--- kind: "section" citation: "42 U.S.C. § 300gg–134" title: "42" title_heading: "The Public Health and Welfare" number: "300gg–134" heading: "Enforcement" release: "119-102" date: "2026-07-12" url: "https://uscodex.org/usc/42/300gg-134" units: - "Chapter 6A — Public Health Service" - "Subchapter XXV — Requirements Relating to Health Insurance Coverage" - "Part E — Health Care Provider Requirements" --- # §300gg–134. Enforcement - (a) **State enforcement—** - (1) **State authority—** Each [State](/usc/42/201.md?p=f) may require a [provider](/usc/42/299b–21.md?p=8) or health care facility (including a [provider](/usc/42/299b–21.md?p=8) of air ambulance [services](/usc/42/201.md?p=a)) subject to the requirements of this part to satisfy such requirements applicable to the [provider](/usc/42/299b–21.md?p=8) or facility. - (2) **Failure to implement requirements—** In the case of a determination by the [Secretary](/usc/42/201.md?p=c) that a [State](/usc/42/201.md?p=f) has failed to substantially enforce the requirements to which [paragraph (1)](#a-1) applies with respect to applicable [providers](/usc/42/299b–21.md?p=8) and facilities in the [State](/usc/42/201.md?p=f), the [Secretary](/usc/42/201.md?p=c) shall enforce such requirements under [subsection (b)](#b) insofar as they relate to [violations](/usc/42/2000e–16a.md?p=c) of such requirements occurring in such [State](/usc/42/201.md?p=f). - (3) **Notification of applicable Secretary—** A [State](/usc/42/201.md?p=f) may notify the [Secretary](/usc/42/201.md?p=c) of Labor, [Secretary](/usc/42/201.md?p=c) of Health and Human [Services](/usc/42/201.md?p=a), or the [Secretary](/usc/42/201.md?p=c) of the Treasury, as applicable, of instances of [violations](/usc/42/2000e–16a.md?p=c) of sections [300gg–131](/usc/42/300gg–131.md), [300gg–132](/usc/42/300gg–132.md), or [300gg–135](/usc/42/300gg–135.md) of this title with respect to [participants](/usc/42/300gg–91.md?p=d-11), [beneficiaries](/usc/42/300gg–91.md?p=d-2), or enrollees under a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5), as applicable[^1] offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) and any enforcement actions taken against [providers](/usc/42/299b–21.md?p=8) or facilities as a result of such [violations](/usc/42/2000e–16a.md?p=c), including the disposition of any such enforcement actions. - (b) **Secretarial enforcement authority—** - (1) **In general—** If a [provider](/usc/42/299b–21.md?p=8) or facility is found by the [Secretary](/usc/42/201.md?p=c) to be in [violation](/usc/42/2000e–16a.md?p=c) of a requirement to which [subsection (a)(1)](#a-1) applies, the [Secretary](/usc/42/201.md?p=c) may apply a civil monetary penalty with respect to such [provider](/usc/42/299b–21.md?p=8) or facility (including, as applicable, a [provider](/usc/42/299b–21.md?p=8) of air ambulance [services](/usc/42/201.md?p=a)) in an amount not to exceed $10,000 per [violation](/usc/42/2000e–16a.md?p=c). The provisions of [subsections (c)](#c) (with the exception of the first sentence of [paragraph (1)](#b-1) of such subsection), (d), (e), (g), (h), (k), and (l) of [section 1320a](/usc/42/1320a.md)—7a of this title shall apply to a civil monetary penalty or assessment under this subsection in the same manner as such provisions apply to a penalty, assessment, or proceeding under [subsection (a)](/usc/42/1320a.md?p=a) of such section. - (2) **Limitation—** The provisions of [paragraph (1)](#b-1) shall apply to enforcement of a provision (or provisions) specified in [subsection (a)(1)](#a-1) only as provided under [subsection (a)(2)](#a-2). - (3) **Complaint process—** The [Secretary](/usc/42/201.md?p=c) shall, through rulemaking, establish a process to receive consumer complaints of [violations](/usc/42/2000e–16a.md?p=c) of such provisions and provide a response to such complaints within 60 days of receipt of such complaints. - (4) **Exception—** The [Secretary](/usc/42/201.md?p=c) shall waive the penalties described under [paragraph (1)](#b-1) with respect to a facility or [provider](/usc/42/299b–21.md?p=8) (including a [provider](/usc/42/299b–21.md?p=8) of air ambulance [services](/usc/42/201.md?p=a)) who does not knowingly violate, and should not have reasonably known it violated, section [300gg–131](/usc/42/300gg–131.md) or [300gg–132](/usc/42/300gg–132.md) of this title (or, in the case of a [provider](/usc/42/299b–21.md?p=8) of air ambulance [services](/usc/42/201.md?p=a), [section 300gg–135 of this title](/usc/42/300gg–135.md)) with respect to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee, if such facility or [provider](/usc/42/299b–21.md?p=8), within 30 days of the [violation](/usc/42/2000e–16a.md?p=c), withdraws the bill that was in [violation](/usc/42/2000e–16a.md?p=c) of such provision and reimburses the health plan or enrollee, as applicable, in an amount equal to the difference between the amount billed and the amount allowed to be billed under the provision, plus interest, at an interest rate determined by the [Secretary](/usc/42/201.md?p=c). - (5) **Hardship exemption—** The [Secretary](/usc/42/201.md?p=c) may establish a hardship exemption to the penalties under this subsection. - (c) **Continued applicability of State law—** The sections specified in [subsection (a)(1)](#a-1)[^2] shall not be construed to supersede any provision of [State](/usc/42/201.md?p=f) law which establishes, implements, or continues in effect any requirement or prohibition except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of such a section. ## Footnotes [^1]: So in original. Probably should be followed by a comma. [^2]: So in original. Subsec. (a)(1) specifies “this part”, but does not specify individual sections. ## Source credit (July 1, 1944, ch. 373, title XXVII, § 2799B–4, as added Pub. L. 116–260, div. BB, title I, § 104(a), Dec. 27, 2020, 134 Stat. 2829.)