may be cited as the ‘Trafficking Survivors Relief Act’.”
#### Short Title of 2024 Amendment
Pub. L. 118–78, § 1, July 30, 2024, 138 Stat. 1512, provided that: “This Act [enacting [section 1352 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title18-section1352&num=0&edition=prelim) and amending [section 201 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title18-section201&num=0&edition=prelim)] may be cited as the ‘Foreign Extortion Prevention Technical Corrections Act’.”
Pub. L. 118–77, § 1, July
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Federal law — U.S. Code and appendices · legal_authorities
Page 84
TITLE 18—CRIMES AND CRIMINAL PROCEDURE
§ 219
tion 218 of title 18 of the United States Code in relation
to which there has been a final conviction for any vio-
lation of chapter 11 of title 18.
SEC. 2. The head of each Executive department and
agency described in section 1 may exercise the author-
ity hereby delegated by promulgating implementing
regulations; provided that the Secretary of Defense, the
Administrator of General Services and the Adminis-
trator of the National Aeronautics and Space Adminis-
tration jointly shall issue government-wide imple-
menting regulations related to voiding or rescission of
contracts.
SEC. 3. Implementing regulations adopted pursuant to
this Order shall, at a minimum, provide the following
procedural protections:
(a) Written notice of the proposed action shall be
given in each case to the person or entity affected;
(b) The person or entity affected shall be afforded an
opportunity to submit pertinent information on its be-
half before a final decision is made;
(c) Upon the request of the person or entity affected,
a hearing shall be held at which it shall have the oppor-
tunity to call witnesses on its behalf and confront any
witness the agency may present; and
(d) The head of the agency or his designee shall issue
a final written decision specifying the amount of res-
titution or any other remedy authorized by section 218,
provided that such remedy shall take into consider-
ation the fair value of any tangible benefits received
and retained by the agency.
RONALD REAGAN.
§ 219. Officers and employees acting as agents of
foreign principals
(a) Whoever, being a public official, is or acts
as an agent of a foreign principal required to
register under the Foreign Agents Registration
Act of 1938 or a lob
Source: Supplied 2024 U.S. Code historical extraction · 18 U.S.C. § 220
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.
Federal law — U.S. Code and appendices · legal_authorities
**(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
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1320a
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Federal law — U.S. Code and appendices · legal_authorities
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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Federal law — U.S. Code and appendices · legal_authorities
**(a) Amounts** Except as provided in [section 1395mm of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395mm&num=0&edition=prelim), and subject to the succeeding provisions of this section, there shall be paid from the Federal Supplementary Medical Insurance Trust Fund, in the case of each individual who is covered under the insurance program established by this part and incurs expenses for services with respect to which benefits are payable under this part, amounts equal to—
(1) in the case of services described in [section 1395k(a)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395k/a/1&num=0&edition=prelim)—80 percent of the reasonable charges for the services; except that (A) an organization which provides medical and other health services (or arranges for their availability) on a prepayment basis (and either is sponsored by a union or employer, or does not provide, or arrange for the provision of, any inpatient hospital services) may elect to be paid 80 percent of the reasonable cost of services for which payment may be made under this part on behalf of individuals enrolled in such organization in lieu of 80 percent of the reasonable charges for such services if the organization undertakes to charge such individuals no more than 20 percent of such reasonable cost plus any amounts payable by them as a result of subsection (b), (B) with respect to items and services described in [section 1395x(s)(10)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/s/10/A&num=0&edition=prelim), the amounts paid shall be 100 percent of the reasonable charges for such items and services, (C) with respect to expenses incurred for those physicians
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395w
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Federal law — U.S. Code and appendices · legal_authorities
Page 3243
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1395w
1 See References in Text note below.
mentary medical insurance program established under
part B of title XVIII of the Social Security Act [42
U.S.C. 1395 et seq.], and (2) provisions will be made for
payment of the monthly premiums of such individuals
for such program.’’
§ 1395w. Appropriations to cover Government
contributions and contingency reserve
(a) In general
There are authorized to be appropriated from
time to time, out of any moneys in the Treasury
not otherwise appropriated, to the Federal Sup-
plementary Medical Insurance Trust Fund—
(1)(A) a Government contribution equal to
the aggregate premiums payable for a month
for enrollees age 65 and over under this part
and deposited in the Trust Fund, multiplied by
the ratio of—
(i) twice the dollar amount of the actuari-
ally adequate rate per enrollee age 65 and
over as determined under section 1395r(a)(1)
of this title for such month minus the dollar
amount of the premium per enrollee for such
month,
as
determined
under
section
1395r(a)(3) of this title, to
(ii) the dollar amount of the premium per
enrollee for such month, plus
(B) a Government contribution equal to the
aggregate premiums payable for a month for
enrollees under age 65 under this part and de-
posited in the Trust Fund, multiplied by the
ratio of—
(i) twice the dollar amount of the actuari-
ally adequate rate per enrollee under age 65
as determined under section 1395r(a)(4) of
this title for such month minus the dollar
amount of the premium per enrollee for such
month,
as
determined
under
section
1395r(a)(3) of this title, to
(ii) the dollar amount of the premium per
enrollee for such month; minus
(C) the aggregate amount of additional pre-
mium payment
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1395w
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Federal law — U.S. Code and appendices · legal_authorities
Page 477
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 263a
(B) information related to development
programs for biological products, including
biosimilar biological products and inter-
changeable biosimilar biological products
and relevant clinical considerations for pre-
scribers, which may include, as appropriate
and applicable, information related to the
comparability of such biological products;
(C) an explanation of the process for re-
porting adverse events for biological prod-
ucts, including biosimilar biological prod-
ucts and interchangeable biosimilar biologi-
cal products; and
(D) an explanation of the relationship be-
tween biosimilar biological products and
interchangeable biosimilar biological prod-
ucts licensed under section 262(k) of this
title and reference products (as defined in
section 262(i) of this title), including the
standards for review and licensing of each
such type of biological product.
(3) Format
The educational materials provided under
paragraph (1) may be—
(A) in formats such as webinars, con-
tinuing education modules, videos, fact
sheets, infographics, stakeholder toolkits, or
other formats as appropriate and applicable;
and
(B) tailored for the unique needs of health
care providers, patients, caregivers, and
other audiences, as the Secretary deter-
mines appropriate.
(4) Other information
In addition to the information described in
paragraph (2), the Secretary shall continue to
publish—
(A) the action package of each biological
product licensed under subsection (a) or (k)
of section 262 of this title; or
(B) the summary review of each biological
product licensed under subsection (a) or (k)
of section 262 of this title.
(5) Confidential and trade secret information
This subsection does not authorize the di
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 263a
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