42 U.S.C. § 1320a

Uniform reporting systems for health services facilities and organizations

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(a) Establishment; criteria for regulations; requirements for hospitalsFor the purposes of reporting the cost of services provided by, of planning, and of measuring and comparing the efficiency of and effective use of services in, hospitals, skilled nursing facilities, intermediate care facilities, home health agencies, health maintenance organizations, and other types of health services facilities and organizations to which payment may be made under this chapter, the Secretary shall establish by regulation, for each such type of health services facility or organization, a uniform system for the reporting by a facility or organization of that type of the following information:(1) The aggregate cost of operation and the aggregate volume of services.(2) The costs and volume of services for various functional accounts and subaccounts.(3) Rates, by category of patient and class of purchaser.(4) Capital assets, as defined by the Secretary, including (as appropriate) capital funds, debt service, lease agreements used in lieu of capital funds, and the value of land, facilities, and equipment.(5) Discharge and bill data.The uniform reporting system for a type of health services facility or organization shall provide for appropriate variation in the application of the system to different classes of facilities or organizations within that type and shall be established, to the extent practicable, consistent with the cooperative system for producing comparable and uniform health information and statistics described in section 242k(e)(1) of this title. In reporting under such a system, hospitals shall employ such chart of accounts, definitions, principles, and statistics as the Secretary may prescribe in order to reach a uniform reconciliation of financial and statistical data for specified uniform reports to be provided to the Secretary.(b) Monitoring, etc., of systems by SecretaryThe Secretary shall—(1) monitor the operation of the systems established under subsection (a);(2) assist with and support demonstrations and evaluations of the effectiveness and cost of the operation of such systems and encourage State adoption of such systems; and(3) periodically revise such systems to improve their effectiveness and diminish their cost.(c) Availability of information to appropriate agencies and organizations

The Secretary shall provide information obtained through use of the uniform reporting systems described in subsection (a) in a useful manner and format to appropriate agencies and organizations, including health systems agencies (designated under section 300l–4 11 See References in Text note below. of this title) and State health planning and development agencies (designated under section 300m 1 of this title), as may be necessary to carry out such agencies’ and organizations’ functions.

(Aug. 14, 1935, ch. 531, title XI, § 1121, as added Pub. L. 95–142, § 19(a), Oct. 25, 1977, 91 Stat. 1203.)Editorial NotesReferences in Text

Section 300l–4 of this title, referred to in subsec. (c), was repealed effective Jan. 1, 1987, by Pub. L. 99–660, title VII, § 701(a), Nov. 14, 1986, 100 Stat. 3799.

Section 300m of this title, referred to in subsec. (c), was in the original a reference to section 1521 of act July 1, 1944, which was repealed effective Jan. 1, 1987, by Pub. L. 99–660, title VII, § 701(a), Nov. 14, 1986, 100 Stat. 3799. Pub. L. 101–354, § 2, Aug. 10, 1990, 104 Stat. 410, enacted section 1503 of act July 1, 1944, which is classified to section 300m of this title.

Prior Provisions

A prior section 1320a, act Aug. 14, 1935, ch. 531, title XI, § 1121, as added Jan. 2, 1968, Pub. L. 90–248, title II, § 250(a), 81 Stat. 920, provided for assistance in the form of institutional services in intermediate care facilities, the subsecs. providing as follows: subsec. (a), modification of certain plans to include such benefit; subsec. (b), eligible individuals; subsec. (c), payments and Federal medical assistance percentage; subsec. (d), conditions, limitations, rights, and obligations applicable to modified plans; and subsec. (e), definition of “intermediate care facility”, which is covered in section 1396d(c) of this title, prior to repeal by Pub. L. 92–223, § 4(c), Dec. 28, 1971, 85 Stat. 810.

Section was additionally amended by Pub. L. 92–603, title II, § 278(a)(24), Oct. 30, 1972, 86 Stat. 1453, without reference to the earlier repeal of this section by Pub. L. 92–223.

Statutory Notes and Related SubsidiariesTime Periods for Establishment of Uniform Reporting Systems; Consultations With Interested Parties

Pub. L. 95–142, § 19(c)(1), Oct. 25, 1977, 91 Stat. 1205, directed Secretary of Health, Education, and Welfare to establish the systems described in subsec. (a) of this section only after consultation with interested parties and for hospitals, skilled nursing facilities, and intermediate care facilities, not later than the end of the one year period beginning on Oct. 25, 1977, and for other types of health services facilities and organizations, not later than the end of the two-year period beginning on Oct. 25, 1977.

