Page:United States Statutes at Large Volume 103 Part 3.djvu/164

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103 STAT. 2232 PUBLIC LAW 101-239—DEC. 19, 1989 damages against that entity), or against any other

entity (including any physician or provider) that has received payment from that entity with respect to the item or service, and may join or intervene in any action •i related to the events that gave rise to the need for the item or service. "(iii) SUBROGATION RIGHTS. — The United States shall be subrogated (to the extent of payment made under this title for such an item or service) to any right under this subsection of an individual or any other entity to payment with respect to such item or service under a primary plan. "(iv) WAIVER OF RIGHTS. —The Secretary may waive ' •' (in whole or in part) the provisions of this subpara- graph in the case of an individual claim if the Secretary determines that the waiver is in the best interests of the program established under this title. "(3) ENFORCEMENT.— "(A) PRIVATE CAUSE OF ACTION. —There is established a private cause of action for damages (which shall be in an amount double the amount otherwise provided) in the case of a primary plan which fails to provide for primary pay- ment (or appropriate reimbursement) in accordance with such paragraphs (1) and (2)(A). "(B) REFERENCE TO EXCISE TAX WITH RESPECT TO NON- ,| CONFORMING GROUP HEALTH PLANS. —For provision imposing ^, an excise tax with respect to nonconforming group health plans, see section 5000 of the Internal Revenue Code of 1986. "(4) COORDINATION OF BENEFITS. —Where payment for an item or service by a primary plan is less than the amount of the charge for such item or service and is not payment in full, payment may be made under this title (without regard to deductibles and coinsurance under this title) for the remainder of such charge, but— "(A) payment under this title may not exceed an amount which would be payable under this title for such item or service if paragraph (2)(A) did not apply; and "(B) payment under this title, when combined with the amount payable under the primary plan, may not exceed— "(i) in the case of an item or service payment for which is determined under this title on the basis of reasonable cost (or other cost-related basis) or under section 1886, the amount which would be payable under this title on such basis, and "(ii) in the case of an item or service for which payment is authorized under this title on another IA] basis— "(I) the amount which would be payable under the primary plan (without regard to deductibles and coinsurance under such plan), or "(II) the reasonable charge or other amount which would be payable under this title (without regard to deductibles and coinsurance under this i" title), whichever is greater.".