Title 42, The Public Health and WelfareRelease 119-110

§1320a–7n Disclosure of Predictive Modeling and Other Analytics Technologies to Identify and Prevent Waste, Fraud, and Abuse

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

Last updated Sep 22, 2026|Official source

Summary

Limits who can see and share certain computer models and analytics used to find and stop waste, fraud, and abuse in Medicare, Medicaid, and CHIP. Those models cannot be released under the Freedom of Information Act (5 U.S.C. 552(b)(3)). State agencies may only use or share these “covered algorithms” to run their Medicaid or CHIP plans (or approved waivers), including letting a contractor help spot fraud. States must have data security and access rules the Secretary approves, and they must follow uniform procedures the Secretary sets. A covered algorithm means the predictive model or analytics tool and the math and methods used to make it.

Full Legal Text

Title 42, §1320a–7n

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

(a)Reference to predictive modeling technologies requirements

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)Limiting disclosure of predictive modeling technologies

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

(1)Nonapplication of FOIA

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)Limitation with respect to use and disclosure of information by State agencies

(A)In general

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)Information security

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)Procedural requirements

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

(c)Covered algorithm defined

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

Sep 22, 2026

Release point: 119-110