US Code

Public Law 119-73 (01/23/2026)

42 U.S.C. § 291i

Recovery of expenditures under certain conditions

(a)

Persons liable

section 291f of this titleIf any facility with respect to which funds have been paid under shall, at any time within 20 years after the completion of construction or modernization—
(1)
section 291e of this titlesection 291d of this title be sold or transferred to any entity (A) which is not qualified to file an application under , or (B) which is not approved as a transferee by the State agency designated pursuant to , or its successor, or
(2)
cease to be a public health center or a public or other nonprofit hospital, outpatient facility, facility for long-term care, or rehabilitation facility,
the United States shall be entitled to recover, whether from the transferor or the transferee (or, in the case of a facility which has ceased to be public or nonprofit, from the owners thereof) an amount determined under subsection (c).
(b)

Notice to Secretary

The transferor of a facility which is sold or transferred as described in subsection (a)(1), or the owner of a facility the use of which is changed as described in subsection (a)(2), shall provide the Secretary written notice of such sale, transfer, or change not later than the expiration of 10 days from the date on which such sale, transfer, or change occurs.

(c)

Amount of recovery; interest; interest period

(1)
Except as provided in paragraph (2), the amount the United States shall be entitled to recover under subsection (a) is an amount bearing the same ratio to the then value (as determined by the agreement of the parties or in an action brought in the district court of the United States for the district for which the facility involved is situated) of so much of the facility as constituted an approved project or projects as the amount of the Federal participation bore to the cost of the construction or modernization of such project or projects.
(2)
(A)
After the expiration of—
(i)
180 days after the date of the sale, transfer, or change of use for which a notice is required by subsection (b), in the case of a facility which is sold or transferred or the use of which changes after , or
(ii)
1
1 So in original. The period probably should be a comma.
thirty days after , or if later 180 days after the date of the sale, transfer, or change of use for which a notice is required by subsection (b), in the case of a facility which was sold or transferred or the use of which changed before .
the amount which the United States is entitled to recover under paragraph (1) with respect to a facility shall be the amount prescribed by paragraph (1) plus interest, during the period described in subparagraph (B), at a rate (determined by the Secretary) based on the average of the bond equivalent of the weekly ninety-day Treasury bill auction rate.
(B)
The period referred to in subparagraph (A) is the period beginning—
(i)
in the case of a facility which was sold or transferred or the use of which changed before , thirty days after such date or if later 180 days after the date of the sale, transfer, or change of use for which a notice is required by subsection (b),
(ii)
in the case of a facility with respect to which notice is provided in accordance with subsection (b), upon the expiration of 180 days after the receipt of such notice, or
(iii)
in the case of a facility with respect to which such notice is not provided as prescribed by subsection (b), on the date of the sale, transfer, or change of use for which such notice was to be provided,
and ending on the date the amount the United States is entitled to under paragraph (1) is collected.
(d)

Waiver

(1)
The Secretary may waive the recovery rights of the United States under subsection (a)(1) with respect to a facility in any State if the Secretary determines, in accordance with regulations, that the entity to which the facility was sold or transferred—
(A)
has established an irrevocable trust—
(i)
section 291c(e) of this title in an amount equal to the greater of twice the cost of the remaining obligation of the facility under clause (2) of or the amount, determined under subsection (c), that the United States is entitled to recover, and
(ii)
section 291c(e) of this title which will only be used by the entity to provide the care required by clause (2) of ; and
(B)
section 291c(e) of this title will meet the obligation of the facility under clause (1) of .
(2)
The Secretary may waive the recovery rights of the United States under subsection (a)(2) with respect to a facility in any State if the Secretary determines, in accordance with regulations, that there is good cause for waiving such rights with respect to such facility.
(e)

Lien

section 291f of this titleThe right of recovery of the United States under subsection (a) shall not constitute a lien on any facility with respect to which funds have been paid under .

July 1, 1944, ch. 373Pub. L. 88–443, § 3(a)78 Stat. 456Pub. L. 91–296, title I84 Stat. 342Pub. L. 98–369, div. B, title III, § 2381(a)98 Stat. 1112(, title VI, § 609, as added , , ; amended § 116(d), , ; , , .)

