CIVIL MONEY PENALTIES AND INTERMEDIATE SANCTIONS AGAINST HMOS/CMPS.

SEC. 4014. CIVIL MONEY PENALTIES AND INTERMEDIATE SANCTIONS AGAINST HMOS/CMPS. Section 1876(i)(6) of the Social Security Act (42 U.S.C. 1395mm) is amended to read as follows: “(6) (A) If the Secretary determines that an eligible organization with a contract under this section— “(i) fails substantially to provide medically necessary items and services that are required (under law or under the contract) to be provided to an individual covered under the contract, if the failure has adversely affected (or has substantial likelihood of adversely affecting) the individual; “(ii) imposes premiums on individuals enrolled under this section in excess of the premiums permitted; “(iii) acts to expel or to refuse to re-enroll an individual in violation of the provisions of this section; “(iv) engages in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment (except as permitted by this section) by eligible individuals with the organization whose medical condition or history indicates a need for substantial future medical services; “(v) misrepresents or falsifies information that is furnished— “(I) to the Secretary under this section, or “(II) to an individual or to any other entity under this section; or “(vi) fails to comply with the requirements of subsection (g)(e)(A); the Secretary may provide for any of the remedies described in subparagraph (B). 101 STAT. 1330–62 “(B) The remedies described in this subparagraph are— “(i) civil money penalties of not more than $25,000 for each determination under subparagraph (A) or, with respect to a determination under clause (iv) or (v)(I), of not more than $100,000 for each such determination, “(ii) suspension of enrollment of individuals under this section after the date the Secretary notifies the organization of a determination under subparagraph (A) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur, or “(iii) suspension of payment to the organization under this section for individuals enrolled after the date the Secretary notifies the organization of a determination under subparagraph (A) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (i) in the same manner as they apply to a civil money penalty under that section.”