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Statutory Text

SEC. 1313 [42 U.S.C. 18033]. FINANCIAL INTEGRITY.
(a) ACCOUNTING FOR EXPENDITURES.—
(1) IN GENERAL.—An Exchange shall keep an accurate accounting
of all activities, receipts, and expenditures and shall
annually submit to the Secretary a report concerning such accountings.
(2) INVESTIGATIONS.—The Secretary, in coordination with
the Inspector General of the Department of Health and Human
Services, may investigate the affairs of an Exchange, may examine
the properties and records of an Exchange, and may require
periodic reports in relation to activities undertaken by an
Exchange. An Exchange shall fully cooperate in any investigation
conducted under this paragraph.
(3) AUDITS.—An Exchange shall be subject to annual audits
by the Secretary.
(4) PATTERN OF ABUSE.—If the Secretary determines that
an Exchange or a State has engaged in serious misconduct
with respect to compliance with the requirements of, or carrying
out of activities required under, this title, the Secretary
may rescind from payments otherwise due to such State involved
under this or any other Act administered by the Secretary
an amount not to exceed 1 percent of such payments per
year until corrective actions are taken by the State that are determined
to be adequate by the Secretary.
(5) PROTECTIONS AGAINST FRAUD AND ABUSE.—With respect
to activities carried out under this title, 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; and
(B) the Secretary has authority to implement under
this title or any other Act.
(6) APPLICATION OF THE FALSE CLAIMS ACT.—
(A) IN GENERAL.—Payments made by, through, or in
connection with an Exchange are subject to the False
Claims Act (31 U.S.C. 3729 et seq.) if those payments include
any Federal funds. Compliance with the requirements
of this Act concerning eligibility for a health insurance
issuer to participate in the Exchange shall be a material
condition of an issuer’s entitlement to receive payments,
including payments of premium tax credits and
cost-sharing reductions, through the Exchange.
[Section 10104(j)(1), p. 834, provides that subparagraph (B) is
deemed ‘‘null, void, and of no effect’’]
[(B) DAMAGES.—Notwithstanding paragraph (1) of section
3729(a) of title 31, United States Code, and subject to
paragraph (2) of such section, the civil penalty assessed
under the False Claims Act on any person found liable
under such Act as described in subparagraph (A) shall be
increased by not less than 3 times and not more than 6
times the amount of damages which the Government sustains
because of the act of that person.]
[Section 10104(j)(2),p. 834, replaced paragraph (4) of section
3730(e) of title 31, United States Code, as follows:]
(2)[sec. 10104(j)(2) of PPACA:] Section 3730(e) of title 31,
United States Code, is amended by striking paragraph (4) and inserting
the following:
‘‘(4)(A) The court shall dismiss an action or claim under
this section, unless opposed by the Government, if substantially
the same allegations or transactions as alleged in the action
or claim were publicly disclosed—
‘‘(i) in a Federal criminal, civil, or administrative hearing
in which the Government or its agent is a party;
‘‘(ii) in a congressional, Government Accountability Office,
or other Federal report, hearing, audit, or investigation;
or
‘‘(iii) from the news media,
unless the action is brought by the Attorney General or the
person bringing the action is an original source of the information.
‘‘(B) For purposes of this paragraph, ‘‘original source’’
means an individual who either (i) prior to a public disclosure
under subsection (e)(4)(a), has voluntarily disclosed to the Government
the information on which allegations or transactions
in a claim are based, or (2) who has knowledge that is independent
of and materially adds to the publicly disclosed allegations
or transactions, and who has voluntarily provided the information
to the Government before filing an action under this
section.’’.
(b) GAO OVERSIGHT.—Not later than 5 years after the first
date on which Exchanges are required to be operational under this
title, 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) [As added by section 10104(k)(3)] 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 3 of the Small Business Act (15
U.S.C. 632)), 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.