Annual Civil Monetary Penalties Inflation Adjustment, 9174-9189 [2017-02300]
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9174
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
TABLE 2—HARDNESS DEFAULTS WITH- DEPARTMENT OF HEALTH AND
IN EACH LEVEL III ECOREGION IN HUMAN SERVICES
OREGON—Continued
45 CFR Part 102
Hardness
mg/L)
Level III ecoregion
9 Eastern Cascades Slopes and
Foothills ...................................
10 Columbia Plateau ..................
11 Blue Mountains ......................
12 Snake River Plain ..................
78 Klamath Mountains ................
80 Northern Basin and Range ...
36.08
58.82
43.49
123.5
40.61
98.62
RIN 0991–AC0
Annual Civil Monetary Penalties
Inflation Adjustment
Department of Health and
Human Services, Office of the Assistant
Secretary for Financial Resources.
ACTION: Final rule.
AGENCY:
The Department of Health and
Human Services (HHS) is updating its
regulations to reflect required annual
inflation-related increases to the civil
monetary penalties in its regulations,
pursuant to the Federal Civil Penalties
Inflation Adjustment Act Improvement
Act of 2015.
DATES: This rule is effective February 3,
2017.
FOR FURTHER INFORMATION CONTACT:
Andrea Brandon, Deputy Assistant
Secretary for Grants and Acquisitions,
Office of the Assistant Secretary for
Financial Resources, Room 514–G,
Hubert Humphrey Building, 200
Independence Avenue SW., Washington
DC 20201; 202–690–6396; FAX 202–
690–5405.
SUPPLEMENTARY INFORMATION:
SUMMARY:
(d) Applicability. (1) The criterion in
paragraph (b) of this section applies to
freshwaters in Oregon where fish and
aquatic life are a designated use, and
applies concurrently with other
applicable water quality criteria.
(2) The criterion established in this
section is subject to Oregon’s general
rules of applicability in the same way
and to the same extent as are other
federally promulgated and state-adopted
numeric criteria when applied to
freshwaters in Oregon where fish and
aquatic life are a designated use.
(i) For all waters with mixing zone
regulations or implementation
procedures, the criterion applies at the
appropriate locations within or at the
boundary of the mixing zones and
outside of the mixing zones; otherwise
the criterion applies throughout the
water body including at the end of any
discharge pipe, conveyance or other
discharge point within the water body.
(ii) The state shall not use a low flow
value that is less stringent than the
values listed below for waters suitable
for the establishment of low flow return
frequencies (i.e., streams and rivers)
when calculating the available dilution
for the purposes of determining the
need for and establishing Water QualityBased Effluent Limitations in National
Pollutant Discharge Elimination System
permits:
asabaliauskas on DSK3SPTVN1PROD with RULES
Acute
criteria
(CMC)
1Q10 or 1B3
Where:
1. 1Q10 is the lowest one-day average
flow event expected to occur once every
ten years, on average (determined
hydrologically).
2. 1B3 is the lowest one-day average flow
event expected to occur once every
three years, on average (determined biologically).
[FR Doc. 2017–02283 Filed 2–2–17; 8:45 am]
BILLING CODE 6560–50–P
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I. Background
The Federal Civil Penalties Inflation
Adjustment Act Improvements Act of
2015 (Sec. 701 of Pub. L. 114–74) (the
‘‘Act’’), which is intended to improve
the effectiveness of civil monetary
penalties (‘‘CMPs’’) and to maintain the
deterrent effect of such penalties,
requires agencies to adjust the civil
monetary penalties for inflation
annually.
The Department of Health and Human
Services (HHS) lists the civil monetary
penalties and the penalty amounts
administered by all of its agencies in
tabular form in 45 CFR 102.3.
II. Calculation of Adjustment
The annual inflation adjustment for
each applicable civil monetary penalty
is determined using the percent increase
in the Consumer Price Index for all
Urban Consumers (CPI–U) for the month
of October of the year in which the
amount of each civil penalty was most
recently established or modified. In the
December 16, 2016, OMB Memorandum
for the Heads of Executive Agencies and
Departments, M–17–11, Implementation
of the 2017 annual adjustment pursuant
to the Federal Civil Penalties Inflation
Adjustment Act Improvements Act of
2015, OMB published the multiplier for
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the required annual adjustment. The
cost-of-living adjustment multiplier for
2017, based on the CPI–U for the month
of October 2016, not seasonally
adjusted, is 1.01636.
Using the 2017 multiplier, HHS
adjusted all its applicable monetary
penalties in 45 CFR 102.3.
III. Statutory and Executive Order
Reviews
The 2015 Act Requires Federal Agencies
To Publish Annual Penalty Inflation
Adjustments Notwithstanding Section
553 of the Administrative Procedure
Act
A. Executive Order 12866: Regulatory
Planning and Review and Executive
Order 13563: Improving Regulation and
Regulatory Review
Section 4 of the 2015 Act directs
federal agencies to publish annual
adjustments no later than January 15,
2017. In accordance with section 553 of
the Administrative Procedure Act
(APA), most rules are subject to notice
and comment and are effective no
earlier than 30 days after publication in
the Federal Register. However, Section
4(b)(2) of the 2015 Act provides that
each agency shall make the annual
inflation adjustments ‘‘notwithstanding
section 553’’ of the APA. According to
OMB’s Memorandum M–17–11,
Memorandum of the Heads of Executive
Departments and Agencies (December
16, 2016) the phrase ‘‘notwithstanding
section 553’’ means that ‘‘the public
procedure the APA generally provides—
notice, an opportunity for comment, and
a delay in effective date—is not required
for agencies to issue regulations
implementing the annual adjustment.’’
Consistent with the language of the 2015
Act and OMB’s implementation
guidance, this rule is not subject to
notice and an opportunity for public
comment and will be effective
immediately upon publication.
B. Review Under Procedural Statutes
and Executive Orders
Pursuant to OMB Memorandum for
the Heads of Executive Departments and
Agencies, M–17–11, HHS has
determined that making technical
changes to the amount of civil monetary
penalties in its regulations does not
trigger any requirements under
procedural statutes and Executive
Orders that govern rulemaking
procedures.
IV. Effective Date
This rule is effective February 3, 2017.
The adjusted civil penalty amounts
apply to civil penalties assessed on or
after February 3, 2017, when the
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Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
violation occurred after November 2,
2015. If the violation occurred prior to
November 2, 2015, or a penalty was
assessed prior to September 6, 2016, the
pre-adjustment civil penalty amounts in
effect prior to September 6, 2016 will
apply.
List of Subjects in 45 CFR Part 102
Administrative practice and
procedure, Penalties.
