42 C.F.R. PART 1003—CIVIL MONEY PENALTIES, ASSESSMENTS AND EXCLUSIONS
Title 42 - Public Health
Authority: 42 U.S.C. 262a, 1302, 1320–7, 1320a–7a, 1320b–10, 1395u(j), 1395u(k), 1395cc(j), 1395w–141(i)(3), 1395dd(d)(1), 1395mm, 1395nn(g), 1395ss(d), 1396b(m), 11131(c), and 11137(b)(2).
Source: 51 FR 34777, Sept. 30, 1986, unless otherwise noted.
(a)Basis. This part implements sections 1128(c), 1128A, 1140, 1860D–31(i)(3), 1876(i)(6), 1877(g), 1882(d) and 1903(m)(5) of the Social Security Act; sections 421(c) and 427(b)(2) of Pub. L. 99–660; and section 201(i) of Pub. L. 107–188 (42 U.S.C. 1320–7(c), 1320a–7a, 1320b–10, 1395w–141(i)(3), 1395dd(d)(1), 1395mm, 1395ss(d), 1396b(m), 11131(c), 11137(b)(2) and 262). (b) Purpose. This part— (1) Provides for the imposition of civil money penalties and, as applicable, assessments against persons who— (i) Have knowingly submitted certain prohibited claims under Federal health care programs; (ii) Seek payment in violation of the terms of an agreement or a limitation on charges or payments under the Medicare program, or a requirement not to charge in excess of the amount permitted under the Medicaid program; (iii) Give false or misleading information that might affect the decision to discharge a Medicare patient from the hospital; (iv)(A) Fail to report information concerning medical malpractice payments or who improperly disclose, use or permit access to information reported under part B of title IV of Public Law 99–660, and regulations specified in 45 CFR part 60, or (B) Are health plans and fail to report information concerning sanctions or other adverse actions imposed on providers as required to be reported to the Healthcare Integrity and Protection Data Bank (HIPDB) in accordance with section 1128E of the Act; (v) Misuse certain Departmental and Medicare and Medicaid program words, letters symbols or emblems; (vi) Violate a requirement of section 1867 of the Act or §489.24 of this title; (vii) Substantially fail to provide an enrollee with required medically necessary items and services; engage in certain marketing, enrollment, reporting, claims payment, employment or contracting abuses; or do not meet the requirements for physician incentive plans for Medicare specified in §§417.479(d) through (f) of this title; (viii) Present or cause to be presented a bill or claim for designated health services (as defined in §411.351 of this title) that they know, or should know, were furnished in accordance with a referral prohibited under §411.353 of this title; (ix) Have collected amounts that they know or should know were billed in violation of §411.353 of this title and have not refunded the amounts collected on a timely basis; (x) Are physicians or entities that enter into an arrangement or scheme that they know or should know has as a principal purpose the assuring of referrals by the physician to a particular entity which, if made directly, would violate the provisions of §411.353 of this title; (xi) Are excluded, and who retain an ownership or control interest of five percent or more in an entity participating in Medicare or a State health care program, or who are officers or managing employees of such an entity (as defined in section 1126(b) of the Act); (xii) Offer inducements that they know or should know are likely to influence Medicare or State health care program beneficiaries to order or receive particular items or services; (xiii) Are physicians who knowingly misrepresent that a Medicare beneficiary requires home health services; (xiv) Have submitted, or caused to be submitted, certain prohibited claims, including claims for services rendered by excluded individuals employed by or otherwise under contract with such person, under one or more Federal health care programs; (xv) Violate the Federal health care programs' anti-kickback statute as set forth in section 1128B of the Act; (xvi) Violate the provisions of part 73 of this title, implementing section 351A(b) and (c) of the Public Health Service Act, with respect to the possession and use within the United States, receipt from outside the United States, and transfer within the United States, of select agents and toxins in use, or transfer of listed biological agents and toxins; or (xvii) Violate the provisions of part 403, subpart H of this title, implementing the Medicare prescription drug discount card and transitional assistance program, by misleading or defrauding program beneficiaries, by overcharging a discount program enrollee, or by misusing transitional assistance funds. (2) Provides for the exclusion of persons from the Medicare or State health care programs against whom a civil money penalty or assessment has been imposed, and the basis for reinstatement of persons who have been excluded; and (3) Sets forth the appeal rights of persons subject to a penalty, assessment and exclusion. [65 FR 24414, Apr. 26, 2000, as amended at 67 FR 11935, Mar. 18, 2002; 67 FR 76905, Dec. 13, 2002; 69 FR 28845, May 19, 2004] For purposes of this part: Act means the Social Security Act. Adverse effect means medical care has not been provided and the failure to provide such necessary medical care has presented an imminent danger to the health, safety, or well-being of the patient or has placed the patient unnecessarily in a high-risk situation. ALJ means an Administrative Law Judge. Assessment means the amount described in §1003.104, and includes the plural of that term. Claim means an application for payment for an item or service to a Federal health care program (as defined in section 1128B(f) of the Act). CMS stands for Centers for Medicare & Medicaid Services, formerly the Health Care Financing Administration (HCFA). Contracting organization means a public or private entity, including of a health maintenance organization (HMO), competitive medical plan, or health insuring organization (HIO) which meets the requirements of section 1876(b) of the Act or is subject to the requirements in section 1903(m)(2)(A) of the Act and which has contracted with the Department or a State to furnish services to Medicare beneficiaries or Medicaid recipients. Department means the Department of Health and Human Services. Enrollee means an individual who is eligible for Medicare or Medicaid and who enters into an agreement to receive services from a contracting organization that contracts with the Department under title XVIII or title XIX of the Act. Exclusion means the temporary or permanent barring of a person from participation in a Federal health care program (as defined in section 1128B(f) of the Act). Inspector General means the Inspector General of the Department or his or her designees. Item or service includes— (a) Any item, device, medical supply or service provided to a patient (i) which is listed in an itemized claim for program payment or a request for payment, or (ii) for which payment is included in other Federal or State health care reimbursement methods, such as a prospective payment system; and (b) In the case of a claim based on costs, any entry or omission in a cost report, books of account or other documents supporting the claim. Maternal and Child Health Services Block Grant program means the program authorized under Title V of the Act. Medicaid means the program of grants to the States for medical assistance authorized under title XIX of the Act. Medical malpractice claim or action means a written complaint or claim demanding payment based on a physician's, dentist's or other health care practitioner's provision of, or failure to provide health care services, and includes the filing of a cause of action based on the law of tort brought in any State or Federal court or other adjudicative body. Medicare means the program of health insurance for the aged and disabled authorized under Title XVIII of the Act. Participating hospital means (1) a hospital or (2) a rural primary care hospital as defined in section 1861(mm)(1) of the Act that has entered into a Medicare provider agreement under section 1866 of the Act. Penalty means the amount described in §1003.103 and includes the plural of that term. Person means an