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