9175
For reasons discussed in the
preamble, the Department of Health and
Human Services amends subtitle A, title
45 of the Code of Federal Regulations as
follows:
Authority: Public Law 101–410, Sec. 701
of Public Law 114–74, 31 U.S.C. 3801–3812.
PART 102—ADJUSTMENT OF CIVIL
MONETARY PENALTIES FOR
INFLATION
§ 102.3
2. Amend § 102.3 by revising the table
to read as follows:
■
*
Penalty adjustment and table.
*
*
*
*
1. The authority citation for part 102
continues to read as follows:
■
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS
[Effective February 3, 2017]
Citation
U.S.C.
CFR 1
HHS
agency
21 U.S.C.:
333(b)(2)(A) .........................
.......................................
FDA ....
333(b)(2)(B) .........................
.......................................
FDA ....
333(b)(3) .............................
.......................................
FDA ....
333(f)(1)(A) ..........................
.......................................
FDA ....
333(f)(2)(A) ..........................
.......................................
FDA ....
333(f)(3)(A) ..........................
.......................................
FDA ....
333(f)(3)(B) ..........................
.......................................
FDA ....
333(f)(4)(A)(i) ......................
.......................................
FDA ....
asabaliauskas on DSK3SPTVN1PROD with RULES
333(f)(4)(A)(ii) ......................
333(f)(9)(A) ..........................
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.......................................
.......................................
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PO 00000
FDA ....
FDA ....
Frm 00049
Date of last
penalty figure or adjustment 3
Description 2
Penalty for violations related to drug samples resulting in a conviction of any representative of
manufacturer or distributor in any 10-year period.
Penalty for violation related to drug samples resulting in a conviction of any representative of
manufacturer or distributor after the second
conviction in any 10-yr period.
Penalty for failure to make a report required by
21 U.S.C. 353(d)(3)(E) relating to drug samples.
Penalty for any person who violates a requirement related to devices for each such violation.
Penalty for aggregate of all violations related to
devices in a single proceeding.
Penalty for any individual who introduces or delivers for introduction into interstate commerce
food that is adulterated per 21 U.S.C.
342(a)(2)(B) or any individual who does not
comply with a recall order under 21 U.S.C.
350l.
Penalty in the case of any other person other
than an individual) for such introduction or delivery of adulterated food.
Penalty for aggregate of all such violations related to adulterated food adjudicated in a single proceeding.
Penalty for all violations adjudicated in a single
proceeding for any person who violates 21
U.S.C. 331(jj)(1) by failing to submit the certification required by 42 U.S.C. 282(j)(5)(B) or
knowingly submitting a false certification; by
failing to submit clinical trial information under
42 U.S.C. 282(j); or by submitting clinical trial
information under 42 U.S.C. 282(j) that is false
or misleading in any particular under 42
U.S.C. 282(j)(5)(D).
Penalty for each day any above violation is not
corrected after a 30-day period following notification until the violation is corrected.
Penalty for any responsible person that violates
a requirement of 21 U.S.C. 355(o) (post-marketing studies, clinical trials, labeling), 21
U.S.C. 355(p) (risk evaluation and mitigation
(REMS)), or 21 U.S.C. 355–1 (REMS).
Penalty for aggregate of all such above violations in a single proceeding.
Penalty for REMS violation that continues after
written notice to the responsible person for the
first 30-day period (or any portion thereof) the
responsible person continues to be in violation.
Penalty for REMS violation that continues after
written notice to responsible person doubles
for every 30-day period thereafter the violation
continues, but may not exceed penalty amount
for any 30-day period.
Penalty for aggregate of all such above violations adjudicated in a single proceeding.
Penalty for any person who violates a requirement which relates to tobacco products for
each such violation.
Fmt 4700
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03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
98,935
100,554
2016
1,978,690
2,011,061
2016
197,869
201,106
2016
26,723
27,160
2016
1,781,560
1,810,706
2016
75,123
76,352
2016
375,613
381,758
2016
751,225
763,515
2016
11,383
11,569
2016
11,383
11,569
2016
284,583
289,239
2016
1,138,330
1,156,953
2016
284,583
289,239
2016
1,138,330
1,156,953
2016
11,383,300
11,569,531
2016
16,503
16,773
9176
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
U.S.C.
333(f)(9)(B)(i)(I) ...................
333(f)(9)(B)(i)(II) ..................
333(f)(9)(B)(ii)(I) ..................
333(f)(9)(B)(ii)(II) .................
333(g)(1) .............................
asabaliauskas on DSK3SPTVN1PROD with RULES
333 note ..............................
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CFR 1
.......................................
.......................................
.......................................
.......................................
.......................................
.......................................
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PO 00000
HHS
agency
FDA ....
FDA ....
FDA ....
FDA ....
FDA ....
FDA ....
Frm 00050
Description 2
Penalty for aggregate of all such violations of tobacco product requirement adjudicated in a
single proceeding.
Penalty per violation related to violations of tobacco requirements.
Penalty for aggregate of all such violations of tobacco product requirements adjudicated in a
single proceeding.
Penalty in the case of a violation of tobacco
product requirements that continues after written notice to such person, for the first 30-day
period (or any portion thereof) the person continues to be in violation.
Penalty for violation of tobacco product requirements that continues after written notice to
such person shall double for every 30-day period thereafter the violation continues, but may
not exceed penalty amount for any 30-day period.
Penalty for aggregate of all such violations related to tobacco product requirements adjudicated in a single proceeding.
Penalty for any person who either does not conduct post-market surveillance and studies to
determine impact of a modified risk tobacco
product for which the HHS Secretary has provided them an order to sell, or who does not
submit a protocol to the HHS Secretary after
being notified of a requirement to conduct
post-market surveillance of such tobacco products.
Penalty for aggregate of for all such above violations adjudicated in a single proceeding.
Penalty for violation of modified risk tobacco
product post-market surveillance that continues after written notice to such person for
the first 30-day period (or any portion thereof)
that the person continues to be in violation.
Penalty for post-notice violation of modified risk
tobacco product post-market surveillance shall
double for every 30-day period thereafter that
the tobacco product requirement violation continues for any 30-day period, but may not exceed penalty amount for any 30-day period.
Penalty for aggregate above tobacco product requirement violations adjudicated in a single
proceeding.
Penalty for any person who disseminates or
causes another party to disseminate a directto-consumer advertisement that is false or
misleading for the first such violation in any 3year period.
Penalty for each subsequent above violation in
any 3-year period.
Penalty to be applied for violations of restrictions
on the sale or distribution of tobacco products
promulgated under 21 U.S.C. 387f(d) (e.g.,
violations of regulations in 21 CFR part 1140)
with respect to a retailer with an approved
training program in the case of a second regulation violation within a 12-month period.
