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HHS/OIG

RIN: 0936-AA04

Publication ID: Fall 2013

Title: ●Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Office of the Inspector General's Civil Monetary Penalty Rules
Abstract: This rule makes changes to the Civil Monetary Penalties Law (CMPL) regulations at 42 CFR 1003 to implement authorities under the Affordable Care Act (ACA) and other statutes. ACA provides for CMPs, assessments, and exclusion for: •Failure to grant access timely access to OIG; •Ordering or prescribing while excluded; •Making false statements, omissions, or misrepresentations in an enrollment application; •Failure to return an overpayment; and •Making or using a false record or statement that is material to a false or fraudulent claim. These statutory changes are reflected in the proposed regulations. We also propose a reorganization of 42 CFR 1003 to make the regulations more accessible to the public and to add clarity to the regulatory scheme. We propose an alternate methodology for calculating penalties and assessments for employing excluded individuals in positions in which the individuals do not directly bill the Federal health care programs for furnishing items or services. We also clarify the liability guidelines under OIG authorities, including the CMPL, the Emergency Medical Treatment and Labor Act; section 1140 of the Social Security Act for conduct involving electronic mail, Internet, and telemarketing solicitations; and section 1927 of the Social Security Act for late or incomplete reporting of drug-pricing information.
Agency: Department of Health and Human Services(HHS)	Priority: Substantive, Nonsignificant
RIN Status: First time published in the Unified Agenda	Agenda Stage of Rulemaking: Proposed Rule Stage
Major: Undetermined	Unfunded Mandates: No
CFR Citation: 42 CFR 1003 and 1005
Legal Authority: 42 USC 262a 42 USC 405(a) 42 USC 405(b) 42 USC 1302 42 USC 1320a–7 42 USC 1320a-7a 42 USC 1320a-7(c) 42 USC 1320b-10 42 USC 1320c–5 42 USC 1395dd(d)(1) 42 USC 1395mm 42 USC 1395nn(g) 42 USC 1395ss(d) 42 USC 1395w-112(b)(3)(E) 42 USC 1395w-141(i)(3) 42 USC 1395w-27(g) 42 USC 1395y(b)(3)(B) 42 USC 1396b(m) 42 USC 1396r-7(b)(3)(B) 42 USC 1396r-7(b)(3)(C) 42 USC 1396t(i)(3) 42 USC 11131c 42 USC 11137(b)(2)

Legal Deadline: None

Timetable:

Action	Date	FR Cite
NPRM	04/00/2014

Regulatory Flexibility Analysis Required: No	Government Levels Affected: None
Small Entities Affected: No	Federalism: No
Included in the Regulatory Plan: No
RIN Data Printed in the FR: No
Agency Contact: Patrice S. Drew Regulations Analyst Department of Health and Human Services Office of the Inspector General 330 Independence Avenue SW., Washington, DC 20201 Phone:202 619-1368 Email: patrice.drew@oig.hhs.gov