U.S. Code > Title 31 Money and Finance > SUBTITLE III—FINANCIAL MANAGEMENT (§§ 3101—3907) > CHAPTER 38—ADMINISTRATIVE REMEDIES FOR FALSE CLAIMS AND STATEMENTS (§§ 3801—3812) > § 3803. Hearing and determinations

§ 3803. Hearing and determinations

(a)
(1) The investigating official of an authority may investigate allegations that a person is liable under section 3802 of this title and shall report the findings and conclusions of such investigation to the reviewing official of the authority. The preceding sentence does not modify any responsibility of an investigating official to report violations of criminal law to the Attorney General.
(2) If the reviewing official of an authority determines, based upon the report of the investigating official under paragraph (1) of this subsection, that there is adequate evidence to believe that a person is liable under section 3802 of this title, the reviewing official shall transmit to the Attorney General a written notice of the intention of such official to refer the allegations of such liability to a presiding officer of such authority. Such notice shall include—
(A) a statement of the reasons of the reviewing official for the referral of such allegations;
(B) a statement specifying the evidence which supports such allegations;
(C) a description of the claims or statements for which liability under section 3802 of this title is alleged;
(D) an estimate of the amount of money or the value of property or services requested or demanded in violation of section 3802 of this title; and
(E) a statement of any exculpatory or mitigating circumstances which may relate to such claims or statements.
(b)
(1) Within 90 days after receipt of a notice from a reviewing official under paragraph (2) of subsection (a), the Attorney General or an Assistant Attorney General designated by the Attorney General shall transmit a written statement to the reviewing official which specifies—
(A) that the Attorney General or such Assistant Attorney General approves or disapproves the referral to a presiding officer of the allegations of liability stated in such notice;
(B) in any case in which the referral of allegations is approved, that the initiation of a proceeding under this section with respect to such allegations is appropriate; and
(C) in any case in which the referral of allegations is disapproved, the reasons for such disapproval.
(2) A reviewing official may refer allegations of liability to a presiding officer only if the Attorney General or an Assistant Attorney General designated by the Attorney General approves the referral of such allegations in a written statement described in paragraph (1) of this subsection.
(3) If the Attorney General or an Assistant Attorney General designated by the Attorney General transmits to an authority head a written finding that the continuation of any hearing under this section with respect to a claim or statement may adversely affect any pending or potential criminal or civil action related to such claim or statement, such hearing shall be immediately stayed and may be resumed only upon written authorization of the Attorney General.
(c)
(1) No allegations of liability under section 3802 of this title with respect to any claim made, presented, or submitted by any person shall be referred to a presiding officer under paragraph (2) of subsection (b) if the reviewing official determines that—
(A) an amount of money in excess of $150,000; or
(B) property or services with a value in excess of $150,000,
is requested or demanded in violation of section 3802 of this title in such claim or in a group of related claims which are submitted at the time such claim is submitted.
(2)
(A) Except as provided in subparagraph (B) of this paragraph, no allegations of liability against an individual under section 3802 of this title with respect to any claim or statement made, presented, or submitted, or caused to be made, presented, or submitted, by such individual relating to any benefits received by such individual shall be referred to a presiding officer under paragraph (2) of subsection (b).
(B) Allegations of liability against an individual under section 3802 of this title with respect to any claim or statement made, presented, or submitted, or caused to be made, presented, or submitted, by such individual relating to any benefits received by such individual may be referred to a presiding officer under paragraph (2) of subsection (b) if—
(i) such claim or statement is made by such individual in making application for such benefits;
(ii) such allegations relate to the eligibility of such individual to receive such benefits; and
(iii) with respect to such claim or statement, the individual—
(I) has actual knowledge that the claim or statement is false, fictitious, or fraudulent;
(II) acts in deliberate ignorance of the truth or falsity of the claim or statement; or
(III) acts in reckless disregard of the truth or falsity of the claim or statement.
