Page:United States Statutes at Large Volume 124.djvu/211

 124 STAT. 185 PUBLIC LAW 111–148—MAR. 23, 2010 (4) PATTERN OF ABUSE.—If the Secretary determines that an Exchange or a State has engaged in serious misconduct with respect to compliance with the requirements of, or carrying out of activities required under, this title, the Secretary may rescind from payments otherwise due to such State involved under this or any other Act administered by the Secretary an amount not to exceed 1 percent of such payments per year until corrective actions are taken by the State that are deter- mined to be adequate by the Secretary. (5) PROTECTIONS AGAINST FRAUD AND ABUSE.—With respect to activities carried out under this title, the Secretary shall provide for the efficient and non-discriminatory administration of Exchange activities and implement any measure or procedure that— (A) the Secretary determines is appropriate to reduce fraud and abuse in the administration of this title; and (B) the Secretary has authority to implement under this title or any other Act. (6) APPLICATION OF THE FALSE CLAIMS ACT.— (A) IN GENERAL.—Payments made by, through, or in connection with an Exchange are subject to the False Claims Act (31 U.S.C. 3729 et seq.) if those payments include any Federal funds. Compliance with the require- ments of this Act concerning eligibility for a health insur- ance issuer to participate in the Exchange shall be a mate- rial condition of an issuer’s entitlement to receive pay- ments, including payments of premium tax credits and cost-sharing reductions, through the Exchange. (B) DAMAGES.—Notwithstanding paragraph (1) of sec- tion 3729(a) of title 31, United States Code, and subject to paragraph (2) of such section, the civil penalty assessed under the False Claims Act on any person found liable under such Act as described in subparagraph (A) shall be increased by not less than 3 times and not more than 6 times the amount of damages which the Government sustains because of the act of that person. (b) GAO OVERSIGHT.—Not later than 5 years after the first date on which Exchanges are required to be operational under this title, the Comptroller General shall conduct an ongoing study of Exchange activities and the enrollees in qualified health plans offered through Exchanges. Such study shall review— (1) the operations and administration of Exchanges, including surveys and reports of qualified health plans offered through Exchanges and on the experience of such plans (including data on enrollees in Exchanges and individuals pur- chasing health insurance coverage outside of Exchanges), the expenses of Exchanges, claims statistics relating to qualified health plans, complaints data relating to such plans, and the manner in which Exchanges meet their goals; (2) any significant observations regarding the utilization and adoption of Exchanges; (3) where appropriate, recommendations for improvements in the operations or policies of Exchanges; and (4) how many physicians, by area and specialty, are not taking or accepting new patients enrolled in Federal Govern- ment health care programs, and the adequacy of provider net- works of Federal Government health care programs. Deadline. Study. Penalty. Determination.