42 U.S.C. § 1396h

State false claims act requirements for increased State share of recoveries

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(a) In general

Notwithstanding section 1396d(b) of this title, if a State has in effect a law relating to false or fraudulent claims that meets the requirements of subsection (b), the Federal medical assistance percentage with respect to any amounts recovered under a State action brought under such law, shall be decreased by 10 percentage points.

(b) RequirementsFor purposes of subsection (a), the requirements of this subsection are that the Inspector General of the Department of Health and Human Services, in consultation with the Attorney General, determines that the State has in effect a law that meets the following requirements:(1) The law establishes liability to the State for false or fraudulent claims described in section 3729 of title 31 with respect to any expenditure described in section 1396b(a) of this title.(2) The law contains provisions that are at least as effective in rewarding and facilitating qui tam actions for false or fraudulent claims as those described in sections 3730 through 3732 of title 31.(3) The law contains a requirement for filing an action under seal for 60 days with review by the State Attorney General.(4) The law contains a civil penalty that is not less than the amount of the civil penalty authorized under section 3729 of title 31.(c) Deemed compliance

A State that, as of January 1, 2007, has a law in effect that meets the requirements of subsection (b) shall be deemed to be in compliance with such requirements for so long as the law continues to meet such requirements.

(d) No preclusion of broader laws

Nothing in this section shall be construed as prohibiting a State that has in effect a law that establishes liability to the State for false or fraudulent claims described in section 3729 of title 31, with respect to programs in addition to the State program under this subchapter, or with respect to expenditures in addition to expenditures described in section 1396b(a) of this title, from being considered to be in compliance with the requirements of subsection (a) so long as the law meets such requirements.

(Aug. 14, 1935, ch. 531, title XIX, § 1909, as added Pub. L. 109–171, title VI, § 6031(a), Feb. 8, 2006, 120 Stat. 72.)Editorial NotesPrior Provisions

A prior section 1396h, act Aug. 14, 1935, ch. 531, title XIX, § 1909, as added and amended Oct. 30, 1972, Pub. L. 92–603, title II, §§ 242(c), 278(b)(9), 86 Stat. 1419, 1454; Oct. 25, 1977, Pub. L. 95–142, § 4(b), 91 Stat. 1181; Dec. 5, 1980, Pub. L. 96–499, title IX, § 917, 94 Stat. 2625; Aug. 18, 1987, Pub. L. 100–93, § 4(a)–(c), 101 Stat. 688, 689, related to criminal penalties for acts involving Medicare and State health care programs, prior to being renumbered section 1128B of title XI of act Aug. 14, 1935, by section 4(d) of Pub. L. 100–93 and transferred to section 1320a–7b of this title.

Statutory Notes and Related SubsidiariesEffective Date

Pub. L. 109–171, title VI, § 6031(b), Feb. 8, 2006, 120 Stat. 73, as amended by Pub. L. 109–432, div. B, title IV, § 405(c)(2)(A)(iii), Dec. 20, 2006, 120 Stat. 3000, provided that: “Except as provided in section 6034(e) [set out as an Effective Date of 2006 Amendment note under section 1396a of this title], the amendments made by this section [enacting this section] take effect on January 1, 2007.”

Notes of Decisions

Cited in 59 cases (6 in the last 5 years), 1976–2026 · leading case: in Re Xerox Corp. & Xerox State Healthcare, LLC F/K/A Acs State Healthcare, Llc, 555 S.W.3d 518 (Tex. 2018).

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in Re Xerox Corp. & Xerox State Healthcare, LLC F/K/A Acs State Healthcare, Llc, 555 S.W.3d 518 (Tex. 2018). · cites it 2× “4 , 72 (codified at 42 U.S.C. § 1396h ). 116 42 U.S.C. § 1396h(a).”

United States v. Stewart Clinical Lab'y, Inc., Edward Morris Jorgensen & James Stewart, 652 F.2d 804 (9th Cir. 1981). · cites it 7× “42 U.S.C. § 1396h(b) originally provided that: “Whoever furnishes items or services to an individual for which payment is or may be made in whole or in part out of Federal funds under a State plan approved under this subchapter and who solicits, offers or receives any— *806 (1)…”

United States v. Delmer Porter, Kenneth A. Berdick, M.D. & Myron Teitelbaum, M.D., 591 F.2d 1048 (5th Cir. 1979). · cites it 3× “Although § 1395nn(b) has not been construed by any other Court of Appeals, the Second Circuit has construed another statute, 42 U.S.C. § 1396h(b), 3 which is almost identical in wording to that of the statute we consider today.”

United States v. Universal Trade & Indus., Inc., Doing Bus. as Universal Med. Labs., & Fereydoun Karimi, 695 F.2d 1151 (9th Cir. 1983). · cites it 8× “STATUTORY FRAMEWORK The relevant statute is 42 U.S.C. § 1396h(b)(2) (Supp. IV 1980). It was amended in 1977 to provide that it is a felony to offer any remuneration to a person to induce such person: (A) to refer an individua] to a person for the furnishing, or arranging for the…”

United States v. Richard Tapert, Harvey Golden, Gerald Weingarden, Donald Freedlander & Robertgash, 625 F.2d 111 (6th Cir. 1980). · cites it 4× “The district court held that the payments violated the original version of 42 U.S.C. § 1396h(b), 1 which was in effect during the years involved in this case.”

Palumbo v. Myers, 149 Cal. App. 3d 1020 (Cal. Ct. App. 1983). · cites it 4× “(See § 14123; 42 U.S.C. § 1396h (d).) *1036 I Under the factual and legal circumstances as I view them, plaintiff's recovery of the balance of his fee for medical treatment from the third party payer was not prohibited.”

UNITED STATES of Am., Plaintiff-Appellee, v. Peter LARM, M.D., & Haruko Larm, Defendants-Appellants, 824 F.2d 780 (9th Cir. 1987). · cites it 3× “, and his wife Haruko Larm, appeal from their convictions for violations of 42 U.S.C. § 1396h(a)(l) (false statements in an application for payments in a federally-approved plan for medical assistance).”

UNITED STATES of Am., Appellee, v. Mabel HUCKABY, Appellant, 698 F.2d 915 (8th Cir. 1983). · cites it 4× “Huckaby argues the evidence was insufficient to establish that she violated 42 U.S.C. § 1396h(a)(3) because the government did not prove: (1) the actual level of care Cumberland provided to the named Medicaid patients, and (2) that she knowingly concealed or failed to disclose…”

United States v. Norman Ruttenberg, United States of Am. v. Royal Fontana Nursing Ctr., Inc., 625 F.2d 173 (7th Cir. 1980). · cites it 3× “00 per day more than the maximum paid by Medicaid was tried and convicted under 42 U.S.C. § 1396h(b) (1972) of taking bribes.”

Medicare&medicaid Gu 34,654 United States of Am. v. Paul G. Brown, United States of Am. v. Stone's Pharmacy, Inc., 763 F.2d 984 (8th Cir. 1985). · cites it 2× “(the “Corporation”) appeal from convictions in a jury trial on forty-seven counts of filing false claims for payment under the Medicaid Program in violation of 42 U.S.C. § 1396h(a)(l)(i) (1982). On appeal, appellants contend, inter alia: (1) that the district court erred in…”

Medicare&medicaid Gu 34,904 United States of Am. v. Roger Wayne Lipkis, 770 F.2d 1447 (9th Cir. 1985). · cites it 2× “There, the defendants were indicted for offering to pay a remuneration to a doctor to induce him to refer his patients to a laboratory, in violation of 42 U.S.C. § 1396h(b)(2)(A). The defendants successfully argued that the government failed to prove that they had attempted to…”

Palmer v. Brown, 752 P.2d 685 (Kan. 1988). “21-3904 (presenting a false claim); 42 U.S.C. § 1396h(a) (1982). Health care providers committing Medicaid fraud may be barred from participation in the program, 42 U.”

Show all 59 citing cases →

— 42 U.S.C. § 1396h(a) — 7 cases

in Re Xerox Corp. & Xerox State Healthcare, LLC F/K/A Acs State Healthcare, Llc, 555 S.W.3d 518 (Tex. 2018). “4 , 72 (codified at 42 U.S.C. § 1396h ). 116 42 U.S.C. § 1396h(a).”

