View all text of Part A [§ 1301 - § 1320b-26]
§ 1320a–7k. Medicare and Medicaid program integrity provisions
(a) Data matching
(1) Integrated data repository
(A) Inclusion of certain data
(i) In general
The Integrated Data Repository of the Centers for Medicare & Medicaid Services shall include, at a minimum, claims and payment data from the following:
(I) The programs under subchapters XVIII and XIX (including parts A, B, C, and D of subchapter XVIII).(II) The program under subchapter XXI.(III) Health-related programs administered by the Secretary of Veterans Affairs.(IV) Health-related programs administered by the Secretary of Defense.(V) The program of old-age, survivors, and disability insurance benefits established under subchapter II.(VI) The Indian Health Service and the Contract Health Service program.(ii) Priority for inclusion of certain data
(B) Data sharing and matching
(i) In general
(ii) Individuals described
The following individuals are described in this clause:
(I) The Commissioner of Social Security.(II) The Secretary of Veterans Affairs.(III) The Secretary of Defense.(IV) The Director of the Indian Health Service.(iii) Definition of system of records
(2) Access to claims and payment databases
(b) OIG authority to obtain information
(1) In general
Notwithstanding 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—
(A) is a provider of medical or other items or services, supplier, grant recipient, contractor, or subcontractor; or
(B) 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.
(2) Inclusion of certain information
(c) Administrative remedy for knowing participation by beneficiary in health care fraud scheme
(1) In general
(2) Applicable individual
For purposes of paragraph (1), the term “applicable individual” means an individual—
(A) entitled to, or enrolled for, benefits under part A of subchapter XVIII or enrolled under part B of such subchapter;
(B) eligible for medical assistance under a State plan under subchapter XIX or under a waiver of such plan; or
(C) eligible for child health assistance under a child health plan under subchapter XXI.
(d) Reporting and returning of overpayments
(1) In general
If a person has received an overpayment, the person shall—
(A) report and return the overpayment to the Secretary, the State, an intermediary, a carrier, or a contractor, as appropriate, at the correct address; and
(B) notify the Secretary, State, intermediary, carrier, or contractor to whom the overpayment was returned in writing of the reason for the overpayment.
(2) Deadline for reporting and returning overpayments
An overpayment must be reported and returned under paragraph (1) by the later of—
(A) the date which is 60 days after the date on which the overpayment was identified; or
(B) the date any corresponding cost report is due, if applicable.
(3) Enforcement
(4) Definitions
In this subsection:
(A) Knowing and knowingly
(B) Overpayment
(C) Person
(i) In general
(ii) Exclusion
(e) Inclusion of national provider identifier on all applications and claims
(Aug. 14, 1935, ch. 531, title XI, § 1128J, as added Pub. L. 111–148, title VI, § 6402(a), Mar. 23, 2010, 124 Stat. 753.)