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HHS/OIG RIN: 0936-AA04 Publication ID: Spring 2016 
Title: Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Office of the Inspector General's Civil Monetary Penalty Rules 

This rule makes changes to the Civil Monetary (CMPL) regulations at 42 CFR 1003 to implement authorities under the Affordable Care Act (ACA) and other statutes. ACA provides for CMS, assessments and exclusions for: (1) Failure to grant timely access to OIG; (2) Ordering and prescribing while excluded; (3) Making false statements, omissions or misrepresentations in an enrollment application; (4) Failure to return an overpayment; and (5) Making or using a false record or statement that is material to a false or fradulent claim. We also finalize a reorganization of 42 CFR 1003 to make the regulations more accessible to the public, and to add clarity to the regulatory scheme. We finalize an alternate methodology for calculating penalties and assessments for employing excluded individuals in 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: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Final Rule Stage 
Major: Yes  Unfunded Mandates: No 
CFR Citation: 42 CFR 1003    42 CFR 1005   
Legal Authority: 42 U.S.C. 262a    42 U.S.C. 405(a)    42 U.S.C. 405(b)    42 U.S.C. 1302    42 U.S.C. 1320a–7    42 U.S.C. 1320a-7a    42 U.S.C. 1320a-7(c)    42 U.S.C. 1320b-10    42 U.S.C. 1320c–5    42 U.S.C. 1395dd(d)(1)    42 U.S.C. 1395mm    42 U.S.C. 1395nn(g)    42 U.S.C. 1395ss(d)    42 U.S.C. 1395w-112(b)(3)(E)    42 U.S.C. 1395w-141(i)(3)    42 U.S.C. 1395w-27(g)    42 U.S.C. 1395y(b)(3)(B)    42 U.S.C. 1396b(m)    42 U.S.C. 1396r-7(b)(3)(B)    42 U.S.C. 1396r-7(b)(3)(C)    42 U.S.C. 1396t(i)(3)    42 U.S.C. 11131c    42 U.S.C. 11137(b)(2)   
Legal Deadline:  None
Action Date FR Cite
NPRM  05/12/2014  79 FR 27079   
NPRM Comment Period End  07/11/2014 
Final Action  09/00/2016 
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