Penalty in the case of a third tobacco product
regulation violation within a 24-month period.
Penalty in the case of a fourth tobacco product
regulation violation within a 24-month period.
Penalty in the case of a fifth tobacco product
regulation violation within a 36-month period.
Penalty in the case of a sixth or subsequent tobacco product regulation violation within a 48month period as determined on a case-bycase basis.
Fmt 4700
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E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
1,100,200
1,118,199
2016
275,050
279,550
2016
1,100,200
1,118,199
2016
275,050
279,550
2016
1,100,200
1,118,199
2016
11,002,000
11,181,993
2016
275,050
279,550
2016
1,100,200
1,118,199
2016
275,050
279,550
2016
1,100,200
1,118,199
2016
11,002,000
11,181,993
2016
284,583
289,239
2016
569,165
578,477
2016
275
279
2016
550
559
2016
2,200
2,236
2016
5,501
5,591
2016
11,002
11,182
9177
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
CFR 1
U.S.C.
335b(a) ................................
.......................................
360pp(b)(1) .........................
.......................................
HHS
agency
FDA ....
FDA ....
42 U.S.C.
262(d) ..................................
.......................................
FDA ....
263b(h)(3) ...........................
.......................................
FDA ....
300aa–28(b)(1) ...................
.......................................
FDA ....
256b(d)(1)(B)(vi) .................
.......................................
HRSA
299c–(3)(d) .........................
.......................................
AHRQ
653(l)(2) ...............................
45 CFR 303.21(f) ..........
ACF ....
262a(i)(1) .............................
42 CFR 1003.910 .........
OIG ....
.......................................
OIG ....
1320a–7a(a) ........................
asabaliauskas on DSK3SPTVN1PROD with RULES
300jj–51 ..............................
42 CFR 1003.210(a)(1)
OIG ....
42 CFR 1003.210(a)(2)
42 CFR 1003.210(a)(3)
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............
............
21:08 Feb 02, 2017
Jkt 241001
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Frm 00051
Description 2
Penalty to be applied for violations of restrictions
on the sale or distribution of tobacco products
promulgated under 21 U.S.C. 387f(d) (e.g.,
violations of regulations in 21 CFR part 1140)
with respect to a retailer that does not have an
approved training program in the case of the
first regulation violation.
Penalty in the case of a second tobacco product
regulation violation within a 12-month period.
Penalty in the case of a third tobacco product
regulation violation within a 24-month period.
Penalty in the case of a fourth tobacco product
regulation violation within a 24-month period.
Penalty in the case of a fifth tobacco product
regulation violation within a 36-month period.
Penalty in the case of a sixth or subsequent tobacco product regulation violation within a 48month period as determined on a case-bycase basis.
Penalty for each violation for any individual who
made a false statement or misrepresentation
of a material fact, bribed, destroyed, altered,
removed, or secreted, or procured the destruction, alteration, removal, or secretion of, any
material document, failed to disclose a material fact, obstructed an investigation, employed
a consultant who was debarred, debarred individual provided consultant services.
Penalty in the case of any other person (other
than an individual) per above violation.
Penalty for any person who violates any such requirements for electronic products, with each
unlawful act or omission constituting a separate violation.
Penalty imposed for any related series of violations of requirements relating to electronic
products.
Penalty per day for violation of order of recall of
biological product presenting imminent or substantial hazard.
Penalty for failure to obtain a mammography certificate as required.
Penalty per occurrence for any vaccine manufacturer that intentionally destroys, alters, falsifies,
or conceals any record or report required.
Penalty for each instance of overcharging a
340B covered entity.
Penalty for an establishment or person supplying
information obtained in the course of activities
for any purpose other than the purpose for
which it was supplied.
Penalty for Misuse of Information in the National
Directory of New Hires.
Penalty for each individual who violates safety
and security procedures related to handling
dangerous biological agents and toxins.
Penalty for any other person who violates safety
and security procedures related to handling
dangerous biological agents and toxins.
Penalty per violation for committing information
blocking.
Penalty for knowingly presenting or causing to
be presented to an officer, employee, or agent
of the United States a false claim.
Penalty for knowingly presenting or causing to
be presented a request for payment which violates the terms of an assignment, agreement,
or PPS agreement.
Penalty for knowingly giving or causing to be
presented to a participating provider or supplier false or misleading information that could
reasonably be expected to influence a discharge decision.
Penalty for an excluded party retaining ownership or control interest in a participating entity.
Fmt 4700
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03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
275
279
2016
550
559
2016
1,100
1,118
2016
2,200
2,236
2016
5,501
5,591
2016
11,002
11,182
2016
419,320
426,180
2016
1,677,280
1,704,720
2016
2,750
2,795
2016
937,500
952,838
2016
215,628
219,156
2016
16,773
17,047
2016
215,628
219,156
2016
5,437
5,526
2016
14,140
14,371
2016
1,450
1,474
2016
327,962
333,327
2016
655,925
666,656
2016
1,000,000
1,016,360
2016
15,024
15,270
2016
15,024
15,270
2016
22,537
22,906
2016
15,024
15,270
9178
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
HHS
agency
Description 2
42 CFR 1003.1010
............
42 CFR 1003.210(a)(4)
............
42 CFR 1003.310(a)(3)
............
Penalty for remuneration offered to induce program beneficiaries to use particular providers,
practitioners, or suppliers.
Penalty for employing or contracting with an excluded individual.
Penalty 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.
Penalty for ordering or prescribing medical or
other item or service during a period in which
the person was excluded.
Penalty for knowingly making or causing to be
made a false statement, omission or misrepresentation of a material fact in any application,
bid, or contract to participate or enroll as a
provider or supplier.
Penalty for knowing of an overpayment and failing to report and return.
Penalty for making or using a false record or
statement that is material to a false or fraudulent claim.
Penalty for failure to grant timely access to HHS
OIG for audits, investigations, evaluations, and
other statutory functions of HHS OIG.
Penalty for payments by a hospital or critical access hospital to induce a physician to reduce
or limit services to individuals under direct
care of physician or who are entitled to certain
medical assistance benefits.
Penalty for physicians who knowingly receive
payments from a hospital or critical access
hospital to induce such physician to reduce or
limit services to individuals under direct care of
physician or who are entitled to certain medical assistance benefits.
Penalty for a physician who executes a document that falsely certifies home health needs
for Medicare beneficiaries.
Penalty for failure to report any final adverse action taken against a health care provider, supplier, or practitioner.
Penalty for the misuse of words, symbols, or emblems in communications in a manner in which
a person could falsely construe that such item
is approved, endorsed, or authorized by HHS.
