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42 U.S.C. § 1320c–9 — Prohibition against disclosure of information

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

42 U.S.C. § 1320c–9 — Prohibition against disclosure of information

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1320c–9

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Stable record: federal_law:legal_authorities:record_usc_ced901630f1cf9c68ad69f77
Source file: Laws/federal/codes/united-states-code/title-42/section-1320c9-prohibition-against-disclosure-of-information--46ec6cfe63.md
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Source location: Title 42, Chapter 7, § 1320c–9; chapter-007-social-security.md

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**(a) Freedom of Information Act inapplicable; exceptions to nondisclosure** An organization, in carrying out its functions under a contract entered into under this part, shall not be a Federal agency for purposes of the provisions of [section 552 of title 5](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section552&num=0&edition=prelim) (commonly referred to as the Freedom of Information Act). Any data or information acquired by any such organization in the exercise of its duties and functions shall be held in confidence and shall not be disclosed to any person except— (1) to the extent that may be necessary to carry out the purposes of this part, (2) in such cases and under such circumstances as the Secretary shall by regulations provide to assure adequate protection of the rights and interests of patients, health care practitioners, or providers of health care, or (3) in accordance with subsection (b). **(b) Disclosure of information permitted** An organization having a contract with the Secretary under this part shall provide in accordance with procedures and safeguards established by the Secretary, data and information— (1) which may identify specific providers or practitioners as may be necessary— (A) to assist Federal and State agencies recognized by the Secretary as having responsibility for identifying and investigating cases or patterns of fraud or abuse, which data and information shall be provided by the quality improvement organization to any such agency at the request of such agency relating to a specific case or pattern; (B) to assist appropriate Federal and State agencies recognized by the Secretary as having responsibility for identifying cases or patterns involving risks to the public health, which data and information shall be provided by the quality improvement organization to any such agency— (i) at the discretion of the quality improvement organization, at the request of such agency relating to a specific case or pattern with respect to which such agency has made a finding, or has a reasonable belief, that there may be a substantial risk to the public health, or (ii) upon a finding by, or the reasonable belief of, the quality improvement organization that there may be a substantial risk to the public health; (C) to assist appropriate State agencies recognized by the Secretary as having responsibility for licensing or certification of providers or practitioners or to assist national accreditation bodies acting pursuant to [section 1395bb of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395bb&num=0&edition=prelim) in accrediting providers for purposes of meeting the conditions described in subchapter XVIII, which data and information shall be provided by the quality improvement organization to any such agency or body at the request of such agency or body relating to a specific case or to a possible pattern of substandard care, but only to the extent that such data and information are required by the agency or body to carry out its respective function which is within the jurisdiction of the agency or body under State law or under [section 1395bb of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395bb&num=0&edition=prelim); and (D) to provide notice in accordance with [section 1320c–3(a)(9)(B) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320c–3/a/9/B&num=0&edition=prelim); (2) to assist the Secretary, and such Federal and State agencies recognized by the Secretary as having health planning or related responsibilities under Federal or State law (including health systems agencies and State health planning and development agencies), in carrying out appropriate health care planning and related activities, which data and information shall be provided in such format and manner as may be prescribed by the Secretary or agreed upon by the responsible Federal and State agencies and such organization, and shall be in the form of aggregate statistical data (without explicitly identifying any individual) on a geographic, institutional, or other basis reflecting the volume and frequency of services furnished, as well as the demographic characteristics of the population subject to review by such organization. The penalty provided in subsection (c) shall not apply to the disclosure of any information received under this subsection, except that such penalty shall apply to the disclosure (by the agency receiving such information) of any such information described in paragraph (1) unless such disclosure is made in a judicial, administrative, or other formal legal proceeding resulting from an investigation conducted by the agency receiving the information. An organization may require payment of a reasonable fee for providing information under this subsection in response to a request for such information. **(c) Penalties** It shall be unlawful for any person to disclose any such information described in subsection (a) other than for the purposes provided in subsections (a) and (b), and any person violating the provisions of this section shall, upon conviction, be fined not more than $1,000, and imprisoned for not more than 6 months, or both, and shall be required to pay the costs of prosecution. **(d) Subpoena and discovery proceedings regarding patient records** No patient record in the possession of an organization having a contract with the Secretary under this part shall be subject to subpoena or discovery proceedings in a civil action. No document or other information produced by such an organization in connection with its deliberations in making determinations under section 1320c–3(a)(1)(B) or 1320c–5(a)(2) of this title shall be subject to subpoena or discovery in any administrative or civil proceeding; except that such an organization shall provide, upon request of a practitioner or other person adversely affected by such a determination, a summary of the organization’s findings and conclusions in making the determination. **(e) Organizations with contracts** For purposes of this section and [section 1320c–6 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320c-6&num=0&edition=prelim), the term “organization with a contract with the Secretary under this part” includes an entity with a contract with the Secretary under section 1320c–3(a)(4)(C) 11 See References in Text note below. of this title.