Tripp v. Coler, 640 F. Supp. 848 (N.D. Ill. 1986).

Fabula v. Buck, 598 F.2d 869 (4th Cir. 1979).

In Re Novartis Pharm. Corp. v. the State of Texas (Tex. App. 2025).

— 42 U.S.C. § 1396h(a)(3) — 2 cases

UNITED STATES of Am., Appellee, v. Mabel HUCKABY, Appellant, 698 F.2d 915 (8th Cir. 1983). “Huckaby argues the evidence was insufficient to establish that she violated 42 U.S.C. § 1396h(a)(3) because the government did not prove: (1) the actual level of care Cumberland provided to the named Medicaid patients, and (2) that she knowingly concealed or failed to disclose…”

United States v. James E. Barrington, 662 F.2d 1046 (4th Cir. 1981).

— 42 U.S.C. § 1396h(a)(3)(i) — 1 case

— 42 U.S.C. § 1396h(a)(l) — 4 cases

UNITED STATES of Am., Plaintiff-Appellee, v. Peter LARM, M.D., & Haruko Larm, Defendants-Appellants, 824 F.2d 780 (9th Cir. 1987). “, and his wife Haruko Larm, appeal from their convictions for violations of 42 U.S.C. § 1396h(a)(l) (false statements in an application for payments in a federally-approved plan for medical assistance).”

In re Cardiac Devices Qui Tam Litig., 221 F.R.D. 318 (D. Conn. 2004).

Rush v. Parham, 440 F. Supp. 383 (N.D. Ga. 1977).

United States v. Taylor, 693 F. Supp. 828 (N.D. Cal. 1988).

— 42 U.S.C. § 1396h(a)(l)(i) — 1 case

Medicare&medicaid Gu 34,654 United States of Am. v. Paul G. Brown, United States of Am. v. Stone's Pharmacy, Inc., 763 F.2d 984 (8th Cir. 1985). “(the “Corporation”) appeal from convictions in a jury trial on forty-seven counts of filing false claims for payment under the Medicaid Program in violation of 42 U.S.C. § 1396h(a)(l)(i) (1982). On appeal, appellants contend, inter alia: (1) that the district court erred in…”

— 42 U.S.C. § 1396h(a)(l)(i)(1982) — 1 case

— 42 U.S.C. § 1396h(aX3) — 1 case

United States v. James E. Barrington, 662 F.2d 1046 (4th Cir. 1981).

— 42 U.S.C. § 1396h(b) — 7 cases

United States v. Delmer Porter, Kenneth A. Berdick, M.D. & Myron Teitelbaum, M.D., 591 F.2d 1048 (5th Cir. 1979). “Although § 1395nn(b) has not been construed by any other Court of Appeals, the Second Circuit has construed another statute, 42 U.S.C. § 1396h(b), 3 which is almost identical in wording to that of the statute we consider today.”

United States v. Stanton G. Polin & Florence Phillips, 194 F.3d 863 (7th Cir. 1999).

United States v. Richard Tapert, Harvey Golden, Gerald Weingarden, Donald Freedlander & Robertgash, 625 F.2d 111 (6th Cir. 1980). “The district court held that the payments violated the original version of 42 U.S.C. § 1396h(b), 1 which was in effect during the years involved in this case.”

United States v. Stewart Clinical Lab'y, Inc., Edward Morris Jorgensen & James Stewart, 652 F.2d 804 (9th Cir. 1981). “42 U.S.C. § 1396h(b) originally provided that: “Whoever furnishes items or services to an individual for which payment is or may be made in whole or in part out of Federal funds under a State plan approved under this subchapter and who solicits, offers or receives any— *806 (1)…”

United States v. William H. Zacher, 586 F.2d 912 (2d Cir. 1978).

— 42 U.S.C. § 1396h(b)(1) — 1 case

UNITED STATES of Am., Appellee, v. A. Alvin GREBER, Appellant, 760 F.2d 68 (3rd Cir. 1985).