Penalty for the misuse of words, symbols, or emblems in a broadcast or telecast in a manner
in which a person could falsely construe that
such item is approved, endorsed, or authorized by HHS.
Penalty for certification of a false statement in
assessment of functional capacity of a Skilled
Nursing Facility resident assessment.
Penalty for causing another to certify or make a
false statement in assessment of functional
capacity of a Skilled Nursing Facility resident
assessment.
Penalty for any individual who notifies or causes
to be notified a Skilled Nursing Facility of the
time or date on which a survey is to be conducted.
Penalty for a Medicare Advantage organization
that substantially fails to provide medically
necessary, required items and services.
Penalty for a Medicare Advantage organization
that charges excessive premiums.
Penalty for a Medicare Advantage organization
that improperly expels or refuses to reenroll a
beneficiary.
Penalty for a Medicare Advantage organization
that engages in practice that would reasonably
be expected to have the effect of denying or
discouraging enrollment.
CFR 1
U.S.C.
.........................................
42 CFR 1003.210(a)(1)
42 CFR 1003.210(a)(6)
42 CFR 1003.210(a)(8)
............
42 CFR 1003.210(a)(7)
............
42 CFR 1003.210(a)(9)
............
.......................................
OIG ....
1320a–7a(b) ........................
42 CFR 1003.210(a)(10)
42 CFR 1003.810 .........
OIG ....
1320b–10(b)(1) ...................
42 CFR 1003.610(a) .....
OIG ....
1320b–10(b)(2) ...................
42 CFR 1003.610(a) .....
OIG ....
1395i–3(b)(3)(B)(ii)(1) .........
42 CFR 1003.210(a)(11)
OIG ....
1395i–3(b)(3)(B)(ii)(2) .........
42 CFR 1003.210(a)(11)
OIG ....
1395i–3(g)(2)(A) ..................
42 CFR 1003.1310 .......
OIG ....
1395w–27(g)(2)(A) ..............
asabaliauskas on DSK3SPTVN1PROD with RULES
1320a–7e(b)(6)(A) ..............
42 CFR 1003.410 .........
OIG ....
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E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
15,024
15,270
2016
14,718
14,959
2016
73,588
74,792
2016
10,874
11,052
2016
54,372
55,262
2016
10,874
11,052
2016
54,372
55,262
2016
16,312
16,579
2016
4,313
4,384
2016
4,313
4,384
2016
7,512
7,635
2016
36,794
37,396
2016
9,893
10,055
2016
49,467
50,276
2016
2,063
2,097
2016
10,314
10,483
2016
4,126
4,194
2016
37,561
38,175
2016
36,794
37,396
2016
36,794
37,396
2016
147,177
149,585
9179
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
CFR 1
U.S.C.
HHS
agency
1395w–141(i)(3) ..................
.......................................
OIG ....
1395cc(g) ............................
.......................................
OIG ....
1395dd(d)(1) .......................
42 CFR 1003.510 .........
OIG ....
asabaliauskas on DSK3SPTVN1PROD with RULES
1395mm(i)(6)(B)(i) ...............
1395nn(g)(3) .......................
VerDate Sep<11>2014
42 CFR 1003.410 .........
42 CFR 1003.310 .........
21:08 Feb 02, 2017
Jkt 241001
PO 00000
OIG ....
OIG ....
Frm 00053
Description 2
Penalty per individual who does not enroll as a
result of a Medicare Advantage organization’s
practice that would reasonably be expected to
have the effect of denying or discouraging enrollment.
Penalty for a Medicare Advantage organization
misrepresenting or falsifying information to
Secretary.
Penalty for a Medicare Advantage organization
misrepresenting or falsifying information to individual or other entity.
Penalty for Medicare Advantage organization
interfering with provider’s advice to enrollee
and non-MCO affiliated providers that balance
bill enrollees.
Penalty for a Medicare Advantage organization
that employs or contracts with excluded individual or entity.
Penalty for a Medicare Advantage organization
enrolling an individual in without prior written
consent.
Penalty for a Medicare Advantage organization
transferring an enrollee to another plan without
consent or solely for the purpose of earning a
commission.
Penalty for a Medicare Advantage organization
failing to comply with marketing restrictions or
applicable implementing regulations or guidance.
Penalty for a Medicare Advantage organization
employing or contracting with an individual or
entity who violates 1395w–27(g)(1)(A)–(J).
Penalty for a prescription drug card sponsor that
falsifies or misrepresents marketing materials,
overcharges program enrollees, or misuse
transitional assistance funds.
Penalty for improper billing by Hospitals, Critical
Access Hospitals, or Skilled Nursing Facilities.
Penalty for a hospital or responsible physician
dumping patients needing emergency medical
care, if the hospital has 100 beds or more.
Penalty for a hospital or responsible physician
dumping patients needing emergency medical
care, if the hospital has less than 100 beds.
Penalty for a HMO or competitive plan is such
plan substantially fails to provide medically
necessary, required items or services.
Penalty for HMOs/competitive medical plans that
charge premiums in excess of permitted
amounts.
Penalty for a HMO or competitive medical plan
that expels or refuses to reenroll an individual
per prescribed conditions.
Penalty for a HMO or competitive medical plan
that implements practices to discourage enrollment of individuals needing services in future.
Penalty per individual not enrolled in a plan as a
result of a HMO or competitive medical plan
that implements practices to discourage enrollment of individuals needing services in the future.
Penalty for a HMO or competitive medical plan
that misrepresents or falsifies information to
the Secretary.
Penalty for a HMO or competitive medical plan
that misrepresents or falsifies information to an
individual or any other entity.
Penalty for failure by HMO or competitive medical plan to assure prompt payment of Medicare risk sharing contracts or incentive plan
provisions.
Penalty for HMO that employs or contracts with
excluded individual or entity.
Penalty for submitting or causing to be submitted
claims in violation of the Stark Law’s restrictions on physician self-referrals.
Fmt 4700
Sfmt 4700
E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
22,077
22,438
2016
147,177
149,585
2016
36,794
37,396
2016
36,794
37,396
2016
36,794
37,396
2016
36,794
37,396
2016
36,794
37,396
2016
36,794
37,396
2016
36,794
37,396
2016
12,856
13,066
2016
5,000
5,082
2016
103,139
104,826
2016
51,570
52,414
2016
51,570
52,414
2016
51,570
52,414
2016
51,570
52,414
2016
206,278
209,653
2016
29,680
30,166
2016
206,278
209,653
2016
51,570
52,414
2016
51,570
52,414
2016
47,340
48,114
2016
23,863
24,253
9180
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
Description 2
CFR 1
HHS
agency
1395nn(g)(4) .......................
