Page:United States Statutes at Large Volume 100 Part 3.djvu/195

 PUBLIC LAW 99-509—OCT. 21, 1986

100 STAT. 2003

(A) in subsection (a), by inserting before "shall" the following: "and any other determination with respect to a claim for benefits under part A", and (B) in subsection (b)(1)— (i) by striking "or" at the end of subparagraph (B), (ii) by inserting ", or" at the end of subparagraph (C), and (iii) by inserting after subparagraph (C) the following new subparagraph: "(D) any other denial (other than under part B of title XI) of a claim for benefits under part A or a claim for benefits with respect to home health services under part B,". (2) EFFECTIVE DATE.—The amendments made by this subsection take effect on the date of the enactment of this Act.

42 USC 1320c.

42 USC 1395ff note.

(c) PROHIBITION OF CERTAIN PHYSICIAN INCENTIVE PLANS.— (1) M A K I N G CERTAIN PLANS SUBJECT TO CIVIL MONETARY PEN-

ALTIES.—Section 1128A of the Social Security Act (42 U.S.C. 1320a-7a) is amended— • ' (A) by striking "subsection (a)" each place it a p p e a r s and inserting "subsection (a) or (b)", vs>^: (B) in subsection (a)(1), by striking "(h)(1)" and "(h)(2)" and inserting "(i)(l)" and "(i)(2)", respectively, fc'i • (C) in subsection (f), by striking "subsection (d)" and inserting "subsection (e)", -• (D) by redesignating subsections (b) through (h) as subsections (c) through (i), respectively, and (E) by inserting after subsection (a) the following n e w subsection: "(b)(1) If a hospital, a n eligible organization with a risk-sharing contract under section 1876, or a n e n t i t y with a contract under section 1903(m) knowingly m a k e s a payment, directly or indirectly, to a physician a s a n i n d u c e m e n t to reduce or limit services provided with respect to individuals who— "(A) a r e entitled to benefits under part A or part B of title XVII or to medical assistance under a State plan approved under title XIX, "(B) in the case of a n eligible organization or a n entity, a r e enrolled with the organization or entity, and "(C) a r e under the direct care of the physician, the hospital or organization shall be subject, in addition to any other penalties that may be prescribed by law, to a civil money penalty of not more than $2,000 for each such individual with respect to whom the payment is m a d e. "(2) Any physician w h o knowingly accepts receipt of a payment described in paragraph (1) shall be subject, in addition to any other penalties that may be prescribed by law, to a civil money p e n a l t y of not more than $2,000 for individual described in such paragraph with respect to whom the payment is m a d e. " (2) EFFECTIVE DATE.—The amendments made by paragraph (1) shall apply to— V (A) payments by hospitals occurring more than 6 months after the date of the enactment of this Act, and (B) payments by eligible organizations or entities occurring on or after April 1, 1989. v3) STUDY.—The Secretary of Health and Human Services shall report to Congress, not later than January 1, 1988, concerning incentive arrangements offered by health mainte-

Post, p. 2008.

contracts. Ante, p. 1999. 42 USC 1396b.

State and local governments. 42 USC 300u. 42 USC 1396.

42 USC 1320a-7a note.

Reports. Health care professionals. 42 USC 1320a-7a note.

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