Page:United States Statutes at Large Volume 101 Part 1.djvu/712

 101 STAT. 682 42 USC 1395.

Contracts. 42 USC 1396b. 42 USC 1396. 42 USC 1396n.

42 USC 1395mm.

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PUBLIC LAW 100-93—AUG. 18, 1987 based on charges or cost) under title XVIII or a State health care program containing charges (or, in applicable cases, requests for payment of costs) for items or services furnished substantially in excess of such individual's or entity's usual charges (or, in applicable cases, substantially in excess of such individual's or entity's costs) for such items or services, unless the Secretary finds there is good cause for such bills or requests containing such charges or costs; "(B) has furnished or caused to be furnished items or services to patients (whether or not eligible for benefits under title XVIII or under a State health care program) substantially in excess of the needs of such patients or of a quality which fails to meet professionally recognized standards of health care; "(C) is— "(i) a health maintenance organization (as defined in section 1903(m)) providing items and services under a State plan approved under title XIX, or "(ii) an entity furnishing services under a waiver approved under section 1915(bKl), and has failed substantially to provide medically necessary items and services that are required (under law or the contract with the State under title XIX) to be provided to individuals covered under that plan or waiver, if the failure has adversely affected (or has a substantial likelihood of adversely affecting) these individuals; or "(D) is an entity providing items and services as an eligible organization under a risk-sharing contract under section 1876 and has failed substantially to provide medically necessary items and services that are required (under law or such contract) to be provided to individuals covered under the risk-sharing contract, if the failure has adversely affected (or has a substantial likelihood of adversely affecting) these individuals. "(7) FRAUD, KICKBACKS, AND OTHER PROHIBITED ACTIVITIES.—

Post, pp. 686-688. Post, p. 689.

42 USC 1320a-3. Post, p. 692.

Any individual or entity that the Secretary determines has committed an act which is described in section 1128A or section 1128B. "(8) ENTITIES CONTROLLED BY A SANCTIONED INDIVIDUAL.—Any

entity with respect to which the Secretary determines that a person— "(A)(i) with an ownership or control interest (as defined in section 1124(a)(3)) in that entity, or "(ii) who is an officer, director, agent, or managing employee (as defined in section 1126(b)) of that entity— is a person— "(B)(i) who has been convicted of any offense described in subsection (a) or in paragraph (1), (2), or (3) of this subsection; "(ii) against whom a civil monetary penalty has been assessed under section 1128A; or "(iii) who has been excluded from participation under a program under title XVIII or under a State health care program. "(9) FAILURE TO DISCLOSE REQUIRED INFORMATION.—Any entity that did not fully and accurately make any disclosure required by section 1124 or section 1126.

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