(1) any director, officer, partner, or employee responsible for management or administration of a health maintenance organization, any person who is directly or indirectly the beneficial owner of more than 5 per centum of the equity of the organization, any person who is the beneficial owner of a mortgage, deed of trust, note, or other interest secured by, and valuing more than 5 per centum of the health maintenance organization, and, in the case of a health maintenance organization organized as a nonprofit corporation, an incorporator or member of such corporation under applicable State corporation law; (2) any entity in which a person described in paragraph (1)— (A) is an officer or director; (B) is a partner (if such entity is organized as a partnership); (C) has directly or indirectly a beneficial interest of more than 5 per centum of the equity; or (D) has a mortgage, deed of trust, note, or other interest valuing more than 5 per centum of the assets of such entity; (3) any person directly or indirectly controlling, controlled by, or under common control with a health maintenance organization; and (4) any spouse, child, or parent of an individual described in paragraph (1). (c) Each health maintenance organization shall make the information reported pursuant to subsection (a) available to its enrollees upon reasonable request. (d) The Secretary shall, as he deems necessary, conduct an evaluation of transactions reported to the Secretary under subsection (a)(3) for the purpose of determining their adverse impact, if any, on the fiscal soundness and reasonableness of charges to the health maintenance organization with respect to which they transpired. The Secretary shall evaluate the reported transactions of not less than five, or if there are more than twenty health maintenance organizations reporting such transactions, not less than one-fourth of the health maintenance organizations reporting any such transactions under subsection (a)(3).1 (f) Nothing in this section shall be construed to confer upon the Secretary any authority to approve or disapprove the rates charged by any health maintenance organization. (g) Any health maintenance organization failing to file with the Secretary the annual financial statement required in subsection (a) shall be ineligible for any Federal assistance under this title until such time as such statement is received by the Secretary and shall not be a qualified health maintenance organization for purposes of section 1310. (h) Whoever knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any statement filed pursuant to this section shall be guilty of a felony and upon conviction thereof shall be fined not more than $25,000 or imprisoned for not more than five years, or both. 1 Subsection (e) was repealed by Public Law 99-660. |