The Bipartisan Budget Act of 2018 (BBA 2018) significantly increased civil and criminal penalties for federal health care program fraud and abuse. Below is a summary of some of the BBA 2018 changes to the maximum penalty amounts, which apply for acts committed after February 9, 2018.

Civil Monetary Penalties

• $5,000
  • A hospital or physician that gives or receives a payment to reduce/limit medically necessary services to Medicare/Medicaid beneficiaries
• $10,000
  • A physician who signs a home health certification knowing all the requirements are not met
• $20,000
  • False claims
  • Requesting payment in violation of assignment agreement
  • Excluded party retaining ownership/controlling interest in a participating entity (per day)
  • Beneficiary inducements
  • Employing/contracting with an excluded individual
  • Ordering/prescribing while excluded
  • Failure to report and return an overpayment
• $30,000
  • Giving/causing to be presented false or misleading information to influence a hospital discharge decision
  • Failure to grant timely access to OIG (per day)
• $100,000
  • Violating the Anti-Kickback Statute
  • Making/causing to be made false statements, omission or misrepresentation of a material fact in an application, bid or contract to participate/enroll as a provider/supplier

Criminal Penalties

• $100,000 plus 10 years imprisonment (a felony) for persons who commit any of the acts listed below in connection with the furnishing of items/services reimbursable by federal health care programs:
  • Violating the Anti-Kickback Statute
  • Making/causing to be made a false statement or representation of a material fact:
    • In an application for or payment under a federal health care program
    • For use in determining rights to such payment
  • Concealing/failing to disclose knowledge of the occurrence of an event affecting the initial/continuing right to any payment with an intent to fraudulently secure such payment
  • Presenting/causing to be presented a claim for a physician service knowing the individual is not a licensed physician
• $20,000 plus one year imprisonment (a misdemeanor) for the same offenses listed above where the conduct is by the same person who furnishes the items/services payable under federal health care programs
• $4,000 plus imprisonment of up to six months (misdemeanor)
  • Repeatedly violating the terms of the assignment agreement