Editorial Notes

Prior Provisions

act July 1, 1944, ch. 373, title VI, § 631Aug. 13, 1946, ch. 958, § 260 Stat. 1041June 19, 1948, ch. 54462 Stat. 531Oct. 25, 1949, ch. 722, § 963 Stat. 901July 12, 1954, ch. 471, § 4(c)68 Stat. 465Aug. 1, 1956, ch. 852, § 19(a)70 Stat. 911Pub. L. 86–70, § 31(c)73 Stat. 149Pub. L. 86–624, § 29(d)74 Stat. 419Pub. L. 87–395, § 575 Stat. 826Pub. L. 87–688, § 4(a)(2)76 Stat. 587Pub. L. 88–443section 291b of this titleA prior section 291i, , as added , ; amended , ; , ; –(f), , 466; , (b), ; , , ; , , ; , , ; , , , related to allotment percentages, and contained various definitions, prior to the general amendment of this subchapter by . See .

section 291h(e) of this titleact July 1, 1944, ch. 373, title VI, § 625Aug. 13, 1946, ch. 958, § 260 Stat. 1041Oct. 25, 1949, ch. 722, § 3(c)63 Stat. 899July 12, 1954, ch. 471, § 4(b)68 Stat. 464Pub. L. 88–443Provisions similar to those comprising this section were contained in , , as added , ; amended , , 901; , , prior to the general amendment of this subchapter by .

Amendments

Pub. L. 98–369section 291f of this title1984— amended section generally. Prior to amendment, section read as follows: “If any facility with respect to which funds have been paid under shall, at any time within twenty years after the completion of construction—

section 291e of this titlesection 291d of this title“(a) be sold or transferred to any person, agency, or organization (1) which is not qualified to file an application under , or (2) which is not approved as a transferee by the State agency designated pursuant to , or its successor, or

“(b) cease to be a public health center or a public or other nonprofit hospital, outpatient facility, facility for long-term care, or rehabilitation facility, unless the Surgeon General determines, in accordance with regulations, that there is good cause for releasing the applicant or other owner from this obligation,

the United States shall be entitled to recover from either the transferor or the transferee (or, in the case of a facility which has ceased to be public or nonprofit, from the owners thereof) an amount bearing the same ratio to the then value (as determined by the agreement of the parties or by action brought in the district court of the United States for the district in which the facility is situated) of so much of the facility as constituted an approved project or projects, as the amount of the Federal participation bore to the cost of the construction or modernization under such project or projects. Such right of recovery shall not constitute a lien upon said facility prior to judgment.”

Pub. L. 91–2961970—Cl. (b). substituted “outpatient facility” for “diagnostic or treatment center”.

Statutory Notes and Related Subsidiaries

Change of Name

section 509(b) of Pub. L. 96–88section 3508(b) of Title 20“Secretary of Health and Human Services” substituted for “Secretary of Health, Education, and Welfare” in subsecs. (b), (c), and (d) pursuant to , which is classified to , Education.

Regulations and Personnel

Pub. L. 98–369, div. B, title III, § 2381(c)98 Stat. 1116

“Not later than the expiration of the one-hundred-and-eighty-day period beginning on the date of the enactment of this section [], the Secretary shall have in effect regulations and personnel to place in effect the amendments made by this section [amending sections 291i and 300s–1a of this title].”
, , , provided that:

Executive Documents

Transfer of Functions

80 Stat. 1610section 202 of this titleOffice of Surgeon General abolished by section 3 of Reorg. Plan No. 3 of 1966, eff. , 31 F.R. 8855, , and functions thereof transferred to Secretary of Health, Education, and Welfare by section 1 of Reorg. Plan No. 3 of 1966, set out as a note under . Office of Surgeon General reestablished within the Office of the Assistant Secretary for Health, see Notice of Department of Health and Human Services, Office of the Assistant Secretary for Health, , 52 F.R. 11754.