195 
Service, and Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations for the collection, prepara-
tion, and submission of applications by Indians for assist-
ance under the Medicaid and State children’s health insur-
ance programs established under titles XIX and XXI of 
the Social Security Act, and benefits under the Medicare 
program established under title XVIII of such Act, see 
subsections (a) and (b) of section 1139 of the Social Secu-
rity Act. 
‘‘(f) DEFINITION OF PREMIUMS AND COST SHAR-
ING.—In this section: 
‘‘(1) PREMIUM.—The term ‘premium’ includes 
any enrollment fee or similar charge. 
‘‘(2) COST SHARING.—The term ‘cost sharing’ 
includes any deduction, deductible, copayment, coin-
surance, or similar charge. 
‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR-
TIES OF COSTS OF HEALTH SERVICES. 
‘‘(a) RIGHT OF RECOVERY.—Except as provided in 
subsection (f), the United States, an Indian Tribe, or 
Tribal Organization shall have the right to recover from 
an insurance company, health maintenance organization, 
employee benefit plan, third-party tortfeasor, or any other 
responsible or liable third party (including a political sub-
division or local governmental entity of a State) the rea-
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196 
sonable charges billed by the Secretary, an Indian Tribe, 
or Tribal Organization in providing health services 
through the Service, an Indian Tribe, or Tribal Organiza-
tion to any individual to the same extent that such indi-
vidual, or any nongovernmental provider of such services, 
would be eligible to receive damages, reimbursement, or 
indemnification for such charges or expenses if— 
‘‘(1) such services had been provided by a non-
governmental provider; and 
‘‘(2) such individual had been required to pay 
such charges or expenses and did pay such charges 
or expenses. 
‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 
Subsection (a) shall provide a right of recovery against 
any State, only if the injury, illness, or disability for which 
health services were provided is covered under— 
‘‘(1) workers’ compensation laws; or 
‘‘(2) a no-fault automobile accident insurance 
plan or program. 
‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 
any State, or of any political subdivision of a State and 
no provision of any contract, insurance or health mainte-
nance organization policy, employee benefit plan, self-in-
surance plan, managed care plan, or other health care plan 
or program entered into or renewed after the date of the 
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enactment of the Indian Health Care Amendments of 
1988, shall prevent or hinder the right of recovery of the 
United States, an Indian Tribe, or Tribal Organization 
under subsection (a). 
‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 
No action taken by the United States, an Indian Tribe, 
or Tribal Organization to enforce the right of recovery 
provided under this section shall operate to deny to the 
injured person the recovery for that portion of the person’s 
damage not covered hereunder. 
‘‘(e) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The United States, an In-
dian Tribe, or Tribal Organization may enforce the 
right of recovery provided under subsection (a) by— 
‘‘(A) intervening or joining in any civil ac-
tion or proceeding brought— 
‘‘(i) by the individual for whom health 
services were provided by the Secretary, an 
Indian Tribe, or Tribal Organization; or 
‘‘(ii) by any representative or heirs of 
such individual, or 
‘‘(B) instituting a civil action, including a 
civil action for injunctive relief and other relief 
and including, with respect to a political sub-
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division or local governmental entity of a State, 
such an action against an official thereof. 
‘‘(2) NOTICE.—All reasonable efforts shall be 
made to provide notice of action instituted under 
paragraph (1)(B) to the individual to whom health 
services were provided, either before or during the 
pendency of such action. 
‘‘(3) RECOVERY FROM TORTFEASORS.— 
‘‘(A) IN GENERAL.—In any case in which 
an Indian Tribe or Tribal Organization that is 
authorized or required under a compact or con-
tract issued pursuant to the Indian Self-Deter-
mination and Education Assistance Act (25 
U.S.C. 450 et seq.) to furnish or pay for health 
services to a person who is injured or suffers a 
disease on or after the date of enactment of the 
Indian Health Care Improvement Act Amend-
ments of 2007 under circumstances that estab-
lish grounds for a claim of liability against the 
tortfeasor with respect to the injury or disease, 
the Indian Tribe or Tribal Organization shall 
have a right to recover from the tortfeasor (or 
an insurer of the tortfeasor) the reasonable 
value of the health services so furnished, paid 
for, or to be paid for, in accordance with the 
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Federal Medical Care Recovery Act (42 U.S.C. 
2651 et seq.), to the same extent and under the 
same circumstances as the United States may 
recover under that Act. 
‘‘(B) TREATMENT.—The right of an In-
dian Tribe or Tribal Organization to recover 
under subparagraph (A) shall be independent of 
the rights of the injured or diseased person 
served by the Indian Tribe or Tribal Organiza-
tion. 
‘‘(f) LIMITATION.—Absent specific written authoriza-
tion by the governing body of an Indian Tribe for the pe-
riod of such authorization (which may not be for a period 
of more than 1 year and which may be revoked at any 
time upon written notice by the governing body to the 
Service), the United States shall not have a right of recov-
ery under this section if the injury, illness, or disability 
for which health services were provided is covered under 
a self-insurance plan funded by an Indian Tribe, Tribal 
Organization, or Urban Indian Organization. Where such 
authorization is provided, the Service may receive and ex-
pend such amounts for the provision of additional health 
services consistent with such authorization. 
‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 
brought to enforce the provisions of this section, a pre-
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