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LegalText 42 U.S.C. § 1320a7n Disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse us united_states_code code_section 42 THE PUBLIC HEALTH AND WELFARE 7 SOCIAL SECURITY 1320a7n 42 U.S.C. § 1320a7n current 119-100 2026-06-26 official https://uscode.house.gov/download/releasepoints/us/pl/119/100/xml_usc42@119-100.zip /us/usc/t42/s1320a7n data/legal/raw/us/code/title-42/usc42.xml f9558d5ec15e49b999e2a8358a31c53f6dd6610d48db3e26fffc3fea646efb91 644321055a08eb1f260a6a3e31ac157fa024756abf612a9fd6857e7e400cf24e 7fae644fe6493e6bf60ed60ecda3a1c226b5037b25ea2e965206bc43ca98a970 2026-07-04 official
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42 U.S.C. § 1320a7n - Disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse

Text

(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 Childrens Health Insurance Program under subchapter XXI, see section 1320a7m of this title.

(b) Limiting disclosure of predictive modeling technologies In implementing such provisions under such section 1320a7m 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 1320a7m (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 1320a7m 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 Childrens 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 1320a7m 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 1320a7m 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 1320a7m(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 Childrens 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.

(Aug. 14, 1935, ch. 531, title XI, § 1128K, as added Pub. L. 114198, title VII, § 706(a), July 22, 2016, 130 Stat. 753.)