Notes of Decisions

Cited in 231 cases (98 in the last 5 years), 1974–2026 · leading case: Michael Friedman v. Kathleen Sebelius

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Michael Friedman v. Kathleen Sebelius (2012) cadc · cites it 6× “Based upon their convictions, the Secretary of Health and Human Services later excluded the individuals from participation in Federal health 3 care programs for 12 years, pursuant to 42 U.S.C. § 1320a- 7(b). They sought review of the Secretary’s decision in the district court,…”

United States ex rel. Shannon Martin, M.D. v. Darren Hathaway (2023) ca6 · cites it 3× “42 U.S.C. § 1320a- 7b(b)(2)(A) (emphasis added).”

United States v. Valladares (2008) ca11 · cites it 2× “§ 287 ; and (c) to knowingly solicit and receive cash kickbacks involving a federal health care program in violation of 42 U.S.C. § 1320a — 7b(b)(l); (2) conspiracy to defraud the Medicare Program in violation of 18 U.”

United States v. Simon Hong (2019) ca9 · cites it 2× “§ 1347 ) and illegal remunerations for health care referrals (42 U.S.C. § 1320a- 7b(1)(A)), and remanded for resentencing, in a case in which the defendant, who owned and operated acupuncture and massage clinics, engaged in a fraudulent Medicare-billing scheme with physical…”

Planned Parenthood v. Joshua Baker (2019) ca4 · cites it 2× “42 U.S.C. § 1320a–2 (A provision “is not to be deemed unenforceable because of its inclusion in a section of [the Act] .”

Guilfoile v. Shields (2019) ca1 “Given that Guilfoile's FCA retaliation claim is premised only on the theory that the conduct that he reported to his employer was prohibited by the AKS, see 42 U.S.C. § 1320a- 7b(g), that separate issue takes on significance only if Guilfoile - 44 - has sufficiently alleged as a…”

United States v. Raymond Shoemaker (2014) ca5 · cites it 2× “§ 666 underlies Counts One and Two, while 42 U.S.C. § 1320a — 7b(b)(2)(B) underlies Counts Four and Five.”

United States v. Anthony Roberts (2015) ca11 “Kickbacks Five defendants, Antonio Macli, Jorge Macli, Huarte, Biscayne Milieu, and Alexander, challenge the sufficiency of the evidence in support of their convictions for conspiracy to receive and pay health care kickbacks in connection with a federal health care program as…”

United States v. Cooper (2022) ca5 · cites it 3× “Essentially, Cooper’s view is that the evidence was insufficient to convict him of paying to induce “refer[rals]” under 42 U.S.C. § 1320a- 7b(b)(2)(A)—the statutory provision on which the district court instructed the jury.”

United States v. Wells (1997) scotus “§ 707 (a)(1) (sameunder funds for social security); 42 U. S. C. § 1320a 7b(a)(1) (maximum five year prison term for knowingly and willfully making false statement of material fact in application for payments in federally-approved plans for medical assistance); 42 U.”

Carter v. Colvin (2016) kyed “10] The language of 42 U.S.C. § 1320a — 8(¿) provides that the OIG is to make information available to the Commissioner immediately when there is reason to believe fraud has taken place, but it provides that the OIG may delay if such a referral would interfere with a pending…”

United States v. Vega (2016) ca1 “The Anti-Kickback Instruction The Government charged Vega with violating the anti-kickback statute pursuant to 42 U.S.C. § 1320a — 7b(b)(1)(B). That statute makes it a crime to knowingly and willfully solicit[] or receive[ ] any remuneration (including any kickback, bribe, or…”

Show all 231 citing cases →

— 42 U.S.C. § 1320a(a) — 1 case

Congress of California Seniors v. Catholic Healthcare West (2001) calctapp

— 42 U.S.C. § 1320a(b)(1)(A) — 1 case

United States of America v. PCPLV LLC, et al. (2026) nvd

— 42 U.S.C. § 1320a(e) — 1 case

Seneca Nursing Home v. The Kansas State Board of Social Welfare (1974) ca10

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