Civil Monetary Penalty Authorities
Below is a list of commonly referenced OIG Civil Monetary Penalty authorities.
Social Security Act (SSA)
SSA Section | 42 U.S.C. § | 42 C.F.R. | Description |
---|---|---|---|
1128A(a)(1)(A), (B) | 1320a-7a(a)(1)(A), (B) | 1003.102(a)(1), (2) | False claims |
1128A(a)(1)(C) | 1320a-7a(a)(1)(C) | 1003.102(a)(4) | Claims submitted with a false certification of physician license |
1128A(a)(1)(D) | 1320a-7a(a)(1)(D) | 1003.102(a)(2), (3) | Claims presented by excluded party |
1128A(a)(2) | 1320a-7a(a)(2) | 1003.102(b)(1)(i) | Assignment agreement, participating physician or supplier agreement violation |
1128A(a)(3) | 1320a-7a(a)(3) | 1003.102(b)(4) | A participating physician or supplier that knowingly gives false or misleading information that could reasonably be expected to influence the decision when to discharge an individual from the hospital |
1128A(a)(4) | 1320a-7a(a)(4) | 1003.102(b)(12) | Excluded party retaining ownership or control interest in participating entity |
1128A(a)(5) | 1320a-7a(a)(5) | 1003.102(b)(13) | Remuneration offered to induce program beneficiaries to use particular providers, practitioners, or suppliers |
1128A(a)(6) | 1320a-7a(a)(6) | 1003.102(a)(2) | Employing or contracting with an excluded individual |
1128A(a)(1)(E) | 1320a-7a(a)(1)(E) | 1003.102(a)(6) | Pattern of claims for medically unnecessary services/supplies |
1128A(a)(7) | 1320a-7a(a)(7) | 1003.102(b)(11) | Improper remuneration to induce referrals |
1128A(a)(8) | 1320a-7a(a)(8) | Ordering or prescribing while excluded | |
1128A(a)(9) | 1320a-7a(a)(9) | Making false statements, omissions, misrepresentations in an enrollment application | |
1128A(a)(10) | 1320a-7a(a)(10) | Known retention of an overpayment | |
1128A(a)[11](8) | 1320a-7a(a)[11](8) | Making or using a false record or statement that is material to a false or fraudulent claim | |
1128A(a)[12](9) | 1320a-7a(a)[12](9) | Failure to grant timely access to OIG for audits, investigations, evaluations, or other statutory functions of OIG | |
1140(b) | 1320b-10(b) | Misuse of Departmental symbols/emblems | |
1834(a)(18)(B) and 1842(j)(2) | 1395m(a)(18)(B) and 1395u(j)(2) | 402.1(c)(5) | Any nonparticipating durable medical equipment supplier that knowingly and willfully fails to make a refund to Medicare beneficiaries for a covered service for which payment is precluded due to an unsolicited telephone contact from the supplier |
1867(d)(1) | 1395dd(d)(1) | Dumping by hospital or responsible physician of patients needing emergency medical care | |
1876(i)(6)(A)(v), 1903(m)(5)(A)(iv), and 1857(g)(1)(E) | 1395mm(i)(6)(A)(v), 1396b(m)(5)(A)(iv), and 1395w-27(g)(1)(E)\ | False or misrepresenting Medicare+Choice/HMO competitive medical plan information to Secretary, and individual, or other entity | |
1877(g)(3) | 1395nn(g)(3) | Presenting claims for designated health services furnished while in a prohibited financial relationship | |
1877(g)(4) | 1395nn(g)(4) | Circumventing physician financial relationship restrictions | |
1927(b)(3)(B) | 1396r-8(b)(3)(B) | False information on a drug manufacturer survey from manufacturer, wholesaler, or seller | |
1927(b)(3)(C) | 1396r-8(b)(3)(C) | 414.806 | Provision of untimely or false information by a drug manufacturer with rebate agreement |
Health Care Quality Improvement Act (HCQIA)
HCQIA Section | 42 U.S. C. § | 42 C.F.R. | Description |
---|---|---|---|
427(b) | 11137(b)(2) | Breaching confidentiality of information reported to the National Practitioner Data Bank |
Public Health Security and Bioterrorism Preparedness and
Response Act (PHSBPR)
PHSBPR Section | 42 U.S. C. § | 42 C.F.R. | Description |
---|---|---|---|
351A(i)(1) | 262a(i)(1) | 73, 1003.102(b)(16) and 103l | Noncompliance with regulations regarding appropriate transfer and/or possession of dangerous biological agents and toxins in violation of 42 CFR Parts 72 and 73 |
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