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42 U.S.C. § 18033 — Financial integrity

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

42 U.S.C. § 18033 — Financial integrity

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18033

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Stable record: federal_law:legal_authorities:record_usc_fb717fddf2e92eec5935188b
Source file: Laws/federal/codes/united-states-code/title-42/section-18033-financial-integrity--73fe684ec1.md
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Source location: Title 42, Chapter 157, § 18033; chapter-157-quality-affordable-health-care-for-all-americans.md

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**(a) Accounting for expenditures** (1) **In general** — An Exchange shall keep an accurate accounting of all activities, receipts, and expenditures and shall annually submit to the Secretary a report concerning such accountings. (2) **Investigations** — The Secretary, in coordination with the Inspector General of the Department of Health and Human Services, may investigate the affairs of an Exchange, may examine the properties and records of an Exchange, and may require periodic reports in relation to activities undertaken by an Exchange. An Exchange shall fully cooperate in any investigation conducted under this paragraph. (3) **Audits** — An Exchange shall be subject to annual audits by the Secretary. (4) **Pattern of abuse** — If the Secretary determines that an Exchange or a State has engaged in serious misconduct with respect to compliance with the requirements of, or carrying out of activities required under, this title,11 See References in Text note below. the Secretary may rescind from payments otherwise due to such State involved under this or any other Act administered by the Secretary an amount not to exceed 1 percent of such payments per year until corrective actions are taken by the State that are determined to be adequate by the Secretary. (5) **Protections against fraud and abuse** — With respect to activities carried out under this title,1 the Secretary shall provide for the efficient and non-discriminatory administration of Exchange activities and implement any measure or procedure that— (A) the Secretary determines is appropriate to reduce fraud and abuse in the administration of this title; 1 and (B) the Secretary has authority to implement under this title 1 or any other Act. (6) **Application of the False Claims Act** (A) *In general* — Payments made by, through, or in connection with an Exchange are subject to the False Claims Act ([31 U.S.C. 3729](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section3729&num=0&edition=prelim) et seq.) if those payments include any Federal funds. Compliance with the requirements of this Act concerning eligibility for a health insurance issuer to participate in the Exchange shall be a material condition of an issuer’s entitlement to receive payments, including payments of premium tax credits and cost-sharing reductions, through the Exchange. (B) *22 See Termination of Provision note below. Damages* — Notwithstanding paragraph (1) of [section 3729(a) of title 31](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section3729/a&num=0&edition=prelim), and subject to paragraph (2) of such section, the civil penalty assessed under the False Claims Act on any person found liable under such Act as described in subparagraph (A) shall be increased by not less than 3 times and not more than 6 times the amount of damages which the Government sustains because of the act of that person. **(b) GAO oversight** Not later than 5 years after the first date on which Exchanges are required to be operational under this title,1 the Comptroller General shall conduct an ongoing study of Exchange activities and the enrollees in qualified health plans offered through Exchanges. Such study shall review— (1) the operations and administration of Exchanges, including surveys and reports of qualified health plans offered through Exchanges and on the experience of such plans (including data on enrollees in Exchanges and individuals purchasing health insurance coverage outside of Exchanges), the expenses of Exchanges, claims statistics relating to qualified health plans, complaints data relating to such plans, and the manner in which Exchanges meet their goals; (2) any significant observations regarding the utilization and adoption of Exchanges; (3) where appropriate, recommendations for improvements in the operations or policies of Exchanges; (4) a survey of the cost and affordability of health care insurance provided under the Exchanges for owners and employees of small business concerns (as defined under [section 632 of title 15](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section632&num=0&edition=prelim)), including data on enrollees in Exchanges and individuals purchasing health insurance coverage outside of Exchanges; and (5) how many physicians, by area and specialty, are not taking or accepting new patients enrolled in Federal Government health care programs, and the adequacy of provider networks of Federal Government health care programs.

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

42 U.S.C. § 18001 — Immediate access to insurance for uninsured individuals with a preexisting condition

**(a) In general** Not later than 90 days after March 23, 2010, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014. **(b) Administration** (1) **In general** — The Secretary may carry out the program under this section directly or through contracts to eligible entities. (2) **Eligible entities** — To be eligible for a contract under paragraph (1), an entity shall— (A) be a State or nonprofit private entity; (B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and (C) agree to utilize contract funding to establish and administer a qualified high risk pool for eligible individuals. (3) **Maintenance of effort** — To be eligible to enter into a contract with the Secretary under this subsection, a State shall agree not to reduce the annual amount the State expended for the operation of one or more State high risk pools during the year preceding the year in which such contract is entered into. **(c) Qualified high risk pool** (1) **In general** — Amounts made available under this section shall be used to establish a qualified high risk pool that meets the requirements of paragraph (2). (2) **Requirements** — A qualified high risk pool meets the requirements of this paragraph if such pool— (A) provides to all eligible individuals health insurance coverage that does not impose any preexisting condition exclusion with respect to such coverage; (B) provides health insurance coverage— (i) in which the issuer’s share of the total allowed costs of benefits provided under such co