42 CFR 1003.310 .........
OIG ....
1395ss(d)(1) ........................
42 CFR 1003.1110 .......
OIG ....
1395ss(d)(2) ........................
42 CFR 1003.1110 .......
OIG ....
1395ss(d)(3)(A)(ii) ...............
42 CFR 1003.1110 .......
OIG ....
Penalty for circumventing Stark Law’s restrictions
on physician self-referrals.
Penalty for a material misrepresentation regarding Medigap compliance policies.
Penalty for selling Medigap policy under false
pretense.
Penalty for an issuer that sells health insurance
policy that duplicates benefits.
Penalty for someone other than issuer that sells
health insurance that duplicates benefits.
Penalty for using mail to sell a non-approved
Medigap insurance policy.
Penalty for a Medicaid MCO that substantially
fails to provide medically necessary, required
items or services.
Penalty for a Medicaid MCO that charges excessive premiums.
Penalty for a Medicaid MCO that improperly expels or refuses to reenroll a beneficiary.
Penalty per individual who does not enroll as a
result of a Medicaid MCO’s practice that would
reasonably be expected to have the effect of
denying or discouraging enrollment.
Penalty for a Medicaid MCO misrepresenting or
falsifying information to the Secretary.
Penalty for a Medicaid MCO misrepresenting or
falsifying information to an individual or another entity.
Penalty for a Medicaid MCO that fails to comply
with contract requirements with respect to physician incentive plans.
Penalty for willfully and knowingly certifying a
material and false statement in a Skilled Nursing Facility resident assessment.
Penalty for willfully and knowingly causing another individual to certify a material and false
statement in a Skilled Nursing Facility resident
assessment.
Penalty for notifying or causing to be notified a
Skilled Nursing Facility of the time or date on
which a survey is to be conducted.
Penalty for the knowing provision of false information or refusing to provide information about
charges or prices of a covered outpatient drug.
Penalty per day for failure to timely provide information by drug manufacturer with rebate
agreement.
Penalty for knowing provision of false information
by drug manufacturer with rebate agreement.
Penalty for notifying home and community-based
providers or settings of survey.
Penalty for failing to report a medical malpractice
claim to National Practitioner Data Bank.
Penalty for breaching confidentiality of information reported to National Practitioner Data
Bank.
Penalty for violation of confidentiality provision of
the Patient Safety and Quality Improvement
Act.
Penalty for each pre-February 18, 2009 violation
of the HIPAA administrative simplification provisions.
Calendar Year Cap ...............................................
Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification
provision in which it is established that the
covered entity or business associate did not
know and by exercising reasonable diligence,
would not have known that the covered entity
or business associate violated such a provision:
Minimum ...............................................................
Maximum ..............................................................
Calendar Year Cap ...............................................
U.S.C.
1395ss(d)(4)(A) ...................
42 CFR 1003.1110 .......
OIG ....
1396b(m)(5)(B)(i) ................
42 CFR 1003.410 .........
OIG ....
1396r(b)(3)(B)(ii)(I) ..............
42 CFR 1003.210(a)(11)
OIG ....
1396r(b)(3)(B)(ii)(II) .............
42 CFR 1003.210(a)(11)
OIG ....
1396r(g)(2)(A)(i) ..................
42 CFR 1003.1310 .......
OIG ....
1396r–8(b)(3)(B) .................
42 CFR 1003.1210 .......
OIG ....
1396r–8(b)(3)(C)(i) ..............
42 CFR 1003.1210 .......
OIG ....
1396r–8(b)(3)(C)(ii) .............
42 CFR 1003.1210 .......
OIG ....
1396t(i)(3)(A) .......................
42 CFR 1003.1310 .......
OIG ....
11131(c) ..............................
42 CFR 1003.810 .........
OIG ....
11137(b)(2) .........................
42 CFR 1003.810 .........
OIG ....
299b–22(f)(1) ......................
42 CFR 3.404 ...............
OCR ...
45 CFR 160.404(b)(1)(i),
(ii)
OCR ...
45 CFR 160.404(b)
(2)(i)(A), (B).
OCR ...
asabaliauskas on DSK3SPTVN1PROD with RULES
1320(d)–5(a) .......................
VerDate Sep<11>2014
21:08 Feb 02, 2017
Jkt 241001
PO 00000
Frm 00054
Fmt 4700
Sfmt 4700
E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
159,089
161,692
2016
9,893
10,055
2016
9,893
10,055
2016
44,539
45,268
2016
26,723
27,160
2016
9,893
10,055
2016
49,467
50,276
2016
49,467
50,276
2016
197,869
201,106
2016
29,680
30,166
2016
197,869
201,106
2016
49,467
50,276
2016
44,539
45,268
2016
2,063
2,097
2016
10,314
10,483
2016
4,126
4,194
2016
178,156
181,071
2016
17,816
18,107
2016
178,156
181,071
2016
3,563
3,621
2016
21,563
21,916
2016
21,563
21,916
2016
11,940
12,135
2016
150
152
2016
37,561
38,175
2016
2016
2016
110
55,010
1,650,300
112
55,910
1,677,299
9181
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
CFR 1
U.S.C.
45 CFR 160.404(b)(2)(ii)
(A), (B)
45 CFR 160.404(b)
(2)(iii)(A), (B)
45 CFR 160.404(b)(2)
(iv)(A), (B)
263a(h)(2)(B) & 1395w–
2(b)(2)(A)(ii).
42 CFR 493.1834(d)(2)
(i).
42 CFR 493.1834(d)(2)
(ii).
HHS
agency
Description 2
OCR ...
Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification
provision in which it is established that the violation was due to reasonable cause and not to
willful neglect:
Minimum ...............................................................
Maximum ..............................................................
Calendar Year Cap ...............................................
Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification
provision in which it is established that the violation was due to willful neglect and was corrected during the 30-day period beginning on
the first date the covered entity or business
associate knew, or, by exercising reasonable
diligence, would have known that the violation
occurred:
Minimum ...............................................................
Maximum ..............................................................
Calendar Year Cap ...............................................
Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification
provision in which it is established that the violation was due to willful neglect and was not
corrected during the 30-day period beginning
on the first date the covered entity or business
associate knew, or by exercising reasonable
diligence, would have known that the violation
occurred:
Minimum ...............................................................
Maximum ..............................................................
Calendar Year Cap ...............................................
Penalty for a clinical laboratory’s failure to meet
participation and certification requirements and
poses immediate jeopardy:
Minimum ...............................................................
Maximum ..............................................................
Penalty for a clinical laboratory’s failure to meet
participation and certification requirements and
the failure does not pose immediate jeopardy:
Minimum ...............................................................
