US Code

Public Law 119-83 (04/13/2026)

42 U.S.C. § 18033

Financial integrity

(a)

Accounting for expenditures

(1)

In general

An Exchange shall keep an accurate accounting of all activities, receipts, and expenditures and shall annually submit to the Secretary a report concerning such accountings.

(2)

Investigations

The Secretary, in coordination with the Inspector General of the Department of Health and Human Services, may investigate the affairs of an Exchange, may examine the properties and records of an Exchange, and may require periodic reports in relation to activities undertaken by an Exchange. An Exchange shall fully cooperate in any investigation conducted under this paragraph.

(3)

Audits

An Exchange shall be subject to annual audits by the Secretary.

(4)

Pattern of abuse

1

1 See References in Text note below.
If the Secretary determines that an Exchange or a State has engaged in serious misconduct with respect to compliance with the requirements of, or carrying out of activities required under, this title, the Secretary may rescind from payments otherwise due to such State involved under this or any other Act administered by the Secretary an amount not to exceed 1 percent of such payments per year until corrective actions are taken by the State that are determined to be adequate by the Secretary.

(5)

Protections against fraud and abuse

1With respect to activities carried out under this title, the Secretary shall provide for the efficient and non-discriminatory administration of Exchange activities and implement any measure or procedure that—
(A)
1 the Secretary determines is appropriate to reduce fraud and abuse in the administration of this title;  and
(B)
1 the Secretary has authority to implement under this title  or any other Act.
(6)

Application of the False Claims Act

(A)

In general

31 U.S.C. 3729Payments made by, through, or in connection with an Exchange are subject to the False Claims Act ( et seq.) if those payments include any Federal funds. Compliance with the requirements of this Act concerning eligibility for a health insurance issuer to participate in the Exchange shall be a material condition of an issuer’s entitlement to receive payments, including payments of premium tax credits and cost-sharing reductions, through the Exchange.

(B)

2
2 See Termination of Provision note below.
  Damages

section 3729(a) of title 31Notwithstanding paragraph (1) of , and subject to paragraph (2) of such section, the civil penalty assessed under the False Claims Act on any person found liable under such Act as described in subparagraph (A) shall be increased by not less than 3 times and not more than 6 times the amount of damages which the Government sustains because of the act of that person.

(b)

GAO oversight

1Not later than 5 years after the first date on which Exchanges are required to be operational under this title, the Comptroller General shall conduct an ongoing study of Exchange activities and the enrollees in qualified health plans offered through Exchanges. Such study shall review—
(1)
the operations and administration of Exchanges, including surveys and reports of qualified health plans offered through Exchanges and on the experience of such plans (including data on enrollees in Exchanges and individuals purchasing health insurance coverage outside of Exchanges), the expenses of Exchanges, claims statistics relating to qualified health plans, complaints data relating to such plans, and the manner in which Exchanges meet their goals;
(2)
any significant observations regarding the utilization and adoption of Exchanges;
(3)
where appropriate, recommendations for improvements in the operations or policies of Exchanges;
(4)
section 632 of title 15 a survey of the cost and affordability of health care insurance provided under the Exchanges for owners and employees of small business concerns (as defined under ), including data on enrollees in Exchanges and individuals purchasing health insurance coverage outside of Exchanges; and
(5)
how many physicians, by area and specialty, are not taking or accepting new patients enrolled in Federal Government health care programs, and the adequacy of provider networks of Federal Government health care programs.

Pub. L. 111–148, title I, § 1313124 Stat. 184 (, title X, § 10104(k), , , 902.)

Editorial Notes

References in Text

Pub. L. 111–148124 Stat. 130 This title, referred to in subsecs. (a)(4), (5) and (b), is title I of , , , which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

Pub. L. 111–148124 Stat. 119 section 18001 of this titleThis Act, referred to in subsec. (a)(4), (6)(A), is , , , known as the Patient Protection and Affordable Care Act. For complete classification of this Act to the Code, see Short Title note set out under and Tables.

Pub. L. 97–258, § 5(b)96 Stat. 1084 The False Claims Act, referred to in subsec. (a)(6), was the popular name for sections 231, 232, 233, and 235 of former Title 31, Money and Finance. Sections 231, 232, 233, and 235 were repealed by , , , and reenacted by the first section thereof as sections 3729 to 3731 of Title 31, Money and Finance.

Amendments

Pub. L. 111–148, § 10104(k)2010—Subsec. (b)(4), (5). , added par. (4) and redesignated former par. (4) as (5).

Statutory Notes and Related Subsidiaries

Termination of Provision

Pub. L. 111–148, title X, § 10104(j)(1)124 Stat. 901

42 U.S.C. 18033(a)(6)(B)“Subparagraph (B) of section 1313(a)(6) of this Act [] is hereby deemed null, void, and of no effect.”
, , , provided that: