Title 42 — The Public Health and WelfareRelease 119-73

§1320a–7n Disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse

Title 42 › Chapter CHAPTER 7— - SOCIAL SECURITY › Subchapter SUBCHAPTER XI— - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION › Part Part A— - General Provisions › § 1320a–7n

Last updated Apr 6, 2026|Official source

Summary

Protects certain computer models and data tools that help find and stop waste, fraud, and abuse in Medicare, Medicaid, and the Children’s Health Insurance Program. These tools must be kept from public release under federal public-records rules. State agencies can only use or share them to run their Medicaid or CHIP plans or to let a contractor help them detect waste, fraud, and abuse. States must have strong data security and access rules that the federal Department approves. States must also follow uniform procedures set by the Department when they get this information. Covered algorithm — a predictive model or analytics tool used to spot waste, fraud, or abuse, including the math and the way the tool was built.

Full Legal Text

Title 42, §1320a–7n

The Public Health and Welfare — Source: USLM XML via OLRC

(a)For provisions relating to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse with respect to the Medicare program under subchapter XVIII, the Medicaid program under subchapter XIX, and the Children’s Health Insurance Program under subchapter XXI, see section 1320a–7m of this title.

(b)In implementing such provisions under such section 1320a–7m with respect to covered algorithms (as defined in subsection (c)), the following shall apply:

(1)The covered algorithms used or developed for purposes of such section 1320a–7m (including by the Secretary or a State (or an entity operating under a contract with a State)) shall be exempt from disclosure under section 552(b)(3) of title 5.

(2)(A)A State agency may not use or disclose covered algorithms used or developed for purposes of such section 1320a–7m except for purposes of administering the State plan (or a waiver of the plan) under the Medicaid program under subchapter XIX or the State child health plan (or a waiver of the plan) under the Children’s Health Insurance Program under subchapter XXI, including by enabling an entity operating under a contract with a State to assist the State to identify or prevent waste, fraud, and abuse with respect to such programs.

(B)A State agency shall have in effect data security and control policies that the Secretary finds adequate to ensure the security of covered algorithms used or developed for purposes of such section 1320a–7m and to ensure that access to such information is restricted to authorized persons for purposes of authorized uses and disclosures described in subparagraph (A).

(C)State agencies to which information is disclosed pursuant to such section 1320a–7m shall adhere to uniform procedures established by the Secretary.

(c)In this section, the term “covered algorithm”—

(1)means a predictive modeling or other analytics technology, as used for purposes of section 1320a–7m(a) of this title to identify and prevent waste, fraud, and abuse with respect to the Medicare program under subchapter XVIII, the Medicaid program under subchapter XIX, and the Children’s Health Insurance Program under subchapter XXI; and

(2)includes the mathematical expressions utilized in the application of such technology and the means by which such technology is developed.

Reference

Citations & Metadata

Citation

42 U.S.C. § 1320a–7n

Title 42 — The Public Health and Welfare

Last Updated

Apr 6, 2026

Release point: 119-73