The Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 requires agencies to adjust civil monetary penalties for inflation annually. Effective November 5, 2019, the Department of Health and Human Services released updated civil monetary penalties for the regulations its agencies are responsible for enforcing.

Below are key changes applicable to healthcare providers.

1. The physician self-referral law, commonly known as the Stark Law, imposes civil monetary penalties for referring certain designated health services to an entity in which a physician has a financial relationship and for billing for those services. In 2018, the penalty per claim was a maximum of $24,748. The annual adjustment for 2019 increases this to $25,372 per claim.
2. The federal anti-kickback statute imposes civil monetary penalties for knowing and willful solicitation, receipt, offer, or payment of remuneration for referring an individual for a service or for purchasing, leasing, or ordering an item to be paid for by a Federal health care program. In 2018, the penalty per violation was a maximum of $100,000. The annual adjustment for 2019 increases this to $102,522.
3. The Civil Monetary Penalty Law also prohibits offering remuneration to induce beneficiaries of Federal health care programs to use particular providers, practitioners, or suppliers. In 2018, the penalty per violation was a maximum of $20,000. The annual adjustment for 2019 increases this to $20,504.
4. The False Claims Act prohibits knowingly presenting or causing to be presented a false or fraudulent claim under to the federal government. In 2016 (when the dollar amounts were last updated), the penalty for violating this prohibition was $10,000 per claim. The 2019 adjustment increases this to $10,461. The False Claims Act also prohibits making, using, or causing to be made or used a false record or statement material to a false or fraudulent claim. In 2016, the penalty for violating this prohibition was $50,000 per violation. The 2019 adjustment increases this to $52,308.

As always, healthcare providers should be mindful of the landscape of regulatory requirements that govern their business. The penalties for violations are large, and, as demonstrated by this 2019 update, the federal government is consistent in increasing the potential liability.