individual, trust or estate, partnership, corporation, professional association or corporation, or other entity, public or private. Physician incentive plan means any compensation arrangement between a contracting organization and a physician group that may directly or indirectly have the effect of reducing or limiting services provided with respect to enrollees in the organization. Preventive care, for purposes of the definition of the term Remuneration as set forth in this section and the preventive care exception to section 231(h) of HIPAA, means any service that— (1) Is a prenatal service or a post-natal well-baby visit or is a specific clinical service described in the current U.S. Preventive Services Task Force's Guide to Clinical Preventive Services, and (2) Is reimbursable in whole or in part by Medicare or an applicable State health care program. Remuneration, as set forth in §1003.102(b)(13) of this part, is consistent with the definition contained in section 1128A(i)(6) of the Act, and includes the waiver of coinsurance and deductible amounts (or any part thereof) and transfers of items or services for free or for other than fair market value. The term “remuneration” does not include— (1) The waiver of coinsurance and deductible amounts by a person, if the waiver is not offered as part of any advertisement or solicitation; the person does not routinely waive coinsurance or deductible amounts; and the person waives coinsurance and deductible amounts after determining in good faith that the individual is in financial need or failure by the person to collect coinsurance or deductible amounts after making reasonable collection efforts; (2) Any permissible practice as specified in section 1128B(b)(3) of the Act or in regulations issued by the Secretary; (3) Differentials in coinsurance and deductible amounts as part of a benefit plan design (as long as the differentials have been disclosed in writing to all beneficiaries, third party payers and providers), to whom claims are presented; or (4) Incentives given to individuals to promote the delivery of preventive care services where the delivery of such services is not tied (directly or indirectly) to the provision of other services reimbursed in whole or in part by Medicare or an applicable State health care program. Such incentives may include the provision of preventive care, but may not include— (i) Cash or instruments convertible to cash; or (ii) An incentive the value of which is disproportionally large in relationship to the value of the preventive care service (i.e., either the value of the service itself or the future health care costs reasonably expected to be avoided as a result of the preventive care). Request for payment means an application submitted by a person to any person for payment for an item or service. Respondent means the person upon whom the Department has imposed, or proposes to impose, a penalty, assessment or exclusion. Responsible physician means a physician who is responsible for the examination, treatment, or transfer of an individual who comes to a participating hospital's emergency department seeking assistance and includes a physician on call for the care of such individual. Secretary means the Secretary of the Department or his or her designees. Select agents and toxins means agents and toxins that are listed by the HHS Secretary as having the potential to pose a severe threat to public health and safety, in accordance with section 351A(a)(1) of the Public Health Service Act. Should know or should have known means that a person, with respect to information— (1) Acts in deliberate ignorance of the truth or falsity of the information; or (2) Acts in reckless disregard of the truth or falsity of the information. For purposes of this definition, no proof of specific intent to defraud is required. Social Services Block Grant program means the program authorized under title XX of the Social Security Act. State includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands, and the Trust Territory of the Pacific Islands. State health care program means a State plan approved under title XIX of the Act, any program receiving funds under title V of the Act or from an allotment to a State under such title, or any program receiving funds under title XX of the Act or from an allotment to a State under such title. Timely basis means, in accordance with §1003.102(b)(9) of this part, the 60-day period from the time the prohibited amounts are collected by the individual or the entity. Transitional assistance means the subsidy funds that Medicare beneficiaries enrolled in the prescription drug discount card and transitional assistance program may apply toward the cost of covered discount card drugs in the manner described in §403.808(d) of this title. [51 FR 34777, Sept. 30, 1986, as amended at 56 FR 28492, June 21, 1991; 57 FR 3345, Jan. 29, 1992; 59 FR 32124, June 22, 1994; 59 FR 36086, July 15, 1994; 60 FR 16584, Mar. 31, 1995; 61 FR 13449, Mar. 27, 1996; 65 FR 24415, Apr. 26, 2000; 65 FR 35584, June 5, 2000; 66 FR 39452, July 31, 2001; 67 FR 11935, Mar. 18, 2002; 67 FR 76905, Dec. 13, 2002; 69 FR 28845, May 19, 2004] (a) The OIG may impose a penalty and assessment against any person whom it determines in accordance with this part has knowingly presented, or caused to be presented, a claim which is for— (1) An item or service that the person knew, or should have known, was not provided as claimed, including a claim that is part of a pattern or practice of claims based on codes that the person knows or should know will result in greater payment to the person than the code applicable to the item or service actually provided; (2) An item or service for which the person knew, or should have known, that the claim was false or fraudulent, including a claim for any item or service furnished by an excluded individual employed by or otherwise under contract with that person; (3) An item or service furnished during a period in which the person was excluded from participation in the Federal health care program to which the claim was made; (4) A physician's services (or an item or service) for which the person knew, or should have known, that the individual who furnished (or supervised the furnishing of) the service— (i) Was not licensed as a physician; (ii) Was licensed as a physician, but such license had been obtained through a misrepresentation of material fact (including cheating on an examination required for licensing); or (iii) Represented to the patient at the time the service was furnished that the physician was certified in a medical specialty board when he or she was not so certified; (5) A payment that such person knows, or should know, may not be made under §411.353 of this title; or (6) An item or service that a person knows or should know is medically unnecessary, and which is part of a pattern of such claims. (b) The OIG may impose a penalty, and where authorized, an assessment against any person (including an insurance company in the case of paragraphs (b)(5) and (b)(6) of this section) whom it determines in accordance with this part— (1) Has knowingly presented or caused to be presented a request for payment in violation of the terms of— (i) An agreement to accept payments on the basis of an assignment under section 1842(b)(3)(B)(ii) of the Act; (ii) An agreement with a State agency or other requirement of a State Medicaid plan not to charge a person for an item or service in excess of the amount permitted to be charged; (iii) An agreement to be a participating physician or supplier under section 1842(h)(1); or (iv) An agreement in accordance with section 1866(a)(1)(G) of the Act not to charge any person for inpatient hospital services for which payment had been denied or reduced under section 1886(f)(2) of the Act. (2)–(3) [Reserved] (4) Has knowingly given or caused to be given to any person, in the case of inpatient hospital services subject to the provisions of section 1886 of the Act, information that he or she knew, or should have known, was false or misleading and that could reasonably have been expected to influence