Office of the Inspector General (OIG) may seek civil monetary penalties and sometimes exclusion for a wide variety of conduct and is authorized to seek different amounts of penalties and assessments based on the type of violation at issue. Penalties range from $10,000 to $50,000 per violation.
Some examples of CMPL violations include:
- Presenting a claim under a grant, contract, or other agreement that is false or fraudulent, or knowingly making or using any false statement, omission, or misrepresentation of a material fact in any application, proposal, bid, progress report, or other document submitted to HHS in order to receive funds under an HHS grant, contract, or other agreement;
- Violating the Anti Kickback Statute (AKS) which prohibits individuals or entities from asking for or receiving any remuneration in exchange for referrals of Federal health care program business.
- Violating the Physician Self-referral Statute (Stark Law) which prohibits individuals or entities from referring Medicare or Medicaid patients for designated health services to entities with which individuals or entities have a direct or indirect financial relationship, unless an exception applies;
- Offers to transfer remuneration to any individual eligible for benefits under Medicare/Medicaid that the offerer knows or should know is likely to influence such individual to order or 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/Medicaid;
- Presenting a claim that the person knows or should know is for an item or service that was not
provided as claimed or is false or fraudulent;
- Presenting a claim that the person knows or should know is for an item or service for which
payment may not be made;
- Presenting a claim that was provided but is already covered under another claim;
- Violating Medicare assignment provisions;
- Violating the Medicare physician agreement;
- Providing false or misleading information expected to influence a decision to discharge;
- Failing to provide an adequate medical screening examination for patients who present to a
hospital emergency department with an emergency medical condition or in labor;
- Making false statements or misrepresentations on applications or contracts to participate in the
Federal health care programs;
- Unauthorized use of words or emblems belonging to the Department of Health and Human Services (HHS) or its programs, operating divisions or agencies, in connection with any communication in a manner which such individual or entity knows or should know would convey, or could be interpreted or construed as conveying, the false impression that the item is approved, endorsed, or authorized by HHS or that the individual or entity has some connection with HHS.