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18001

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

15 U.S.C. § 632 — Definitions

**(a) Small business concerns** (1) **In general** — For the purposes of this chapter, a small-business concern, including but not limited to enterprises that are engaged in the business of production of food and fiber, ranching and raising of livestock, aquaculture, and all other farming and agricultural related industries, shall be deemed to be one which is independently owned and operated and which is not dominant in its field of operation. (2) **Establishment of size standards** (A) *In general* — In addition to the criteria specified in paragraph (1) and subject to the requirements specified under subparagraph (C), the Administrator may specify detailed definitions or standards by which a business concern may be determined to be a small business concern for the purposes of this chapter or any other Act. (B) *Additional criteria* — The standards described in paragraph (1) may utilize number of employees, dollar volume of business, net worth, net income, a combination thereof, or other appropriate factors. (C) *Requirements* — Unless specifically authorized by statute, no Federal department (including the Administration when acting pursuant to subparagraph (A)) or agency may prescribe a size standard for categorizing a business concern as a small business concern, unless such proposed size standard— (i) is proposed after an opportunity for public notice and comment; (ii) provides for determining— (I) the size of a manufacturing concern as measured by the manufacturing concern’s average employment based upon employment during each of the manufacturing concern’s pay periods for the preceding 24 months; (II) the size of a business concern providing services on the basis of the annual average gross receipts of the business concern over

Source: Supplied U.S. Code snapshot — release unconfirmed · 15 U.S.C. § 632

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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

31 U.S.C. § 3729 — False claims

Page 335 TITLE 31—MONEY AND FINANCE § 3729 1 So in original. Probably should be ‘‘101–410’’. costs of bringing a civil action for the debt if the plaintiff denies the debt or does not agree to the setoff; and (B) have a civil action brought if one has not already been brought. (c) If the Government loses a civil action to recover a debt or recovers less than the amount the Secretary withholds under this section, the Secretary shall pay the plaintiff the balance and interest of 6 percent for the time the money is withheld. (Pub. L. 97–258, Sept. 13, 1982, 96 Stat. 977; Pub. L. 104–316, title II, § 202(p), Oct. 19, 1996, 110 Stat. 3844.) HISTORICAL AND REVISION NOTES Revised Section Source (U.S. Code) Source (Statutes at Large) 3728(a) ..... 31:227(1st sentence words before semicolon). Mar. 3, 1875, ch. 149, 18 Stat. 481; restated Mar. 3, 1933, ch. 212, § 13, 47 Stat. 1516. 3728(b) ..... 31:227(1st sentence words after semi- colon, 2d, 3d sen- tences). 3728(c) ..... 31:227(last sen- tence). In the section, the words ‘‘of the United States’’ are omitted as unnecessary. In subsection (a), the words ‘‘final . . . recovered . . . duly allowed by legal authority’’, ‘‘for payment’’, and ‘‘in any manner, whether as principal or surety’’ are omitted as surplus. In subsection (b)(1), the words ‘‘due from the plaintiff to the United States’’ are omitted as surplus. In subsection (b)(2)(A), the words ‘‘of such judgment’’, ‘‘be sufficient to’’, and ‘‘charges and’’ are omitted as surplus. The words ‘‘of bringing a civil action’’ are sub- stituted for ‘‘in prosecuting the debt’’ for consistency in the revised title and with other titles of the United States Code. The words ‘‘of the United States to final judgment’’ and ‘‘to the United States’’ ar

Source: Supplied 2024 U.S. Code historical extraction · 31 U.S.C. § 3729

Stored review status: historical_2024_not_currentness_verified. The source passage cites 31 U.S.C. § 3729. This identifies an authority to review, not proof of applicability.

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

42 U.S.C. § 18033 — Financial integrity

Page 9112 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 18033 1 See References in Text note below. 2 See Termination of Provision note below. Subsec. (f)(1)(A)(ii). Pub. L. 111–148, § 10104(i)(3), struck out ‘‘(except with respect to territorial agree- ments under this subsection)’’ before period at end. § 18033. Financial integrity (a) Accounting for expenditures (1) In general An Exchange shall keep an accurate ac- counting of all activities, receipts, and ex- penditures and shall annually submit to the Secretary a report concerning such account- ings. (2) Investigations The Secretary, in coordination with the In- spector General of the Department of Health and Human Services, may investigate the af- fairs of an Exchange, may examine the prop- erties and records of an Exchange, and may re- quire periodic reports in relation to activities undertaken by an Exchange. An Exchange shall fully cooperate in any investigation con- ducted under this paragraph. (3) Audits An Exchange shall be subject to annual au- dits by the Secretary. (4) Pattern of abuse If the Secretary determines that an Ex- change or a State has engaged in serious mis- conduct with respect to compliance with the requirements of, or carrying out of activities required under, this title,1 the Secretary may rescind from payments otherwise due to such State involved under this or any other Act ad- ministered by the Secretary an amount not to exceed 1 percent of such payments per year until corrective actions are taken by the State that are determined to be adequate by the Secretary. (5) Protections against fraud and abuse With respect to activities carried out under this title,1 the Secretary shall provide for the efficient and non-discriminatory administra- tion of Exchange activities

Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 18033

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