the decision when to discharge such person or another person from the hospital. (5) Fails to report information concerning— (i) A payment made under an insurance policy, self-insurance or otherwise, for the benefit of a physician, dentist or other health care practitioner in settlement of, or in satisfaction in whole or in part of, a medical malpractice claim or action or a judgment against such a physician, dentist or other practitioner in accordance with section 421 of Public Law 99–660 (42 U.S.C. 11131) and as required by regulations at 45 CFR part 60; or (ii) An adverse action required to be reported to the Healthcare Integrity and Protection Data Bank as established by section 221 of Public Law 104–191 and set forth in section 1128E of the Act. (6) Improperly discloses, uses or permits access to information reported in accordance with part B of title IV of Pub. L. 99–660, in violation of section 427 of Pub. L. 99–660 (42 U.S.C. 11137) or regulations at 45 CFR part 60. (The disclosure of information reported in accordance with part B of title IV in response to a subpoena or a discovery request is considered to be an improper disclosure in violation of section 427 of Pub. L. 99–660. However, disclosure or release by an entity of original documents or underlying records from which the reported information is obtained or derived is not considered to be an improper disclosure in violation of section 427 of Pub. L. 99–660.) (7) Has made use of the words, letters, symbols or emblems as defined in paragraph (b)(7)(i) of this section in such a manner that such person knew or should have known would convey, or in a manner which reasonably could be interpreted or construed as conveying, the false impression that an advertisement, solicitation or other item was authorized, approved or endorsed by the Department or CMS, or that such person or organization has some connection with or authorization from the Department or CMS. Civil money penalties— (i) May be imposed, regardless of the use of a disclaimer of affiliation with the United States Government, the Department or its programs, for misuse of— (A) The words “Department of Health and Human Services,” “Health and Human Services,” “Centers for Medicare & Medicaid Services,” “Medicare,” or “Medicaid,” or any other combination or variation of such words; (B) The letters “DHHS,” “HHS,” or “CMS,” or any other combination or variation of such letters; or (C) A symbol or emblem of the Department or CMS (including the design of, or a reasonable facsimile of the design of, the Medicare card, the check used for payment of benefits under title II, or envelopes or other stationery used by the Department or CMS) or any other combination or variation of such symbols or emblems; and (ii) Will not be imposed against any agency or instrumentality of a State, or political subdivision of the State, that makes use of any symbol or emblem, or any words or letters which specifically identifies that agency or instrumentality of the State or political subdivision. (8) Is a contracting organization that CMS determines has committed an act or failed to comply with the requirements set forth in §417.500(a) or §434.67(a) of this title or failed to comply with the requirement set forth in §434.80(c) of this title. (9) Has not refunded on a timely basis, as defined in §1003.101 of this part, amounts collected as the result of billing an individual, third party payer or other entity for a designated health service that was provided in accordance with a prohibited referral as described in §411.353 of this title. (10) Is a physician or entity that enters into— (i) A cross referral arrangement, for example, whereby the physician owners of entity “X” refer to entity “Y,” and the physician owners of entity “Y” refer to entity “X” in violation of §411.353 of this title, or (ii) Any other arrangement or scheme that the physician or entity knows, or should know, has a principal purpose of circumventing the prohibitions of §411.353 of this title. (11) Has violated section 1128B of the Act by unlawfully offering, paying, soliciting or receiving remuneration in return for the referral of business paid for by Medicare, Medicaid or other Federal health care programs. (12) Who is not an organization, agency or other entity, and who is excluded from participating in Medicare or a State health care program in accordance with sections 1128 or 1128A of the Act, and who— (i) Knows or should know of the action constituting the basis for the exclusion, and retains a direct or indirect ownership or control interest of five percent or more in an entity that participates in Medicare or a State health care program; or (ii) Is an officer or managing employee (as defined in section 1126(b) of the Act) of such entity. (13) Offers or transfers remuneration (as defined in §1003.101 of this part) to any individual eligible for benefits under Medicare or a State health care program, that such person knows or should know is likely to influence such individual to order or to receive from a particular provider, practitioner or supplier any item or service for which payment may be made, in whole or in part, under Medicare or a State health care program. (14) Is a physician and who executes a document falsely by certifying that a Medicare beneficiary requires home health services when the physician knows that the beneficiary does not meet the eligibility requirements set forth in sections 1814(a)(2)(C) or 1835(a)(2)(A) of the Act. (15) Has knowingly and willfully presented, or caused to be presented, a bill or request for payment for items and services furnished to a hospital patient for which payment may be made under the Medicare or another Federal health care program, if that bill or request is inconsistent with an arrangement under section 1866(a)(1)(H) of the Act, or violates the requirements for such an arrangement. (16) Is involved in the possession or use in the United States, receipt from outside the United States, or transfer within the United States, of select agents and toxins in violation of part 73 of this chapter as determined by the HHS Secretary, in accordance with sections 351A(b) and (c) of the Public Health Service Act. (17) Is an endorsed sponsor under the Medicare prescription drug discount card program who knowingly misrepresented or falsified information in outreach material or comparable material provided to a program enrollee or other person. (18) Is an endorsed sponsor under the Medicare prescription drug discount card program who knowingly charged a program enrollee in violation of the terms of the endorsement contract. (19) Is an endorsed sponsor under the Medicare prescription drug discount card program who knowingly used transitional assistance funds of any program enrollee in any manner that is inconsistent with the purpose of the transitional assistance program. (c)(1) The Office of the Inspector General (OIG) may impose a penalty for violations of section 1867 of the Act or §489.24 of this title against— (i) Any participating hospital with an emergency department that— (A) Knowingly violates the statute on or after August 1, 1986 or; (B) Negligently violates the statute on or after May 1, 1991; and (ii) Any responsible physician who— (A) Knowingly violates the statute on or after August 1, 1986; (B) Negligently violates the statute on or after May 1, 1991; (C) Signs a certification under section 1867(c)(1)(A) of the Act if the physician knew or should have known that the benefits of transfer to another facility did not outweigh the risks of such a transfer; or (D) Misrepresents an individual's condition or other information, including a hospital's obligations under this section. (2) For purposes of this section, a responsible physician or hospital “knowingly” violates section 1867 of the Act if the responsible physician or hospital recklessly disregards, or deliberately ignores a material fact. (d)(1) In any case in which it is determined that more than one person was responsible for presenting or causing to be presented a claim as described in paragraph (a) of this section, each such person may