Civil Monetary Penalty Authorities
Below is a list of commonly referenced OIG Civil Monetary Penalty authorities.
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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 |