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

1 U.S.C. § 106 — Printing bills and joint resolutions

Every bill or joint resolution in each House of Congress shall, when such bill or resolution passes either House, be printed, and such printed copy shall be called the engrossed bill or resolution as the case may be. Said engrossed bill or resolution shall be signed by the Clerk of the House or the Secretary of the Senate, and shall be sent to the other House, and in that form shall be dealt with by that House and its officers, and, if passed, returned signed by said Clerk or Secretary. When such bill, or joint resolution shall have passed both Houses, it shall be printed and shall then be called the enrolled bill, or joint resolution, as the case may be, and shall be signed by the presiding officers of both Houses and sent to the President of the United States. During the last six days of a session such engrossing and enrolling of bills and joint resolutions may be done otherwise than as above prescribed, upon the order of Congress by concurrent resolution.

Source: Supplied U.S. Code snapshot — release unconfirmed · 1 U.S.C. § 106

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

5 U.S.C. § 552 — Public information; agency rules, opinions, orders, records, and proceedings

**(a)** Each agency shall make available to the public information as follows: (1) Each agency shall separately state and currently publish in the Federal Register for the guidance of the public— (A) descriptions of its central and field organization and the established places at which, the employees (and in the case of a uniformed service, the members) from whom, and the methods whereby, the public may obtain information, make submittals or requests, or obtain decisions; (B) statements of the general course and method by which its functions are channeled and determined, including the nature and requirements of all formal and informal procedures available; (C) rules of procedure, descriptions of forms available or the places at which forms may be obtained, and instructions as to the scope and contents of all papers, reports, or examinations; (D) substantive rules of general applicability adopted as authorized by law, and statements of general policy or interpretations of general applicability formulated and adopted by the agency; and (E) each amendment, revision, or repeal of the foregoing. Except to the extent that a person has actual and timely notice of the terms thereof, a person may not in any manner be required to resort to, or be adversely affected by, a matter required to be published in the Federal Register and not so published. For the purpose of this paragraph, matter reasonably available to the class of persons affected thereby is deemed published in the Federal Register when incorporated by reference therein with the approval of the Director of the Federal Register. (2) Each agency, in accordance with published rules, shall make available for public inspection in an electronic format— (A) final opinions, including concurring and dissen

Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 552

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

42 U.S.C. § 1395bb — Application to Medicare Advantage program and related managed care programs

**(a) Special rules relating to offering of qualified prescription drug coverage** (1) **In general** — An MA organization on and after January 1, 2006— (A) may not offer an MA plan described in [section 1395w–21(a)(2)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/a/2/A&num=0&edition=prelim) in an area unless either that plan (or another MA plan offered by the organization in that same service area) includes required prescription drug coverage (as defined in paragraph (2)); and (B) may not offer prescription drug coverage (other than that required under parts A and B) to an enrollee— (i) under an MSA plan; or (ii) under another MA plan unless such drug coverage under such other plan provides qualified prescription drug coverage and unless the requirements of this section with respect to such coverage are met. (2) **Qualifying coverage** — For purposes of paragraph (1)(A), the term “required coverage” means with respect to an MA–PD plan— (A) basic prescription drug coverage; or (B) qualified prescription drug coverage that provides supplemental prescription drug coverage, so long as there is no MA monthly supplemental beneficiary premium applied under the plan (due to the application of a credit against such premium of a rebate under [section 1395w–24(b)(1)(C) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–24/b/1/C&num=0&edition=prelim)). **(b) Application of default enrollment rules** (1) **Seamless continuation** — In applying [section 1395w–21(c)(3)(A)(ii) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/c/3/A/ii&num=0&edition=prelim), an individual who is enrolled in a health benefits p

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395bb

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

42 U.S.C. § 1320c — Purpose

The purpose of this part is to establish the contracting process which the Secretary must follow pursuant to the requirements of [section 1395y(g) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395y/g&num=0&edition=prelim), including the definition of the quality improvement organizations with which the Secretary shall contract, the functions such quality improvement organizations are to perform, the confidentiality of medical records, and related administrative matters to facilitate the carrying out of the purposes of this part.

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

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