Page:United States Statutes at Large Volume 103 Part 3.djvu/113

 PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2181 services), specified by the Secretary, that are commonly performed or furnished by a physician or in a physician's office, but does not include services furnished to an HMO enrollee under a risk-sharing contract under section 1876. "(B) HMO ENROLLEE.—The term 'HMO enrollee' means, with respect to a fiscal year, an individual enrolled under this part who is enrolled with an entity under a risk- sharing contract under section 1876 in the fiscal year. '(g) LDOTATION ON BENEFICIABT LIABILITY.— "(1) LIMITATION ON ACTUAL CHARGES FOR UNASSIGNED CLAIMS.—If a nonparticipating physician knowingly and will- fully bills on a repeated basis for physicians' services (furnished with respect to an individual enrolled under this part on or after January 1, 1991) an actual charge in excess of the limiting charge descx^ped in paragraph (2) and for which payment is not made on an assignment-related basis under this part, the Sec- retary may apply sanctions against such physician in accord- ance with section 1842(j)(2). "(2) LIMITING CHARGE DEFINED.— "(A) FOR 1991.—For physicians' services of a physician furnished during 1991, the 'limiting charge' shall be the same percentage (or, if less, 25 percent) above the recog- nized payment amount under this part with respect to the physician (as a nonparticipating physician) as the percent- age by which— "(i) the maximum allowable actual charge (as deter- mined under section 1842(j)(l)(C) as of December 31, 1990, or, if less, the maximum actual charge otherwise permitted for the service under this part as of such date) for the service of the physician, exceeds "(ii) the recognized payment amount for the service of the physician (as a nonparticipating physician) as of such date. "(B) FOR 1992.—For physicians' services furnished during 1992, the 'limiting charge' shall be the same percentage (or, if less, 20 percent) above the recognized payment amount under this part for nonparticipating physicians as the percentage by which— "(i) the limiting chaise (as determined under subparagraph (A) as of Ik^^mber 31, 1991) for the service, exceeds "(ii) the reo^nized payment amount for the service for nonparticipating physicians as of such date. "(CD AFTER 1992.—For physicians' services furnished in a year after 1992, the 'limiting charge' shall be 115 percent of the recognized payment amount under this part for nonparticipating physicians. "G)) RECOGNIZED PAYMENT AMOUNT. —In this section, the term 'recognized payment amount' means, for services fur- nished on or after January 1, 1992, the fee schedule amount determined under subsection (a), and, for services furnished during 1991, the applicable percentage (as defined in sec- tion 18420)X4XAXiv)) of the prevailing chaise (or fee sched- ule amount) for nonparticipating physicians for that year. "(3) LDJOTATION ON CHARGES FOR MEDICARE BENEFICIARIES EU- GIBLB FOR MEDICAm BENEFITS. —

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