be held liable for the penalty prescribed by this part, and an assessment may be imposed against any one such person or jointly and severally against two or more such persons, but the aggregate amount of the assessments collected may not exceed the amount that could be assessed if only one person was responsible. (2) In any case in which it is determined that more than one person was responsible for presenting or causing to be presented a request for payment or for giving false or misleading information as described in paragraph (b) of this section, each such person may be held liable for the penalty prescribed by this part. (3) In any case in which it is determined that more than one person was responsible for failing to report information that is required to be reported on a medical malpractice payment, or for improperly disclosing, using, or permitting access to information, as described in paragraphs (b)(5) and (b)(6) of this section, each such person may be held liable for the penalty prescribed by this part. (4) In any case in which it is determined that more than one responsible physician violated the provisions of section 1867 of the Act or of §489.24 of this title, a penalty may be imposed against each responsible physician. (5) Under this section, a principal is liable for penalties and assessments for the actions of his or her agent acting within the scope of the agency. (e) For purposes of this section, the term “knowingly” is defined consistent with the definition set forth in the Civil False Claims Act (31 U.S.C. 3729(b)), that is, a person, with respect to information, has actual knowledge of information, acts in deliberate ignorance of the truth or falsity of the information, or acts in reckless disregard of the truth or falsity of the information, and that no proof of specific intent to defraud is required. [57 FR 3345, Jan. 29, 1992; 57 FR 9670, Mar. 20, 1992, as amended at 59 FR 32124, June 22, 1994; 59 FR 36086, July 15, 1994; 60 FR 16584, Mar. 31, 1995; 60 FR 58241, Nov. 27, 1995; 64 FR 39428, July 22, 1999; 65 FR 18550, Apr. 7, 2000; 65 FR 24415, Apr. 26, 2000; 65 FR 35584, June 5, 2000; 67 FR 76905, Dec. 13, 2002; 69 FR 28845, May 19, 2004] (a) Except as provided in paragraphs (b) through (k) of this section, the OIG may impose a penalty of not more than— (1) $2,000 for each wrongful act occurring before January 1, 1997 that is subject to a determination under §1003.102; and (2) $10,000 for each wrongful act occurring on or after January 1, 1997 that is subject to a determination under §1003.102. (b) The OIG may impose a penalty of not more than $15,000 for each person with respect to whom a determination was made that false or misleading information was given under §1003.102(b)(4), or for each item and service that is subject to a determination under §1003.102(a)(5) or §1003.102(b)(9) of this part. The OIG may impose a penalty of not more than $100,000 for each arrangement or scheme that is subject to a determination under §1003.102(b)(10) of this part. (c) The OIG may impose a penalty of not more than $11,0001 1 As adjusted in accordance with the Federal Civil Monetary Penalty Inflation Adjustment Act of 1990 (Pub. L. 101–140), as amended by the Debt Collection Improvement Act of 1996 (Pub. L. 104–134). (d)(1) The OIG may impose a penalty of not more than $5,000 for each violation resulting from the misuse of Departmental, CMS, Medicare or Medicaid program words, letters, symbols or emblems as described in §1003.102(b)(7) relating to printed media, and a penalty of not more than $25,000 in the case of such misuse related to a broadcast or telecast, that is related to a determination under §1003.102(b)(7). (2) For purposes of this paragraph, a violation is defined as— (i) In the case of a direct mailing solicitation or advertisement, each separate piece of mail which contains one or more words, letters, symbols or emblems related to a determination under §1003.102(b)(7); (ii) In the case of a printed solicitation or advertisement, each reproduction, reprinting or distribution of such item related to a determination under §1003.102(b)(7); and (iii) In the case of a broadcast or telecast, each airing of a single commercial or solicitation related to a determination under §1003.102(b)(7). (e) For violations of section 1867 of the Act or §489.24 of this title, the OIG may impose— (1) Against each participating hospital with an emergency department, a penalty of not more than $50,000 for each negligent violation occurring on or after May 1, 1991, except that if the participating hospital has fewer than 100 State-licensed, Medicare-certified beds on the date the penalty is imposed, the penalty will not exceed $25,000; and (2) Against each responsible physician, a penalty of not more than $50,000 for each negligent violation occurring on or after May 1, 1991. (f)(1) The OIG may, in addition to or in lieu of other remedies available under law, impose a penalty of up to $25,000 for each determination by CMS that a contracting organization has— (i) Failed substantially to provide an enrollee with required medically necessary items and services and the failure adversely affects (or has the likelihood of adversely affecting) the enrollee; (ii) Imposed premiums on enrollees in excess of amounts permitted under section 1876 or title XIX of the Act; (iii) Acted to expel or to refuse to re-enroll a Medicare beneficiary in violation of the provisions of section 1876 of the Act and for reasons other than the beneficiary's health status or requirements for health care services; (iv) Misrepresented or falsified information furnished to an individual or any other entity under section 1876 or section 1903(m) of the Act; (v) Failed to comply with the requirements of section 1876(g)(6)(A) of the Act, regarding prompt payment of claims; or (vi) Failed to comply with the requirements of §§417.479 (d) through (i) of this title for Medicare, and §§417.479 (d) through (g) and (i) of this title for Medicaid, regarding certain prohibited incentive payments to physicians. (2) The OIG may, in addition to or in lieu of other remedies available under law, impose a penalty of up to $25,000 for each determination by CMS that a contracting organization with a contract under section 1876 of the Act— (i) Employs or contracts with individuals or entities excluded, under section 1128 or section 1128A of the Act, from participation in Medicare for the provision of health care, utilization review, medical social work, or administrative services; or (ii) Employs or contracts with any entity for the provision of services (directly or indirectly) through an excluded individual or entity. (3) The OIG may, in addition to or in lieu of other remedies available under law, impose a penalty of up to $100,000 for each determination that a contracting organization has— (i) Misrepresented or falsified information to the Secretary under section 1876 of the Act or to the State under section 1903(m) of the Act; or (ii) Acted to expel or to refuse to re-enroll a Medicaid recipient because of the individual's health status or requirements for health care services, or engaged in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment (except as permitted by section 1876 or section 1903(m) of the Act) with the contracting organization by Medicare beneficiaries and Medicaid recipients whose medical condition or history indicates a need for substantial future medical services. (4) If enrolles are charged more than the allowable premium, the OIG will impose an additional penalty equal to double the amount of excess premium charged by the contracting organization. The excess premium amount will be deducted from the penalty and returned to the enrollee. (5) The OIG will impose an additional $15,000 penalty for each individual not enrolled when CMS determines that a contracting organization has committed a violation described in paragraph (f)(3)(ii) of this section. (6) For purposes of paragraph (f) of this section, a violation is each incident where a person has committed an act listed in §417.500(a) or §434.67(a) of this title, or failed to