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Civil Monetary Penalties Law

Overview

The Civil Monetary Penalties Law authorizes the imposition of substantial civil money penalties against an entity that engages in activities including, but not limited to: (1) knowingly presenting or causing to be presented, a claim for services not provided as claimed or which is otherwise false or fraudulent in any way; (2) knowingly giving or causing to be given false or misleading information reasonably expected to influence the decision to discharge a patient; (3) offering or giving remuneration to any beneficiary of a federal health care program likely to influence the receipt of reimbursable items or services; (4) arranging for reimbursable services with an entity which is excluded from participation from a federal health care program; (5) knowingly or willfully soliciting or receiving remuneration for a referral of a federal health care program beneficiary; or (6) using a payment intended for a federal health care program beneficiary for another use. 42 U.S.C. § 1320a-7a.

Policy

The Secretary of Health and Human Services, acting through the OIG, has both mandatory and permissive authority to exclude individuals and entities from participation in federal health care programs pursuant to this statute.

Excerpt from Janine Sarti, Asha B. Scielzo, Navigating the Compliance and Governance Landscape: A Glossary of Key Terms, Fundamentals of Health Law (American Health Lawyers Association Nov. 2011).

Authority

The Social Security Act authorizes the Secretary of HHS to seek civil monetary penalties (CMPs) and assessments for many types of conduct. Many of the OIG's CMPs are in the Civil Monetary Penalties Law (CMPL), 42 U.S.C. § 1320a-7a, and the OIG's CMPs codified elsewhere in the Social Security Act adopt by reference many of the provisions of the CMPL.

The OIG is authorized to seek different amounts of CMPs and assessments based on the type of violation at issue. See 42 CFR § 1003.103. For example, in a case of false or fraudulent claims, the OIG may seek a penalty of up to $10,000 for each item or service improperly claimed, and an assessment of up to three times the amount improperly claimed. 42 U.S.C. § 1320a-7a(a). In a kickback case, the OIG may seek a penalty of up to $50,000 for each improper act and damages of up to three times the amount of remuneration at issue (regardless of whether some of the remuneration was for a lawful purpose). 42 U.S.C. § 1320a-7a(a).

From OIG website, http://oig.hhs.gov/fraud/enforcement/cmp/index.asp (last accessed Apr. 30, 2012).

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Last modified at 8/10/2012 9:51 AM  by Charlyn Stanberry 
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