Source: https://www.law.cornell.edu/uscode/text/42/1320a%E2%80%937k
Timestamp: 2019-12-09 09:36:01
Document Index: 225792956

Matched Legal Cases: ['§ 1320', '§ 1320', '§ 1320', '§\u202f1320', '§\u202f1128', '§\u202f6402']

42 U.S. Code § 1320a–7k - Medicare and Medicaid program integrity provisions | US Law | LII / Legal Information Institute
U.S. Code › Title 42 › Chapter 7 › Subchapter XI › Part A › § 1320a–7k
42 U.S. Code § 1320a–7k - Medicare and Medicaid program integrity provisions
§ 1320a–7k.
Medicare and Medicaid program integrity provisions
(i) In generalThe Integrated Data Repository of the Centers for Medicare & Medicaid Services shall include, at a minimum, claims and payment data from the following:
The programs under subchapters XVIII and XIX (including parts A, B, C, and D of subchapter XVIII).
The program under subchapter XXI.
Health-relatedprograms administered by the Secretary of Veterans Affairs.
Health-relatedprograms administered by the Secretary of Defense.
The program of old-age, survivors, and disability insurance benefits established under subchapter II.
The Indian Health Service and the Contract Health Serviceprogram.
Inclusion of the data described in subclause (I) of such clause [1] in the Integrated Data Repository shall be a priority. Data described in subclauses (II) through (VI) of such clause [1] shall be included in the Integrated Data Repository as appropriate.
(ii) Individuals describedThe following individuals are described in this clause:
(1) In generalNotwithstanding and in addition to any other provision of law, the Inspector General of the Department of Health and Human Services may, for purposes of protecting the integrity of the programs under subchapters XVIII and XIX, obtain information from any individual (including a beneficiary provided all applicable privacy protections are followed) or entity that—
is a provider of medical or other items or services, supplier, grant recipient, contractor, or subcontractor; or
directly or indirectly provides, orders, manufactures, distributes, arranges for, prescribes, supplies, or receives medical or other items or services payable by any Federal health care program (as defined in section 1320a–7b(f) of this title) regardless of how the item or service is paid for, or to whom such payment is made.
Information which the Inspector General may obtain under paragraph (1) includes any supporting documentation necessary to validate claims for payment or payments under subchapter XVIII or XIX, including a prescribing physician’s medical records for an individual who is prescribed an item or service which is covered under part B of subchapter XVIII, a covered part D drug (as defined in section 1395w–102(e) of this title) for which payment is made under an MA–PD plan under part C of such subchapter, or a prescription drug plan under part D of such subchapter, and any records necessary for evaluation of the economy, efficiency, and effectiveness of the programs under subchapters XVIII and XIX.
(2) Applicable individualFor purposes of paragraph (1), the term “applicable individual” means an individual—
entitled to, or enrolled for, benefits under part A of subchapter XVIII or enrolled under part B of such subchapter;
eligible for medical assistance under a State plan under subchapter XIX or under a waiver of such plan; or
eligible for child health assistance under a child health plan under subchapter XXI.
(1) In generalIf a person has received an overpayment, the person shall—
(2) Deadline for reporting and returning overpaymentsAn overpayment must be reported and returned under paragraph (1) by the later of—
The terms “knowing” and “knowingly” have the meaning given those terms in section 3729(b) of title 31.
The term “overpayment” means any funds that a person receives or retains under subchapter XVIII or XIX to which the person, after applicable reconciliation, is not entitled under such subchapter.
The term “person” means a provider of services, supplier, medicaid managed care organization (as defined in section 1396b(m)(1)(A) of this title), Medicare Advantage organization (as defined in section 1395w–28(a)(1) of this title), or PDP sponsor (as defined in section 1395w–151(a)(13) of this title).
(Aug. 14, 1935, ch. 531, title XI, § 1128J, as added Pub. L. 111–148, title VI, § 6402(a), Mar. 23, 2010, 124 Stat. 753.)
[1]  So in original. Probably should be “clause (i)”.