(C) For purposes of this subsection, the term “benefits” means—
(i) benefits under the supplemental security income program under title XVI of the Social Security Act;
(ii) old age, survivors, and disability insurance benefits under title II of the Social Security Act;
(iii) benefits under title XVIII of the Social Security Act;
(iv) assistance under a State program funded under part A of title IV of the Social Security Act;
(v) medical assistance under a State plan approved under section 1902(a) of the Social Security Act;
(vi) benefits under title XX of the Social Security Act;
(vii) benefits under the supplemental nutrition assistance program (as defined in section 3(l) of the Food and Nutrition Act of 2008);
(viii) benefits under chapters 11, 13, 15, 17, and 21 of title 38;
(ix) benefits under the Black Lung Benefits Act;
(x) benefits under the special supplemental nutrition program for women, infants, and children established under section 17 of the Child Nutrition Act of 1966;
(xi) benefits under section 336 of the Older Americans Act;
(xii) any annuity or other benefit under the Railroad Retirement Act of 1974;
(xiii) benefits under the Richard B. Russell National School Lunch Act;
(xiv) benefits under any housing assistance program for lower income families or elderly or handicapped persons which is administered by the Secretary of Housing and Urban Development or the Secretary of Agriculture;
(xv) benefits under the Low-Income Home Energy Assistance Act of 1981; and
(xvi) benefits under part A of the Energy Conservation in Existing Buildings Act of 1976,
which are intended for the personal use of the individual who receives the benefits or for a member of the individual’s family.
(d)
(1) On or after the date on which a reviewing official is permitted to refer allegations of liability to a presiding officer under subsection (b) of this section, the reviewing official shall mail, by registered or certified mail, or shall deliver, a notice to the person alleged to be liable under section 3802 of this title. Such notice shall specify the allegations of liability against such person and shall state the right of such person to request a hearing with respect to such allegations.
(2) If, within 30 days after receiving a notice under paragraph (1) of this subsection, the person receiving such notice requests a hearing with respect to the allegations contained in such notice—
(A) the reviewing official shall refer such allegations to a presiding officer for the commencement of such hearing; and
(B) the presiding officer shall commence such hearing by mailing by registered or certified mail, or by delivery of, a notice which complies with paragraphs (2)(A) and (3)(B)(i) of subsection (g) to such person.
(e)
(1)
(A) Except as provided in subparagraph (B) of this paragraph, at any time after receiving a notice under paragraph (2)(B) of subsection (d), the person receiving such notice shall be entitled to review, and upon payment of a reasonable fee for duplication, shall be entitled to obtain a copy of, all relevant and material documents, transcripts, records, and other materials, which relate to such allegations and upon which the findings and conclusions of the investigating official under paragraph (1) of subsection (a) are based.
(B) A person is not entitled under subparagraph (A) to review and obtain a copy of any document, transcript, record, or material which is privileged under Federal law.
(2) At any time after receiving a notice under paragraph (2)(B) of subsection (d), the person receiving such notice shall be entitled to obtain all exculpatory information in the possession of the investigating official or the reviewing official relating to the allegations contained in such notice. The provisions of subparagraph (B) of paragraph (1) do not apply to any document, transcript, record, or other material, or any portion thereof, in which such exculpatory information is contained.
(f) Any hearing commenced under paragraph (2) of subsection (d) shall be conducted by the presiding officer on the record in order to determine—
(1) the liability of a person under section 3802 of this title; and
(2) if a person is determined to be liable under such section, the amount of any civil penalty or assessment to be imposed on such person.
Any such determination shall be based on the preponderance of the evidence.
(g)
(1) Each hearing under subsection (f) of this section shall be conducted—
(A) in the case of an authority to which the provisions of subchapter II of chapter 5 of title 5 apply, in accordance with—
(i) the provisions of such subchapter to the extent that such provisions are not inconsistent with the provisions of this chapter; and
(ii) procedures promulgated by the authority head under paragraph (3) of this subsection; or
(B) in the case of an authority to which the provisions of such subchapter do not apply, in accordance with procedures promulgated by the authority head under paragraphs (2) and (3) of this subsection.
(2) An authority head of an authority described in subparagraph (B) of paragraph (1) shall by regulation promulgate procedures for the conduct of hearings under this chapter. Such procedures shall include:
(A) The provision of written notice of the hearing to any person alleged to be liable under section 3802 of this title, including written notice of—
(i) the time, place, and nature of the hearing;
(ii) the legal authority and jurisdiction under which the hearing is to be held; and
(iii) the matters of facts and law to be asserted.
(B) The provision to any person alleged to be liable under section 3802 of this title of opportunities for the submission of facts, arguments, offers of settlement, or proposals of adjustment.
(C) Procedures to ensure that the presiding officer shall not, except to the extent required for the disposition of ex parte matters as authorized by law—
(i) consult a person or party on a fact in issue, unless on notice and opportunity for all parties to the hearing to participate; or
(ii) be responsible to or subject to the supervision or direction of the investigating official or the reviewing official.