comply with a requirement set forth in §434.80(c) of this title. (g) The OIG may impose a penalty of not more than $25,000 against a health plan for failing to report information on an adverse action required to be reported to the Healthcare Integrity and Protection Data Bank in accordance with section 1128E of the Act and §1003.102(b)(5)(ii). (h) For each violation of §1003.102(b)(11), the OIG may impose— (1) A penalty of not more than $50,000, and (2) An assessment of up to three times the total amount of remuneration offered, paid, solicited or received, as specified in §1003.104(b). (i) For violations of §1003.102(b)(14) of this part, the OIG may impose a penalty of not more than the greater of— (1) $5,000, or (2) Three times the amount of Medicare payments for home health services that are made with regard to the false certification of eligibility by a physician in accordance with sections 1814(a)(2)(C) or 1835(a)(2)(A) of the Act. (j) The OIG may impose a penalty of not more than $10,000 per day for each day that the prohibited relationship described in §1001.102(b)(12) of this part occurs. (k) For violations of section 1862(a)(14) of the Act and §1003.102(b)(15), the OIG may impose a penalty of not more than $2,000 for each bill or request for payment for items and services furnished to a hospital patient. (l) For violations of section 351A(b) or (c) of the Public Health Service Act and 42 CFR part 73, the OIG may impose a penalty of not more than $250,000 in the case of an individual, and not more than $500,000 in the case of any other person. (m) For violations of section 1860D–31 of the Act and 42 CFR part 403, subpart H, regarding the misleading or defrauding of program beneficiaries, or the misuse of transitional assistance funds, the OIG may impose a penalty of not more than $10,000 for each individual violation. [57 FR 3346, Jan. 29, 1992, as amended at 59 FR 32125, June 22, 1994; 59 FR 48566, Sept. 22, 1994; 60 FR 16584, Mar. 31, 1995; 60 FR 58241, Nov. 27, 1995; 61 FR 13449, Mar. 27, 1996; 61 FR 52301, Oct. 7, 1996; 64 FR 39429, July 22, 1999; 65 FR 18550, Apr. 7, 2000; 65 FR 24416, Apr. 26, 2000; 65 FR 35584, June 5, 2000; 67 FR 76905, Dec. 13, 2002; 69 FR 28845, May 19, 2004] (a) The OIG may impose an assessment, where authorized, in accordance with §1003.102, of not more than— (1) Two times the amount for each item or service wrongfully claimed prior to January 1, 1997; and (2) Three times the amount for each item or service wrongfully claimed on or after January 1, 1997. (b) The assessment is in lieu of damages sustained by the Department or a State agency because of that claim. [65 FR 24416, Apr. 26, 2000] (a)(1) Except as set forth in paragraph (b) of this section, the following persons may be subject, in lieu of or in addition to any penalty or assessment, to an exclusion from participation in Medicare for a period of time determined under §1003.107. There will be exclusions from Federal health care programs for the same period as the Medicare exclusion for any person who— (i) Is subject to a penalty or assessment under §1003.102(a), (b)(1), (b)(4), (b)(12), (b)(13) or (b)(15); or (ii) Commits a gross and flagrant, or repeated, violation of section 1867 of the Act or §489.24 of this title on or after May 1, 1991. For purposes of this section, a gross and flagrant violation is one that presents an imminent danger to the health, safety or well-being of the individual who seeks emergency examination and treatment or places that individual unnecessarily in a high-risk situation. (b)(1)(i) With respect to any exclusion based on liability for a penalty or assessment under §1003.102 (a), (b)(1), or (b)(4), the OIG will consider an application from a State agency for a waiver if the person is the sole community physician or the sole source of essential specialized services in a community. With respect to any exclusion imposed under §1003.105(a)(1)(ii), the OIG will consider an application from a State agency for a waiver if the physician's exclusion from the State health care program would deny beneficiaries access to medical care or would otherwise cause hardship to beneficiaries. (ii) If a waiver is granted, it is applicable only to the State health care program for which the State requested the waiver. (iii) If the OIG subsequently obtains information that the basis for a waiver no longer exists, or the State agency submits evidence that the basis for the waiver no longer exists, the waiver will cease and the person will be excluded from the State health care program for the remainder of the period that the person is excluded from Medicare. (iv) The OIG notifies the State agency whether its request for a waiver has been granted or denied. (v) The decision to deny a waiver is not subject to administrative or judicial review. (2) For purposes of this section, the definitions contained in §1001.2 of this chapter for “sole community physician” and “sole source of essential specialized services in a community” apply. (c) When the Inspector General proposes to exclude a nursing facility from the Medicare and Medicaid programs, he or she will, at the same time he or she notifies the respondent, notify the appropriate State licensing authority, the State Office of Aging, the long-term care ombudsman, and the State Medicaid agency of the Inspector General's intention to exclude the facility. [59 FR 32125, June 22, 1994, as amended at 64 FR 39429, July 22, 1999; 65 FR 24416, Apr. 26, 2000; 65 FR 35584, June 5, 2000] (a) Amount of penalty. (1) In determining the amount of any penalty or assessment in accordance with §1003.102(a), (b)(1), (b)(4), and (b)(9) through (b)(16) of this part, the Department will take into account— (i) The nature of the claim, referral arrangement or other wrongdoing; (ii) The degree of culpability of the person against whom a civil money penalty is proposed; (iii) The history of prior offenses of the person against whom a civil money penalty is proposed; (iv) The financial condition of the person against whom a civil money penalty is proposed; (v) The completeness and timeliness of the refund with respect to §1003.102(b)(9); (vi) The amount of financial interest involved with respect to §1003.102(b)(12); (vii) The amount of remuneration offered or transferred with respect to §1003.102(b)(13); and (viii) Such other matters as justice may require. (2) In determining the amount of any penalty in accordance with §§1003.102 (b)(5) and (b)(6), the Department will take into account— (i) The nature and circumstances of the failure to properly report information, or the improper disclosure of information, as required; (ii) The degree of culpability of the person in failing to provide timely and complete data or in improperly disclosing, using or permitting access to information, as appropriate; (iii) The materiality, or significance of omission, of the information to be reported, or the materiality of the improper disclosure of, or use of, or access to information, as appropriate; (iv) Any prior history of the person with respect to violations of these provisions; and (v) Such other matters as justice may require. (3)(i) In determining the amount of any penalty in accordance with §1003.102(b)(7), the OIG will take into account— (A) The nature and objective of the advertisement, solicitation or other communication, and the degree to which it has the capacity to deceive members of the public; (B) The degree of culpability of the individual, organization or entity in the use of the prohibited words, letters, symbols or emblems; (C) The frequency and scope of the violation, and whether a specific segment of the population was targeted; (D) The prior history of the individual, organization or entity in its willingness or refusal to comply with informal requests to correct violations; (E) The history of prior offenses of the individual, organization or entity in its misuse of Departmental and program words, letters, symbols and emblems; (F) The financial condition of the individual, organization or entity involved with the violation; and (G) Such other matters as justice may require. (ii) The