(a) Determination and notification(1) DeterminationThe owner or operator of each long-term care facility that receives Federal funds under this chapter shall annually determine whether the facility received at least $10,000 in such Federal funds during the preceding year.
(2) NotificationIf the owner or operator determines under paragraph (1) that the facility received at least $10,000 in such Federal funds during the preceding year, such owner or operator shall annually notify each covered individual (as defined in paragraph (3)) of that individual’s obligation to comply with the reporting requirements described in subsection (b).
(3) Covered individual definedIn this section, the term “covered individual” means each individual who is an owner, operator, employee, manager, agent, or contractor of a long-term care facility that is the subject of a determination described in paragraph (1).
(b) Reporting requirements(1) In generalEach covered individual shall report to the Secretary and 1 or more law enforcement entities for the political subdivision in which the facility is located any reasonable suspicion of a crime (as defined by the law of the applicable political subdivision) against any individual who is a resident of, or is receiving care from, the facility.
(2) TimingIf the events that cause the suspicion—(A) result in serious bodily injury, the individual shall report the suspicion immediately, but not later than 2 hours after forming the suspicion; and
(B) do not result in serious bodily injury, the individual shall report the suspicion not later than 24 hours after forming the suspicion.
(c) Penalties(1) In generalIf a covered individual violates subsection (b)—(A) the covered individual shall be subject to a civil money penalty of not more than $200,000; and
(B) the Secretary may make a determination in the same proceeding to exclude the covered individual from participation in any Federal health care program (as defined in section 1320a–7b(f) of this title).
(2) Increased harmIf a covered individual violates subsection (b) and the violation exacerbates the harm to the victim of the crime or results in harm to another individual—(A) the covered individual shall be subject to a civil money penalty of not more than $300,000; and
(B) the Secretary may make a determination in the same proceeding to exclude the covered individual from participation in any Federal health care program (as defined in section 1320a–7b(f) of this title).
(3) Excluded individualDuring any period for which a covered individual is classified as an excluded individual under paragraph (1)(B) or (2)(B), a long-term care facility that employs such individual shall be ineligible to receive Federal funds under this chapter.
(4) Extenuating circumstances(A) In generalThe Secretary may take into account the financial burden on providers with underserved populations in determining any penalty to be imposed under this subsection.
(B) Underserved population definedIn this paragraph, the term “underserved population” means the population of an area designated by the Secretary as an area with a shortage of elder justice programs or a population group designated by the Secretary as having a shortage of such programs. Such areas or groups designated by the Secretary may include—(i) areas or groups that are geographically isolated (such as isolated in a rural area);
(ii) racial and ethnic minority populations; and
(iii) populations underserved because of special needs (such as language barriers, disabilities, alien status, or age).
(d) Additional penalties for retaliation(1) In generalA long-term care facility may not—(A) discharge, demote, suspend, threaten, harass, or deny a promotion or other employment-related benefit to an employee, or in any other manner discriminate against an employee in the terms and conditions of employment because of lawful acts done by the employee; or
(B) file a complaint or a report against a nurse or other employee with the appropriate State professional disciplinary agency because of lawful acts done by the nurse or employee,
for making a report, causing a report to be made, or for taking steps in furtherance of making a report pursuant to subsection (b)(1).
(2) Penalties for retaliationIf a long-term care facility violates subparagraph (A) or (B) of paragraph (1) the facility shall be subject to a civil money penalty of not more than $200,000 or the Secretary may classify the entity as an excluded entity for a period of 2 years pursuant to section 1320a–7(b) of this title, or both.
(3) Requirement to post noticeEach long-term care facility shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying the rights of employees under this section. Such sign shall include a statement that an employee may file a complaint with the Secretary against a long-term care facility that violates the provisions of this subsection and information with respect to the manner of filing such a complaint.
(e) ProcedureThe provisions of section 1320a–7a of this title (other than subsections (a) and (b) and the second sentence of subsection (f)) shall apply to a civil money penalty or exclusion under this section in the same manner as such provisions apply to a penalty or proceeding under section 1320a–7a(a) of this title.