Maximum ..............................................................
Failure to provide the Summary of Benefits and
Coverage.
Penalty for violations of regulations related to the
medical loss ratio reporting and rebating.
Penalty for manufacturer or group purchasing organization failing to report information required
under 42 U.S.C. 1320a–7h(a), relating to physician ownership or investment interests:
Minimum ...............................................................
Maximum ..............................................................
Calendar Year Cap ...............................................
Penalty for manufacturer or group purchasing organization knowingly failing to report information required under 42 U.S.C. 1320a–7h(a), relating to physician ownership or investment interests:
Minimum ...............................................................
Maximum ..............................................................
Calendar Year Cap ...............................................
Penalty for an administrator of a facility that fails
to comply with notice requirements for the closure of a facility.
Minimum penalty for the first offense of an administrator who fails to provide notice of facility
closure.
Minimum penalty for the second offense of an
administrator who fails to provide notice of facility closure.
Minimum penalty for the third and subsequent
offenses of an administrator who fails to provide notice of facility closure.
OCR ...
OCR ...
CMS ...
CMS ...
300gg–15(f) .........................
45 CFR 147.200(e) .......
CMS ...
300gg–18 ............................
45 CFR 158.606 ...........
CMS ...
1320a–7h(b)(1) ...................
42 CFR 402.105(d)(5),
42 CFR 403.912(a) &
(c).
CMS ...
1320a–7h(b)(2) ...................
42 CFR 402.105(h), 42
CFR 403.912(b) & (c).
CMS ...
asabaliauskas on DSK3SPTVN1PROD with RULES
CMS
1320a–7j(h)(3)(A) ................
VerDate Sep<11>2014
42 CFR 488.446(a)(1),
(2), & (3).
21:08 Feb 02, 2017
Jkt 241001
PO 00000
CMS ...
Frm 00055
Fmt 4700
Sfmt 4700
E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
2016
2016
1,100
55,010
1,650,300
1,118
55,910
1,677,299
2016
2016
2016
11,002
55,010
1,650,300
11,182
55,910
1,677,299
2016
2016
2016
55,010
1,650,300
1,650,300
55,910
1,677,299
1,677,299
2016
2016
6,035
19,787
6,134
20,111
2016
2016
2016
99
5,936
1,087
101
6,033
1,105
2016
109
111
2016
2016
2016
1,087
10,874
163,117
1,105
11,052
165,786
2016
2016
2016
2016
10,874
108,745
1,087,450
108,745
11,052
110,524
1,105,241
110,524
2016
544
553
2016
1,631
1,658
2016
3,262
3,315
9182
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
.......................................
1320a–8(a)(1) .....................
Description 2
CFR 1
U.S.C.
HHS
agency
CMS ...
Penalty for an entity knowingly making a false
statement or representation of material fact in
the determination of the amount of benefits or
payments related to old-age, survivors, and
disability insurance benefits, special benefits
for certain World War II veterans, or supplemental security income for the aged, blind,
and disabled.
Penalty for violation of 42 U.S.C. 1320a–8(a)(1)
if the violator is a person who receives a fee
or other income for services performed in connection with determination of the benefit
amount or the person is a physician or other
health care provider who submits evidence in
connection with such a determination.
Penalty for a representative payee (under 42
U.S.C. 405(j), 1007, or 1383(a)(2)) converting
any part of a received payment from the benefit programs described in the previous civil
monetary penalty to a use other than for the
benefit of the beneficiary.
Penalty for failure of covered individuals to report
to the Secretary and 1 or more law enforcement officials any reasonable suspicion of a
crime against a resident, or individual receiving care, from a long-term care facility.
Penalty for failure of covered individuals to report
to the Secretary and 1 or more law enforcement officials any reasonable suspicion of a
crime against a resident, or individual receiving care, from a long-term care facility if such
failure exacerbates the harm to the victim of
the crime or results in the harm to another individual.
Penalty for a long-term care facility that retaliates
against any employee because of lawful acts
done by the employee, or files a complaint or
report with the State professional disciplinary
agency against an employee or nurse for lawful acts done by the employee or nurse.
Penalty for any person who knowingly and willfully fails to furnish a beneficiary with an
itemized statement of items or services within
30 days of the beneficiary’s request.
Penalty per day for a Skilled Nursing Facility that
has a Category 2 violation of certification requirements:
Minimum ...............................................................
Maximum ..............................................................
Penalty per instance of Category 2 noncompliance by a Skilled Nursing Facility:
Minimum ...............................................................
Maximum ..............................................................
Penalty per day for a Skilled Nursing Facility that
has a Category 3 violation of certification requirements:
Minimum ...............................................................
Maximum ..............................................................
Penalty per instance of Category 3 noncompliance by a Skilled Nursing Facility:
Minimum ...............................................................
Maximum ..............................................................
Penalty per day and per instance for a Skilled
Nursing Facility that has Category 3 noncompliance with Immediate Jeopardy:
Per Day (Minimum) ..............................................
Per Day (Maximum) .............................................
Per Instance (Minimum) .......................................
Per Instance (Maximum) ......................................
Penalty per day of a Skilled Nursing Facility that
fails to meet certification requirements. These
amounts represent the upper range per day:
Minimum ...............................................................
Maximum ..............................................................
Penalty per day of a Skilled Nursing Facility that
fails to meet certification requirements. These
amounts represent the lower range per day:
1320a–8(a)(3) .....................
.......................................
CMS ...
1320b–25(c)(1)(A) ...............
.......................................
CMS ...
1320b–25(c)(2)(A) ...............
.......................................
CMS ...
1320b–25(d)(2) ...................
.......................................
CMS ...
1395b–7(b)(2)(B) ................
42 CFR 402.105(g) .......
CMS ...
1395i–3(h)(2)(B)(ii)(I) ..........
42 CFR 488.408(d)(1)
(iii).
CMS ...
42 CFR 488.408(d)(1)
(iv)
42 CFR 488.408(e)(1)
(iii)
42 CFR 488.408(e)(1)
(iv)
asabaliauskas on DSK3SPTVN1PROD with RULES
42 CFR 488.408(e)(2)(ii)
42 CFR 488.438(a)(1)(i)
42 CFR 488.438(a)(1)(ii)
VerDate Sep<11>2014
21:08 Feb 02, 2017
Jkt 241001
PO 00000
CMS ...
CMS ...
CMS ...
CMS ...
CMS ...
CMS ...