use of a disclaimer of affiliation with the United States Government, the Department or its programs will not be considered as a mitigating factor in determining the amount of penalty in accordance with §1003.102(b)(7). (4) In determining the amount of any penalty in accordance with §1003.102(c), the OIG takes into account— (i) The degree of culpability of the respondent; (ii) The seriousness of the condition of the individual seeking emergency medical treatment; (iii) Any other instances where the respondent failed to provide appropriate emergency medical screening, stabilization and treatment of individuals coming to a hospital's emergency department or to effect an appropriate transfer; (iv) The respondent's financial condition; (v) The nature and circumstances of the violation; and (vi) Such other matters as justice may require. (5) In determining the appropriate amount of any penalty in accordance with §1003.103(f), the OIG will consider as appropriate— (i) The nature and scope of the required medically necessary item or service not provided and the circumstances under which it was not provided; (ii) The degree of culpability of the contracting organization; (iii) The seriousness of the adverse effect that resulted or could have resulted from the failure to provide required medically necessary care; (iv) The harm which resulted or could have resulted from the provision of care by a person that the contracting organization is expressly prohibited, under section 1876(i)(6) or section 1903(p)(2) of the Act, from contracting with or employing; (v) The harm which resulted or could have resulted from the contracting organization's expulsion or refusal to re-enroll a Medicare beneficiary or Medicaid recipient; (vi) The nature of the misrepresentation or fallacious information furnished by the contracting organization to the Secretary, State, enrollee or other entity under section 1876 or section 1903(m) of the Act; (vii) The extent to which the failure to provide medically necessary services could be attributed to a prohibited inducement to reduce or limit services under a physician incentive plan and the harm to the enrollee which resulted or could have resulted from such failure. It would be considered an aggravating factor if the contracting organization knowingly or routinely engaged in any prohibited practice which acted as an inducement to reduce or limit medically necessary services provided with respect to a specific enrollee in the organization; (viii) The history of prior offenses by the contracting organization or principals of the contracting organization, including whether, at any time prior to determination of the current violation or violations, the contracting organization or any of its principals were convicted of a criminal charge or were held liable for civil or administrative sanctions in connection with a program covered by this part or any other public or private program of payment for medical services; and (ix) Such other matters as justice may require. (b) Determining the amount of the penalty or assessment. As guidelines for taking into account the factors listed in paragraph (a)(1) of this section, the following circumstances are to be considered— (1) Nature and circumstances of the incident. It should be considered a mitigating circumstance if all the items or services or incidents subject to a determination under §1003.102 included in the action brought under this part were of the same type and occurred within a short period of time, there were few such items or services or incidents, and the total amount claimed or requested for such items or services was less than $1,000. It should be considered an aggravating circumstance if— (i) Such items or services or incidents were of several types, occurred over a lengthy period of time; (ii) There were many such items or services or incidents (or the nature and circumstances indicate a pattern of claims or requests for payment for such items or services or a pattern of incidents); (iii) The amount claimed or requested for such items or services was substantial; or (iv) The false or misleading information given resulted in harm to the patient, a premature discharge or a need for additional services or subsequent hospital admission. (2) Degree of culpability. It should be considered a mitigating circumstance if corrective steps were taken promptly after the error was discovered. It should be considered an aggravating circumstance if— (i) The respondent knew the item or service was not provided as claimed or if the respondent knew that the claim was false or fraudulent; (ii) The respondent knew that the items or services were furnished during a period that he or she had been excluded from participation and that no payment could be made as specified in §§1003.102(a)(3) and 1003.102(b)(12), or because payment would violate the terms of an assignment or an agreement with a State agency or other agreement or limitation on payment under §1003.102(b); (iii) The respondent knew that the information could reasonably be expected to influence the decision of when to discharge a patient from a hospital; or (iv) The respondent knew that the offer or transfer of remuneration described in §1003.102(b)(13) of this part would influence a beneficiary to order or receive from a particular provider, practitioner or supplier items or services reimbursable under Medicare or a State health care program. (3) Prior offenses. It should be considered an aggravating circumstance if at any time prior to the incident or presentation of any claim or request for payment which included an item or service subject to a determination under §1003.102, the respondent was held liable for criminal, civil or administrative sanctions in connection with a program covered by this part or any other public or private program of reimbursement for medical services. (4) Other wrongful conduct. It should be considered an aggravating circumstance if there is proof that a respondent engaged in wrongful conduct, other than the specific conduct upon which liability is based, relating to government programs or in connection with the delivery of a health care item or service. The statute of limitations governing civil money penalty proceedings will not apply to proof of other wrongful conduct as an aggravating circumstance. (5) Financial condition. In all cases, the resources available to the respondent will be considered when determining the amount of the penalty and assessment. (6) Other matters as justice may require. Other circumstances of an aggravating or mitigating nature should be taken into account if, in the interests of justice, they require either a reduction of the penalty or assessment or an increase in order to assure the achievement of the purposes of this part. (c) In determining the amount of the penalty and assessment to be imposed for every item or service or incident subject to a determination under §§1003.102(a), (b)(1) and (b)(4)— (1) If there are substantial or several mitigating circumstances, the aggregate amount of the penalty and assessment should be set at an amount sufficiently below the maximium permitted by §§1003.103(a) and 1003.104, to reflect that fact. (2) If there are substantial or several aggravating circumstances, the aggregate amount of the penalty and assessment should be set at an amount sufficiently close or at the maximum permitted by §§1003.103(a) and 1003.104, to reflect that fact. (3) Unless there are extraordinary mitigating circumstances, the aggregate amount of the penalty and assessment should never be less than double the approximate amount of damages and costs (as defined in paragraph (f) of this section) sustained by the United States, or any State, as a result of claims or incidents subject to a determination under §§1003.102(a), (b)(1) and (b)(4). (d) In considering the factors listed in paragraph (a)(4) of this section for violations subject to a determination under §1003.103(e), the following circumstances are to be considered, as appropriate, in determining the amount of any penalty— (1) Degree of culpability. It would be a mitigating