(D) Procedures to ensure that the investigating official and the reviewing official do not participate or advise in the decision required under subsection (h) of this section or the review of the decision by the authority head under subsection (i) of this section, except as provided in subsection (j) of this section.
(E) The provision to any person alleged to be liable under section 3802 of this title of opportunities to present such person’s case through oral or documentary evidence, to submit rebuttal evidence, and to conduct such cross-examination as may be required for a full and true disclosure of the facts.
(F) Procedures to permit any person alleged to be liable under section 3802 of this title to be accompanied, represented, and advised by counsel or such other qualified representative as the authority head may specify in such regulations.
(G) Procedures to ensure that the hearing is conducted in an impartial manner, including procedures to—
(i) permit the presiding officer to at any time disqualify himself; and
(ii) permit the filing, in good faith, of a timely and sufficient affidavit alleging personal bias or another reason for disqualification of a presiding officer or a reviewing official.
(3)
(A) Each authority head shall promulgate by regulation procedures described in subparagraph (B) of this paragraph for the conduct of hearings under this chapter. Such procedures shall be in addition to the procedures described in paragraph (1) or paragraph (2) of this subsection, as the case may be.
(B) The procedures referred to in subparagraph (A) of this paragraph are:
(i) Procedures for the inclusion, in any written notice of a hearing under this section to any person alleged to be liable under section 3802 of this title, of a description of the procedures for the conduct of the hearing.
(ii) Procedures to permit discovery by any person alleged to be liable under section 3802 of this title only to the extent that the presiding officer determines that such discovery is necessary for the expeditious, fair, and reasonable consideration of the issues, except that such procedures shall not apply to documents, transcripts, records, or other material which a person is entitled to review under paragraph (1) of subsection (e) or to information to which a person is entitled under paragraph (2) of such subsection. Procedures promulgated under this clause shall prohibit the discovery of the notice required under subsection (a)(2) of this section.
(4) Each hearing under subsection (f) of this section shall be held—
(A) in the judicial district of the United States in which the person alleged to be liable under section 3802 of this title resides or transacts business;
(B) in the judicial district of the United States in which the claim or statement upon which the allegation of liability under such section was made, presented, or submitted; or
(C) in such other place as may be agreed upon by such person and the presiding officer who will conduct such hearing.
(h) The presiding officer shall issue a written decision, including findings and determinations, after the conclusion of the hearing. Such decision shall include the findings of fact and conclusions of law which the presiding officer relied upon in determining whether a person is liable under this chapter. The presiding officer shall promptly send to each party to the hearing a copy of such decision and a statement describing the right of any person determined to be liable under section 3802 of this title to appeal the decision of the presiding officer to the authority head under paragraph (2) of subsection (i).
(i)
(1) Except as provided in paragraph (2) of this subsection and section 3805 of this title, the decision, including the findings and determinations, of the presiding officer issued under subsection (h) of this section are final.
(2)
(A)
(i) Except as provided in clause (ii) of this subparagraph, within 30 days after the presiding officer issues a decision under subsection (h) of this section, any person determined in such decision to be liable under section 3802 of this title may appeal such decision to the authority head.
(ii) If, within the 30-day period described in clause (i) of this subparagraph, a person determined to be liable under this chapter requests the authority head for an extension of such 30-day period to file an appeal of a decision issued by the presiding officer under subsection (h) of this section, the authority head may extend such period if such person demonstrates good cause for such extension.
(B) Any authority head reviewing under this section the decision, findings, and determinations of a presiding officer shall not consider any objection that was not raised in the hearing conducted pursuant to subsection (f) of this section unless a demonstration is made of extraordinary circumstances causing the failure to raise the objection. If any party demonstrates to the satisfaction of the authority head that additional evidence not presented at such hearing is material and that there were reasonable grounds for the failure to present such evidence at such hearing, the authority head shall remand the matter to the presiding officer for consideration of such additional evidence.
(C) The authority head may affirm, reduce, reverse, compromise, remand, or settle any penalty or assessment determined by the presiding officer pursuant to this section. The authority head shall promptly send to each party to the appeal a copy of the decision of the authority head and a statement describing the right of any person determined to be liable under section 3802 of this title to judicial review under section 3805 of this title.
(j) The reviewing official has the exclusive authority to compromise or settle any allegations of liability under section 3802 of this title against a person without the consent of the presiding officer at any time after the date on which the reviewing official is permitted to refer allegations of liability to a presiding officer under subsection (b) of this section and prior to the date on which the presiding officer issues a decision under subsection (h) of this section. Any such compromise or settlement shall be in writing.