Frm 00056
Fmt 4700
Sfmt 4700
E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
7,954
8,084
2016
7,500
7,623
2016
6,229
6,331
2016
217,490
221,048
2016
326,235
331,572
2016
217,490
221,048
2016
147
149
2016
2016
103
6,188
105
6,289
2016
2016
2,063
20,628
2,097
20,965
2016
2016
6,291
20,628
6,394
20,965
2016
2016
2,063
20,628
2,097
20,965
2016
2016
2016
2016
6,291
20,628
2,063
20,628
6,394
20,965
2,097
20,965
2016
2016
6,291
20,628
6,394
20,965
9183
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
CFR 1
U.S.C.
42 CFR 488.438(a)(2)
HHS
agency
CMS ...
42 CFR 402.105(d)(2)(i)
CMS ...
1395l(i)(6) ............................
.......................................
CMS ...
1395l(q)(2)(B)(i) ...................
42 CFR 402.105(a) .......
CMS ...
1395m(a)(11)(A) .................
42 CFR 402.1(c)(4),
402.105(d)(2)(ii).
CMS ...
1395m(a)(18)(B) .................
42 CFR 402.1(c)(5),
402.105(d)(2)(iii).
CMS ...
1395m(b)(5)(C) ...................
42 CFR 402.1(c)(6),
402.105(d)(2)(iv).
CMS ...
1395m(h)(3) ........................
42 CFR 402.1(c)(8),
402.105(d)(2)(vi).
CMS ...
1395m(j)(2)(A)(iii) ................
.......................................
CMS ...
1395m(j)(4) ..........................
asabaliauskas on DSK3SPTVN1PROD with RULES
1395l(h)(5)(D) .....................
42 CFR 402.1(c)(10),
402.105(d)(2)(vii).
CMS ...
VerDate Sep<11>2014
21:08 Feb 02, 2017
Jkt 241001
PO 00000
Frm 00057
Description 2
Minimum ...............................................................
Maximum ..............................................................
Penalty per instance of a Skilled Nursing Facility
that fails to meet certification requirements:
Minimum ...............................................................
Maximum ..............................................................
Penalty for knowingly, willfully, and repeatedly
billing for a clinical diagnostic laboratory test
other than on an assignment-related basis.
(Penalties are assessed in the same manner
as 42 U.S.C. 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).
Penalty for knowingly and willfully presenting or
causing to be presented a bill or request for
payment for an intraocular lens inserted during
or after cataract surgery for which the Medicare payment rate includes the cost of acquiring the class of lens involved.
Penalty for knowingly and willfully failing to provide information about a referring physician
when seeking payment on an unassigned
basis.
Penalty for any durable medical equipment supplier that knowingly and willfully charges for a
covered service that is furnished on a rental
basis after the rental payments may no longer
be made. (Penalties are assessed in the same
manner as 42 U.S.C. 1395u(j)(2)(B), which is
assessed according to 1320a–7a(a)).
Penalty for any nonparticipating durable medical
equipment supplier that knowingly and willfully
fails to make a refund to Medicare beneficiaries for a covered service for which payment is precluded due to an unsolicited telephone contact from the supplier. (Penalties are
assessed in the same manner as 42 U.S.C.
1395u(j)(2)(B), which is assessed according to
1320a–7a(a)).
Penalty for any nonparticipating physician or
supplier that knowingly and willfully charges a
Medicare beneficiary more than the limiting
charge for radiologist services. (Penalties are
assessed in the same manner as 42 U.S.C.
1395u(j)(2)(B), which is assessed according to
1320a–7a(a)).
Penalty for any supplier of prosthetic devices,
orthotics, and prosthetics that knowing and
willfully charges for a covered prosthetic device, orthotic, or prosthetic that is furnished on
a rental basis after the rental payment may no
longer be made. (Penalties are assessed in
the
same
manner
as
42
U.S.C.
1395m(a)(11)(A), that is in the same manner
as 1395u(j)(2)(B), which is assessed according
to 1320a–7a(a)).
Penalty for any supplier of durable medical
equipment including a supplier of prosthetic
devices, prosthetics, orthotics, or supplies that
knowingly and willfully distributes a certificate
of medical necessity in violation of Section
1834(j)(2)(A)(i) of the Act or fails to provide the
information
required
under
Section
1834(j)(2)(A)(ii) of the Act.
Penalty for any supplier of durable medical
equipment, including a supplier of prosthetic
devices, prosthetics, orthotics, or supplies that
knowingly and willfully fails to make refunds in
a timely manner to Medicare beneficiaries for
series billed other than on as assignment-related basis under certain conditions. (Penalties
are assessed in the same manner as 42
U.S.C. 1395m(j)(4) and 1395u(j)(2)(B), which
is assessed according to 1320a–7a(a)).
Fmt 4700
Sfmt 4700
E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
2016
103
6,188
105
6,289
2016
2016
2016
2,063
20,628
15,024
2,097
20,965
15,270
2016
3,957
4,022
2016
3,787
3,849
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
2016
1,591
1,617
2016
15,024
15,270
9184
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
CFR 1
U.S.C.
HHS
agency
Description 2
Penalty for any person or entity who knowingly
and willfully bills or collects for any outpatient
therapy services or comprehensive outpatient
rehabilitation services on other than an assignment-related basis. (Penalties are assessed in
the same manner as 42 U.S.C. 1395m(k)(6)
and 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).
Penalty for any supplier of ambulance services
who knowingly and willfully fills or collects for
any services on other than an assignment-related basis. (Penalties are assessed in the
same manner as 42 U.S.C. 1395u(b)(18)(B),
which is assessed according to 1320a–7a(a)).
Penalty for any practitioner specified in Section
1842(b)(18)(C) of the Act or other person that
knowingly and willfully bills or collects for any
services by the practitioners on other than an
assignment-related basis. (Penalties are assessed in the same manner as 42 U.S.C.
1395u(j)(2)(B), which is assessed according to
1320a–7a(a)).
Penalty for any physician who charges more
than 125% for a non-participating referral.
(Penalties are assessed in the same manner
as 42 U.S.C. 1320a–7a(a)).
Penalty for any physician who knowingly and
willfully presents or causes to be presented a
claim for bill for an assistant at a cataract surgery performed on or after March 1, 1987, for
which payment may not be made because of
section 1862(a)(15). (Penalties are assessed
in the same manner as 42 U.S.C.
1395u(j)(2)(B), which is assessed according to
1320a–7a(a)).
Penalty for any nonparticipating physician who
does not accept payment on an assignmentrelated basis and who knowingly and willfully
fails to refund on a timely basis any amounts
collected for services that are not reasonable
or medically necessary or are of poor quality
under 1842(l)(1)(A). (Penalties are assessed in
the same manner as 42 U.S.C. 1395u(j)(2)(B),
which is assessed according to 1320a–7a(a)).
