108 STAT. 4410
PUBLIC LAW 103-432—OCT. 31, 1994
SEC. 123. EXTRA -BILUNG LIMITS.
(a) ENFORCEMENT OF LIMITS.— Section 1848(g) (42 U.S.C.
1395w-4(g)), as amended by section 13517(a) of OBRA-1993, is
amended—
(1) by amending paragraph (1) to read as follows:
" (1) LIMITATION ON ACTUAL CHARGES. —
"(A) IN GENERAL.—In the case of a nonparticipating
physician or nonparticipating supplier or other person (as
defined in section 1842(i)(2)) who does not accept payment
on an assignment-related basis for a physician's service
furnished with respect to an individual enrolled under this
part, the following rules apply:
"(i) APPLICATION OF LIMITING CHARGE. —No person
may bill or collect an actual charge for the service
in excess of the limiting charge described in paragraph
(2) for such service.
" (ii) No LIABILITY FOR EXCESS CHARGES. —No person is liable for payment of any amounts billed for
the service in excess of such limiting charge.
"(iii) CORRECTION OF EXCESS CHARGES. — If such
a physician, supplier, or other person bills, but does
not collect, an actual charge for a service in violation
of clause (i), the physician, supplier, or other person
shall reduce on a timely basis the actual charge billed
for the service to an amount not to exceed the limiting
charge for the service.
"(iv) REFUND OF EXCESS COLLECTIONS. — If such a
physician, supplier, or other person collects an actual
charge for a service in violation of clause (i), the physician, supplier, or other person shall provide on a timely
basis a refund to the individual charged in the amount
by which the amount collected exceeded the limiting
charge for the service. The amount of such a refund
shall be reduced to the extent the individual has an
outstanding balance owed by the individual to the
physician.
"(B) SANCTIONS.— If a physician, supplier, or other
person—
"(i) knowingly and willfully bills or collects for
services in violation of subparagraph (A)(i) on a
repeated basis, or
"(ii) fails to comply with clause (iii) or (iv) of
subparagraph (A) on a timely basis,
the Secretary may apply sanctions against the physician,
supplier, or other person in accordance with paragraph
(2) of section 1842(j). In applying this subparagraph, paragraph (4) of such section applies in the same manner
as such paragraph applies to such section and any reference
in such section to a physician is deemed also to include
a reference to a supplier or other person under this
subparagraph.
"(C) TIMELY BASIS.— For purposes of this paragraph,
a correction of a bill for an excess charge or refund of
an amount with respect to a violation of subparagraph
(A)(i) in the case of a service is considered to be provided
'on a timely basis', if the reduction or refund is made
not later than 30 days after the date the physician, sup-
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