circumstance if the respondent hospital had appropriate policies and procedures in place, and had effectively trained all of its personnel in the requirements of section 1867 of the Act and §489.24 of this title, but an employee or responsible physician acted contrary to the respondent hospital's policies and procedures. (2) Seriousness of individual's condition. It would be an aggravating circumstance if the respondent's violation(s) occurred with regard to an individual who presented to the hospital a request for treatment of a medical condition that was clearly an emergency, as defined by §489.24(b) of this title. (3) Prior offenses. It would be an aggravating circumstance if there is evidence that at any time prior to the current violation(s) the respondent was found to have violated any provision of section 1867 of the Act or §489.24 of this title. (4) Financial condition. In all cases, the resources available to the respondent would be considered when determining the amount of the penalty. A respondent's audited financial statements, tax returns or financial disclosure statements, as appropriate, will be reviewed by OIG in making a determination with respect to the respondent's financial condition. (5) Nature and circumstances of the incident. It would be considered a mitigating circumstance if an individual presented a request for treatment, but subsequently exhibited conduct that demonstrated a clear intent to leave the respondent hospital voluntarily. In reviewing such circumstances, the OIG would evaluate the respondent's efforts to— (i) Provide the services required by section 1867 of the Act and §489.24 of this title, despite the individual's withdrawal of the request for examination or treatment; and (ii) Document any attempts to inform the individual (or his or her representative) of the risks of leaving the respondent hospital without receiving an appropriate medical screening examination or treatment, and obtain written acknowledgment from the individual (or his or her representative) prior to the individual's departure from the respondent hospital that he or she is leaving contrary to medical advice. (6) Other matters as justice may require. (i) It would be considered a mitigating circumstance if the respondent hospital— (A) Developed and implemented a corrective action plan; (B) Took immediate appropriate action against any hospital personnel or responsible physician who violated section 1867 of the Act or §489.24 of this title prior to any investigation of the respondent hospital by CMS; or (C) Is a rural or publicly-owned facility that is faced with severe physician staffing and financial deficiencies. (ii) It would be considered an aggravating circumstance if an individual was severely harmed or died as a result, directly or indirectly, of the respondent's violation of section 1867 of the Act or §489.24 of this title. (iii) Other circumstances of an aggravating or mitigating nature will be taken into account if, in the interests of justice, they require either a reduction of the penalty or an increase in order to assure the achievement of the purposes of this part. (e) In considering the factors listed in paragraph (a)(5) of this section for violations subject to a determination under §1003.103(f), the following circumstances are to be considered, as appropriate, in determining the amount of any penalty— (f)(1) The standards set forth in this section are binding, except to the extent that their application would result in imposition of an amount that would exceed limits imposed by the United States Constitution. (2) The amount imposed will not be less than the approximate amount required to fully compensate the United States, or any State, for its damages and costs, tangible and intangible, including but not limited to the costs attributable to the investigation, prosecution and administrative review of the case. (3) Nothing in this section will limit the authority of the Department to settle any issue or case as provided by §1003.126, or to compromise any penalty and assessment as provided by §1003.128. [57 FR 3347, Jan. 29, 1992, as amended at 59 FR 32125, June 22, 1994; 59 FR 36086, July 15, 1994; 59 FR 48567, Sept. 22, 1994; 60 FR 16584, Mar. 31, 1995; 60 FR 58241, Nov. 27, 1995; 61 FR 13449, Mar. 27, 1996; 64 FR 39429, July 22, 1999; 65 FR 24416, Apr. 26, 2000; 67 FR 11935, Mar. 18, 2002; 70 FR 13325, Mar. 18, 2005] (a) In determining whether to exclude a person under this part and the duration of any exclusion, the Department considers the circumstances described in §1003.106(a). (b) With respect to determinations to exclude a person under §§1003.102(a), (b)(1), (b)(4), (b)(12) or (b)(13) of this part, the Department considers those circumstances described in §1003.106(b). Where there are aggravating circumstances with respect to such determinations, the person should be excluded. (c) The guidelines set forth in this section are not binding. Nothing in this section limits the authority of the Department to settle any issue or case as provided by §1003.126 of this part. [59 FR 32126, June 22, 1994, as amended at 65 FR 24418, Apr. 26, 2000] Penalties, assessments, and exclusions imposed under this part are in addition to any other penalties prescribed by law. [59 FR 32126, June 22, 1994] (a) If the Inspector General proposes a penalty and, when applicable, assessment, or proposes to exclude a respondent from participation in a Federal health care program, as applicable, in accordance with this part, he or she must deliver or send by certified mail, return receipt requested, to the respondent written notice of his or her intent to impose a penalty, assessment and exclusion, as applicable. The notice includes— (1) Reference to the statutory basis for the penalty, assessment and exclusion; (2) A description of the claims, requests for payment, or incidents with respect to which the penalty, assessment and exclusion are proposed (except in cases where the Inspector General is relying upon statistical sampling in accordance with §1003.133 in which case the notice shall describe those claims and requests for payment comprising the sample upon which the Inspector General is relying and will also briefly describe the statistical sampling technique utilized by the Inspector General); (3) The reason why such claims, requests for payments or incidents subject the respondent to a penalty, assessment and exclusion; (4) The amount of the proposed penalty, assessment and the period of proposed exclusion (where applicable); (5) Any circumstances described in §1003.106 that were considered when determining the amount of the proposed penalty and assessment and the period of exclusion; (6) Instructions for responding to the notice, including— (i) A specific statement of respondent's right to a hearing, and (ii) A statement that failure to request a hearing within 60 days permits the imposition of the proposed penalty, assessment and exclusion without right of appeal; and (7) In the case of a notice sent to a respondent who has an agreement under section 1866 of the Act, the notice also indicates that the imposition of an exclusion may result in the termination of the provider's agreement in accordance with section 1866(b)(2)(C) of the Act. (b) Any person upon whom the Inspector General has proposed the imposition of a penalty, assessment or exclusion may appeal such proposed penalty, assessment or exclusion to the DAB in accordance with §1005.2 of this chapter. The provisions of part 1005 of this chapter govern such appeals. (c) If the respondent fails, within the time permitted, to exercise his or her right to a hearing under this section, any exclusion, penalty, or assessment becomes final. [57 FR 3348, Jan. 29, 1992, as amended at 59 FR 32126, June 22, 1994; 64 FR 39429, July 22, 1999; 65 FR 24418, Apr. 26, 2000] If the respondent does not request a hearing within the time prescribed by §1003.109(a), the Inspector General may impose the proposed penalty, assessment, and exclusion, or any less severe penalty, assessment, and suspension. The Inspector General shall notify the respondent by