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Civil Monetary Penalty Authorities

This table is a non-exhaustive list of commonly referenced Civil Monetary Penalty authorities.

Social Security Act (SSA)
SSA Section 42 U.S.C. § 42 C.F.R. § Description
1128A(a)(1)(A) 1320a-7a(a)(1)(A) 1003.200(a)(1) Claims for items or services not provided as claimed
1128A(a)(1)(B) 1320a-7a(a)(1)(B) 1003.200(a)(2) False or fraudulent claims
1128A(a)(1)(C) 1320a-7a(a)(1)(C) 1003.200(a)(4) Claims for physician services not furnished or supervised by a licensed physician
1128A(a)(1)(D) 1320a-7a(a)(1)(D) 1003.200(a)(3) Claims for items or services furnished by an excluded person
1128A(a)(1)(E) 1320a-7a(a)(1)(E) 1003.200(a)(5) Pattern of claims for medical or other items or services not medically necessary
1128A(a)(2) 1320a-7a(a)(2) 1003.200(b)(1) Assignment agreement, participating physician or supplier agreement violation
1128A(a)(4) 1320a-7a(a)(4) 1003.200(b)(3) Excluded party retaining ownership or control interest in participating entity
1128A(a)(5) 1320a-7a(a)(5) 1003.1000 Remuneration offered to induce program beneficiaries to use particular providers, practitioners, or suppliers
1128A(a)(6) 1320a-7a(a)(6) 1003.200(b)(4) Employing, arranging or contracting with an excluded individual
1128A(a)(7) 1320a-7a(a)(7) 1003.300 Improper remuneration to induce referrals
1128A(a)(8) 1320a-7a(a)(8) 1003.200(b)(6) Ordering or prescribing while excluded
1128A(a)(9) 1320a-7a(a)(9) 1003.200(b)(7) Making false statements, omissions, misrepresentations in an enrollment application
1128A(a)(10) 1320a-7a(a)(10) 1003.200(b)(8) Known retention of an overpayment
1128A(a)[11](8) 1320a-7a(a)[11](8) 1003.200(b)(9) 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) 1003.200(b)(10) Failure to grant timely access to OIG for audits, investigations, evaluations, or other statutory functions of OIG
1140(b) 1320b-10(b) 1003.600 Misuse of Departmental symbols/emblems
1867(d)(1) 1395dd(d)(1) 1003.500 Dumping by hospital or responsible physician of patients needing emergency medical care
1877(g)(3) 1395nn(g)(3) 1003.300 Presenting claims for designated health services furnished while in a prohibited financial relationship
1877(g)(4) 1395nn(g)(4) 1003.300 Circumventing physician financial relationship restrictions
1927(b)(3)(B) 1396r-8(b)(3)(B) 1003.1200 False information on a drug manufacturer survey from manufacturer, wholesaler, or seller
1927(b)(3)(C) 1396r-8(b)(3)(C) 1003.1200 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) 1003.800 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) 1003.900 Noncompliance with regulations regarding appropriate transfer and/or possession of dangerous biological agents and toxins in violation of 42 CFR Part 73