(f) DefinitionsIn this section, the terms “elder justice”, “long-term care facility”, and “law enforcement” have the meanings given those terms in section 1397j of this title.
Structure US Code
Title 42— THE PUBLIC HEALTH AND WELFARE
SUBCHAPTER XI— GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION
§ 1304. Reservation of right to amend or repeal
§ 1305. Short title of chapter
§ 1306a. Public access to State disbursement records
§ 1306c. Restriction on access to the Death Master File
§ 1310. Cooperative research or demonstration projects
§ 1311. Public assistance payments to legal representatives
§ 1312. Medical care guides and reports for public assistance and medical assistance
§ 1313. Assistance for United States citizens returned from foreign countries
§ 1314. Public advisory groups
§ 1314a. Measurement and reporting of welfare receipt
§ 1315. Demonstration projects
§ 1315a. Center for Medicare and Medicaid Innovation
§ 1315b. Providing Federal coverage and payment coordination for dual eligible beneficiaries
§ 1316. Administrative and judicial review of public assistance determinations
§ 1318. Alternative Federal payment with respect to public assistance expenditures
§ 1320. Approval of certain projects
§ 1320a. Uniform reporting systems for health services facilities and organizations
§ 1320a–1. Limitation on use of Federal funds for capital expenditures
§ 1320a–2. Effect of failure to carry out State plan
§ 1320a–3a. Disclosure requirements for other providers under part B of Medicare
§ 1320a–4. Issuance of subpenas by Comptroller General
§ 1320a–6. Adjustments in SSI benefits on account of retroactive benefits under subchapter II
§ 1320a–6a. Interagency coordination to improve program administration
§ 1320a–7a. Civil monetary penalties
§ 1320a–7b. Criminal penalties for acts involving Federal health care programs
§ 1320a–7c. Fraud and abuse control program
§ 1320a–7d. Guidance regarding application of health care fraud and abuse sanctions
§ 1320a–7e. Health care fraud and abuse data collection program
§ 1320a–7f. Coordination of medicare and medicaid surety bond provisions
§ 1320a–7g. Funds to reduce medicaid fraud and abuse
§ 1320a–7h. Transparency reports and reporting of physician ownership or investment interests
§ 1320a–7i. Reporting of information relating to drug samples
§ 1320a–7j. Accountability requirements for facilities
§ 1320a–7k. Medicare and Medicaid program integrity provisions
§ 1320a–8. Civil monetary penalties and assessments for subchapters II, VIII and XVI
§ 1320a–8a. Administrative procedure for imposing penalties for false or misleading statements
§ 1320a–8b. Attempts to interfere with administration of this chapter
§ 1320a–9. Demonstration projects
§ 1320a–10. Effect of failure to carry out State plan
§ 1320b–1. Notification of Social Security claimant with respect to deferred vested benefits
§ 1320b–2. Period within which certain claims must be filed
§ 1320b–4. Nonprofit hospital or critical access hospital philanthropy
§ 1320b–5. Authority to waive requirements during national emergencies
§ 1320b–7. Income and eligibility verification system
§ 1320b–8. Hospital protocols for organ procurement and standards for organ procurement agencies
§ 1320b–9a. Child health quality measures
§ 1320b–9b. Adult health quality measures
§ 1320b–10. Prohibitions relating to references to Social Security or Medicare
§ 1320b–11. Blood donor locator service
§ 1320b–12. Research on outcomes of health care services and procedures
§ 1320b–13. Social security account statements
§ 1320b–15. Protection of social security and medicare trust funds
§ 1320b–17. Cross-program recovery of overpayments from benefits
§ 1320b–19. The Ticket to Work and Self-Sufficiency Program
§ 1320b–20. Work incentives outreach program
§ 1320b–21. State grants for work incentives assistance to disabled beneficiaries
§ 1320b–23. Pharmacy benefit managers transparency requirements
§ 1320b–24. Consultation with Tribal Technical Advisory Group