certified mail, return receipt requested, of any penalty, assessment, and exclusion that has been imposed and of the means by which the respondent may satisfy the judgment. The respondent has no right to appeal a penalty, assessment, and exclusion, with respect to which he or she has not requested a hearing. [51 FR 34777, Sept. 30, 1986, as amended at 57 FR 3348, Jan. 29, 1992] (a) Where a final determination pertaining to the respondent's liability under §1003.102 has been rendered in any proceeding in which the respondent was a party and had an opportunity to be heard, the respondent shall be bound by such determination in any proceeding under this part. (b) In a proceeding under this part that— (1) Is against a person who has been convicted (whether upon a verdict after trial or upon a plea of guilty or nolo contendere) of a Federal crime charging fraud or false statements, and (2) Involves the same transactions as in the criminal action, the person is estopped from denying the essential elements of the criminal offense. [57 FR 3348, Jan. 29, 1992, as amended at 64 FR 39429, July 22, 1999] The Inspector General has exclusive authority to settle any issues or case, without consent of the ALJ. [65 FR 24418, Apr. 26, 2000] Section 1128A(e) of the Act authorizes judicial review of a penalty, assessment or exclusion that has become final. Judicial review may be sought by a respondent only with respect to a penalty, assessment or exclusion with respect to which the respondent filed an exception under §1005.21(c) of this chapter unless the failure or neglect to urge such exception will be excused by the court in accordance with section 1128A(e) of the Act because of extraordinary circumstances. [57 FR 3348, Jan. 29, 1992] (a) Once a determination by the Secretary has become final, collection of any penalty and assessment will be the responsibility of CMS, except in the case of the Maternal and Child Health Services Block Grant program, where the collection will be the responsibility of the PHS, and in the case of the Social Services Block Grant program, where the collection will be the responsibility of the Office of Human Development Services. (b) A penalty or assessment imposed under this part may be compromised by the Inspector General, and may be recovered in a civil action brought in the United States district court for the district where the claim was presented, or where the respondent resides. (c) The amount of a penalty and assessment when finally determined, or the amount agreed upon in compromise, may be deducted from any sum then or later owing by the United States, or by a State agency, to the respondent. (d) Matters that were raised or that could have been raised in a hearing before an ALJ or in an appeal under section 1128A(e) of the Act may not be raised as a defense in a civil action by the United States to collect a penalty under this part. [51 FR 34777, Sept. 30, 1986, as amended at 57 FR 3349, Jan. 29, 1992; 65 FR 24418, Apr. 26, 2000] Whenever a penalty, assessment or exclusion become final, the following organizations and entities will be notified about such action and the reasons for it—the appropriate State or local medical or professional association; the appropriate Quality Improvement Organization; as appropriate, the State agency responsible or the administration of each State health care program; the appropriate Medicare carrier or intermediary; the appropriate State or local licensing agency or organization (including the Medicare and Medicaid State survey agencies); and the long-term care ombudsman. In cases involving exclusions, notice will also be given to the public of the exclusion and its effective date. [57 FR 3349, Jan. 29, 1992] No action under this part will be entertained unless commenced, in accordance with §1003.109(a) of this part, within 6 years from the date on which the claim was presented, the request for payment was made, or the incident occurred. [57 FR 3349, Jan. 29, 1992] (a) In meeting the burden of proof set forth in §1005.15, the Inspector General may introduce the results of a statistical sampling study as evidence of the number and amount of claims and/or requests for payment as described in §1003.102 that were presented or caused to be presented by respondent. Such a statistical sampling study, if based upon an appropriate sampling and computed by valid statistical methods, shall constitute prima facie evidence of the number and amount of claims or requests for payment as described in §1003.102. (b) Once the Inspector General has made a prima facie case as described in paragraph (a) of this section, the burden of production shall shift to respondent to produce evidence reasonably calculated to rebut the findings of the statistical sampling study. The Inspector General will then be given the opportunity to rebut this evidence. [51 FR 34777, Sept. 30, 1986, as amended at 57 FR 3349, Jan. 29, 1992] The effect of an exclusion will be as set forth in §1001.1901 of this chapter. [57 FR 3349, Jan. 29, 1992] A person who has been excluded in accordance with this part may apply for reinstatement at the end of the period of exclusion. The OIG will consider any request for reinstatement in accordance with the provisions of §§1001.3001 through 1001.3004 of this chapter. [57 FR 3349, Jan. 29, 1992]
Title 42: Public Health
PART 1003—CIVIL MONEY PENALTIES, ASSESSMENTS AND EXCLUSIONS
Section Contents
§ 1003.100 Basis and purpose.
§ 1003.101 Definitions.
§ 1003.102 Basis for civil money penalties and assessments.
§ 1003.103 Amount of penalty.
§ 1003.104 Amount of assessment.
§ 1003.105 Exclusion from participation in Medicare, Medicaid and all Federal health care programs.
§ 1003.106 Determinations regarding the amount of the penalty and assessment.
§ 1003.107 Determinations regarding exclusion.
§ 1003.108 Penalty, assessment, and exclusion not exclusive.
§ 1003.109 Notice of proposed determination.
§ 1003.110 Failure to request a hearing.
§ 1003.114 Collateral estoppel.
§ 1003.126 Settlement.
§ 1003.127 Judicial review.
§ 1003.128 Collection of penalty and assessment.
§ 1003.129 Notice to other agencies.
§ 1003.132 Limitations.
§ 1003.133 Statistical sampling.
§ 1003.134 Effect of exclusion.
§ 1003.135 Reinstatement.
§ 1003.100 Basis and purpose.
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§ 1003.101 Definitions.
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§ 1003.102 Basis for civil money penalties and assessments.
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§ 1003.103 Amount of penalty.
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§ 1003.104 Amount of assessment.
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§ 1003.105 Exclusion from participation in Medicare, Medicaid and all Federal health care programs.
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§ 1003.106 Determinations regarding the amount of the penalty and assessment.
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§ 1003.107 Determinations regarding exclusion.
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§ 1003.108 Penalty, assessment, and exclusion not exclusive.
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§ 1003.109 Notice of proposed determination.
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§ 1003.110 Failure to request a hearing.
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§ 1003.114 Collateral estoppel.
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§ 1003.126 Settlement.
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§ 1003.127 Judicial review.
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§ 1003.128 Collection of penalty and assessment.
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§ 1003.129 Notice to other agencies.
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§ 1003.132 Limitations.
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§ 1003.133 Statistical sampling.
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§ 1003.134 Effect of exclusion.
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§ 1003.135 Reinstatement.
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