42 USC 18033 - Financial integrity

U.S Code last checked for updates: Feb 22, 2025

§ 18033.

Financial integrity

(a)

Accounting for expenditures

(1)

In general

(2)

Investigations

(3)

Audits

(4)

Pattern of abuse

(5)

Protections against fraud and abuse

With respect to activities carried out under this title,¹ 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; ¹ and

(B)

the Secretary has authority to implement under this title ¹ or any other Act.

(6)

Application of the False Claims Act

(A)

In general

(B)

 See Termination of Provision note below.

Damages

(b)

GAO oversight

Not later than 5 years after the first date on which Exchanges are required to be operational under this title,¹ 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 purchasing 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;

(4)

a survey of the cost and affordability of health care insurance provided under the Exchanges for owners and employees of small business concerns (as defined under section 632 of title 15), including data on enrollees in Exchanges and individuals purchasing health insurance coverage outside of Exchanges; and

(5)

how many physicians, by area and specialty, are not taking or accepting new patients enrolled in Federal Government health care programs, and the adequacy of provider networks of Federal Government health care programs.

(Pub. L. 111–148, title I, § 1313, title X, § 10104(k), Mar. 23, 2010, 124 Stat. 184, 902.)

cite as: 42 USC 18033