— 42 U.S.C. § 1396h(b)(2) — 3 cases

United States v. Mitchell, 85 F.3d 800 (1st Cir. 1996).

United States v. Universal Trade & Indus., Inc., Doing Bus. as Universal Med. Labs., & Fereydoun Karimi, 695 F.2d 1151 (9th Cir. 1983). “STATUTORY FRAMEWORK The relevant statute is 42 U.S.C. § 1396h(b)(2) (Supp. IV 1980). It was amended in 1977 to provide that it is a felony to offer any remuneration to a person to induce such person: (A) to refer an individua] to a person for the furnishing, or arranging for the…”

In Re Novartis Pharm. Corp. v. the State of Texas (2026).

— 42 U.S.C. § 1396h(b)(2)(A) — 5 cases

United States v. Mohammed Hadi Fekri, Nat'l Lab'y Enter., Inc., Defendants, 650 F.2d 1044 (9th Cir. 1981).

Medicare&medicaid Gu 34,904 United States of Am. v. Roger Wayne Lipkis, 770 F.2d 1447 (9th Cir. 1985). “There, the defendants were indicted for offering to pay a remuneration to a doctor to induce him to refer his patients to a laboratory, in violation of 42 U.S.C. § 1396h(b)(2)(A). The defendants successfully argued that the government failed to prove that they had attempted to…”

United States v. Duz-Mor Diagnostic Lab'y, Inc., 650 F.2d 223 (9th Cir. 1981).

— 42 U.S.C. § 1396h(b)(2)(B) — 5 cases

United States v. Duz-Mor Diagnostic Lab'y, Inc., 650 F.2d 223 (9th Cir. 1981).

United States v. Mohammed Hadi Fekri, Nat'l Lab'y Enter., Inc., Defendants, 650 F.2d 1044 (9th Cir. 1981).

— 42 U.S.C. § 1396h(b)(3) — 1 case

People v. Bynum, 557 N.E.2d 238 (Ill. App. Ct. 1990).

— 42 U.S.C. § 1396h(b)(l) — 9 cases

United States v. Norman Ruttenberg, United States of Am. v. Royal Fontana Nursing Ctr., Inc., 625 F.2d 173 (7th Cir. 1980). “00 per day more than the maximum paid by Medicaid was tried and convicted under 42 U.S.C. § 1396h(b) (1972) of taking bribes.”

The Hanlester Network v. Donna E. Shalala, Sec'y of the Dep't of Health & Human Servs., 51 F.3d 1390 (9th Cir. 1995).

United States v. Anderson, 85 F. Supp. 2d 1084 (D. Kan. 1999).

United States v. Harold Perlstein, 632 F.2d 661 (6th Cir. 1980).

— 42 U.S.C. § 1396h(b)(l)(A) — 1 case

United States v. Morris Pardee Adkins, M.D., & Franklin Dalano Holefield, 683 F.2d 1289 (9th Cir. 1982).

— 42 U.S.C. § 1396h(b)(l)(B) — 1 case

In re Anonymous Nos. 61 D.B. 85 & 62 D.B. 81, 12 Pa. D. & C.4th 211 (Pa. 1989).

— 42 U.S.C. § 1396h(c) — 1 case

Wilmac Corp. v. Bowen, 811 F.2d 809 (3rd Cir. 1987).

— 42 U.S.C. § 1396h(d) — 2 cases

LOCAL 913 v. Manitowoc Cnty., 410 N.W.2d 641 (Wis. Ct. App. 1987).

New York City Health & Hospitals Corp. v. Perales, 954 F.2d 854 (2d Cir. 1992).

— 42 U.S.C. § 1396h(d)(l) — 2 cases

Smith v. Caggiano, 421 N.E.2d 473 (Mass. App. Ct. 1981).

New York City Health & Hospitals Corp. v. Perales, 954 F.2d 854 (2d Cir. 1992).

— 42 U.S.C. § 1396h(m)(2)(A)(iv) — 1 case

John B. v. Goetz, 879 F. Supp. 2d 787 (M.D. Tenn. 2010).

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