Title 42, The Public Health and WelfareRelease 119-110

§300gg–134 Enforcement

Title 42 › CHAPTER 6A — PUBLIC HEALTH SERVICE › SUBCHAPTER XXV — REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part E — Health Care Provider Requirements › § 300gg–134

Last updated Sep 23, 2026|Official source

Summary

States can make doctors, hospitals, and other health facilities (including air ambulance services) follow the rules in this part. If the federal Secretary finds a State is not enforcing those rules, the Secretary can step in and enforce them for problems that happen in that State. A State can tell the Secretary of Labor, the Secretary of Health and Human Services, or the Secretary of the Treasury about violations of sections 300gg–131, 300gg–132, or 300gg–135 that affect participants, beneficiaries, or enrollees in group or individual health plans, and about any enforcement actions and outcomes. The Secretary must create a way for consumers to send complaints and must answer those complaints within 60 days. If a provider or facility is found to have broken a rule, the Secretary can fine them up to $10,000 for each violation. The Secretary must follow certain penalty procedures already used for other health laws. The Secretary will waive a fine if the provider did not and could not reasonably have known about the violation and, within 30 days, cancels the bill and repays the plan or enrollee the extra amount plus interest at a rate the Secretary sets. The Secretary can also allow hardship exemptions. State laws stay in effect unless they stop these federal rules from working.

Full Legal Text

Title 42, §300gg–134

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

(a)State enforcement

(1)State authority

Each State may require a provider or health care facility (including a provider of air ambulance services) subject to the requirements of this part to satisfy such requirements applicable to the provider or facility.

(2)Failure to implement requirements

In the case of a determination by the Secretary that a State has failed to substantially enforce the requirements to which paragraph (1) applies with respect to applicable providers and facilities in the State, the Secretary shall enforce such requirements under subsection (b) insofar as they relate to violations of such requirements occurring in such State.

(3)Notification of applicable Secretary

A State may notify the Secretary of Labor, Secretary of Health and Human Services, or the Secretary of the Treasury, as applicable, of instances of violations of section 300gg–131, 300gg–132, or 300gg–135 of this title with respect to participants, beneficiaries, or enrollees under a group health plan or group or individual health insurance coverage, as applicable offered by a health insurance issuer and any enforcement actions taken against providers or facilities as a result of such violations, including the disposition of any such enforcement actions.

(b)Secretarial enforcement authority

(1)In general

If a provider or facility is found by the Secretary to be in violation of a requirement to which subsection (a)(1) applies, the Secretary may apply a civil monetary penalty with respect to such provider or facility (including, as applicable, a provider of air ambulance services) in an amount not to exceed $10,000 per violation. The provisions of subsections (c) (with the exception of the first sentence of paragraph (1) of such subsection), (d), (e), (g), (h), (k), and (l) of section 1320a—7a of this title shall apply to a civil monetary penalty or assessment under this subsection in the same manner as such provisions apply to a penalty, assessment, or proceeding under subsection (a) of such section.

(2)Limitation

The provisions of paragraph (1) shall apply to enforcement of a provision (or provisions) specified in subsection (a)(1) only as provided under subsection (a)(2).

(3)Complaint process

The Secretary shall, through rulemaking, establish a process to receive consumer complaints of violations of such provisions and provide a response to such complaints within 60 days of receipt of such complaints.

(4)Exception

The Secretary shall waive the penalties described under paragraph (1) with respect to a facility or provider (including a provider of air ambulance services) who does not knowingly violate, and should not have reasonably known it violated, section 300gg–131 or 300gg–132 of this title (or, in the case of a provider of air ambulance services, section 300gg–135 of this title) with respect to a participant, beneficiary, or enrollee, if such facility or provider, within 30 days of the violation, withdraws the bill that was in violation of such provision and reimburses the health plan or enrollee, as applicable, in an amount equal to the difference between the amount billed and the amount allowed to be billed under the provision, plus interest, at an interest rate determined by the Secretary.

(5)Hardship exemption

The Secretary may establish a hardship exemption to the penalties under this subsection.

(c)Continued applicability of State law

The sections specified in subsection (a)(1) shall not be construed to supersede any provision of State law which establishes, implements, or continues in effect any requirement or prohibition except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of such a section.

Reference

Citations & Metadata

Citation

42 U.S.C. § 300gg–134

Title 42, The Public Health and Welfare

Last Updated

Sep 23, 2026

Release point: 119-110