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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 | |
Abstract:
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.
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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 |
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Timetable:
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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 |