OIG Proposes Rule to Implement Expanded Civil Monetary Penalty Authority under the ACA


The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has published a proposed rule that would amend the health care program civil monetary penalty (CMP) regulations (Proposed Rule). Notably, the Proposed Rule would codify the OIG’s expanded statutory authority under the Affordable Care Act (ACA) to impose CMPs on providers and suppliers and would allow for significant penalties in a variety of scenarios. For example, the Proposed Rule would permit the OIG to impose $10,000 per day penalties on providers and suppliers who fail to timely report and return an identified overpayment. Furthermore, the Proposed Rule would allow the OIG to impose $10,000 per day penalties—at the 9-digit NDC level—on drug manufacturers who fail to timely report and certify drug-pricing data. Such proposals could increase the OIG’s ability to leverage substantial penalties beyond that which is permitted under current regulations. Likewise, the OIG would codify its expanded authority under the ACA to permit CMPs for conduct including:

..Failure to grant OIG timely access to records, upon reasonable request;

..Ordering or prescribing while excluded when the excluded person knows or should know that the item or service may be paid for by a federal health care program;

..Making false statements, omissions, or misrepresentations in an enrollment or similar bid or application to participate in a federal health care program; and

..Making or using a false record or statement that is material to a false or fraudulent claim.

Please see full alert below for more information.

LOADING PDF: If there are any problems, click here to download the file.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Reed Smith | Attorney Advertising

Written by:


Reed Smith on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.