Penalty for any nonparticipating physician charging more than $500 who does not accept payment for an elective surgical procedure on an
assignment related basis and who knowingly
and willfully fails to disclose the required information regarding charges and coinsurance
amounts and fails to refund on a timely basis
any amount collected for the procedure in excess of the charges recognized and approved
by the Medicare program. (Penalties are assessed in the same manner as 42 U.S.C.
1395u(j)(2)(B), which is assessed according to
1320a–7a(a)).
Penalty for any physician who knowingly, willfully, and repeatedly bills one or more beneficiaries for purchased diagnostic tests any
amount other than the payment amount specified by the Act. (Penalties are assessed in the
same manner as 42 U.S.C. 1395u(j)(2)(B),
which is assessed according to 1320a–7a(a)).
Penalty for any practitioner specified in Section
1842(b)(18)(C) of the Act or other person that
knowingly and willfully bills or collects for any
services pertaining to drugs or biologics by the
practitioners on other than an assignment-related basis. (Penalties are assessed in the
same manner as 42 U.S.C. 1395u(b)(18)(B)
and 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).
42 CFR 402.1(c)(31),
402.105(d)(3).
CMS ...
1395m(l)(6) ..........................
42 CFR 402.1(c)(32),
402.105(d)(4).
CMS ...
1395u(b)(18)(B) ..................
42 CFR 402.1(c)(11),
402.105(d)(2)(viii).
CMS ...
1395u(j)(2)(B) ......................
42 CFR 402.1(c) ...........
CMS ...
1395u(k) ..............................
42 CFR 402.1(c)(12),
402.105(d)(2)(ix).
CMS ...
1395u(l)(3) ...........................
42 CFR 402.1(c)(13),
402.105(d)(2)(x).
CMS ...
1395u(m)(3) ........................
42 CFR 402.1(c)(14),
402.105(d)(2)(xi).
CMS ...
1395u(n)(3) .........................
42 CFR 402.1(c)(15),
402.105(d)(2)(xii).
CMS ...
1395u(o)(3)(B) .....................
asabaliauskas on DSK3SPTVN1PROD with RULES
1395m(k)(6) .........................
42 CFR 414.707(b) .......
CMS ...
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Fmt 4700
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E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
2016
15,024
15,270
9185
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
Description 2
CFR 1
HHS
agency
1395u(p)(3)(A) .....................
.......................................
CMS ...
1395w–3a(d)(4)(A) ..............
42 CFR 414.806 ...........
CMS ...
1395w–4(g)(1)(B) ................
42 CFR 402.1(c)(17),
402.105(d)(2)(xiii).
CMS ...
1395w–4(g)(3)(B) ................
42 CFR 402.1(c)(18),
402.105(d)(2)(xiv).
CMS ...
1395w–27(g)(3)(A);
1857(g)(3).
42 CFR 422.760(b); 42
CFR 423.760(b).
CMS ...
1395w–27(g)(3)(B);
1857(g)(3).
.......................................
CMS ...
1395w–27(g)(3)(D); 1857
(g)(3).
.......................................
CMS ...
1395y(b)(3)(C) .....................
42 CFR 411.103(b) .......
CMS ...
1395y(b)(5)(C)(ii) .................
42 CFR 402.1(c)(20), 42
CFR 402.105(b)(2).
CMS ...
1395y(b)(6)(B) .....................
42 CFR 402.1(c)(21),
402.105(a).
CMS ...
1395y(b)(7)(B)(i) .................
.......................................
CMS ...
1395y(b)(8)(E) .....................
.......................................
CMS ...
1395nn(g)(5) .......................
42 CFR 411.361 ...........
CMS ...
Penalty for any physician or practitioner who
knowingly and willfully fails promptly to provide
the appropriate diagnosis codes upon CMS or
Medicare administrative contractor request for
payment or bill not submitted on an assignment-related basis.
Penalty for a pharmaceutical manufacturer’s misrepresentation of average sales price of a
drug, or biologic.
Penalty for any nonparticipating physician, supplier, or other person that furnishes physician
services not on an assignment-related basis
who either knowingly and willfully bills or collects in excess of the statutorily-defined limiting charge or fails to make a timely refund or
adjustment. (Penalties are assessed in the
same manner as 42 U.S.C. 1395u(j)(2)(B),
which is assessed according to 1320a–7a(a)).
Penalty for any person that knowingly and willfully bills for statutorily defined State-plan approved physicians’ services on any other basis
than an assignment-related basis for a Medicare/Medicaid dual eligible beneficiary. (Penalties are assessed in the same manner as 42
U.S.C. 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).
Penalty for each termination determination the
Secretary makes that is the result of actions
by a Medicare Advantage organization or Part
D sponsor that has adversely affected an individual covered under the organization’s contract.
Penalty for each week beginning after the initiation of civil money penalty procedures by the
Secretary because a Medicare Advantage organization or Part D sponsor has failed to
carry out a contract, or has carried out a contract inconsistently with regulations.
Penalty for a Medicare Advantage organization’s
or Part D sponsor’s early termination of its
contract.
Penalty for an employer or other entity to offer
any financial or other incentive for an individual entitled to benefits not to enroll under a
group health plan or large group health plan
which would be a primary plan.
Penalty for any non-governmental employer that,
before October 1, 1998, willfully or repeatedly
failed to provide timely and accurate information requested relating to an employee’s group
health insurance coverage.
Penalty for any entity that knowingly, willfully,
and repeatedly fails to complete a claim form
relating to the availability of other health benefits in accordance with statute or provides inaccurate information relating to such on the
claim form.
Penalty for any entity serving as insurer, third
party administrator, or fiduciary for a group
health plan that fails to provide information
that identifies situations where the group
health plan is or was a primary plan to Medicare to the HHS Secretary.
Penalty for any non-group health plan that fails
to identify claimants who are Medicare beneficiaries and provide information to the HHS
Secretary to coordinate benefits and pursue
any applicable recovery claim.
Penalty for any person that fails to report information required by HHS under Section 1877(f)
concerning ownership, investment, and compensation arrangements.
asabaliauskas on DSK3SPTVN1PROD with RULES
U.S.C.
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E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
3,957
4,022
2016
12,856
13,066
2016
15,024
15,270
2016
15,024
15,270
2016
36,794
37,396
2016
14,718
14,959
2016
136,689
138,925
2016
8,908
9,054
2016
1,450
1,474
2016
3,182
3,234
2016
1,138
1,157
2016
1,138
1,157
2016
18,936
19,246
9186
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
CFR 1
U.S.C.
HHS
agency
Description 2
Penalty for any durable medical equipment supplier, including a supplier of prosthetic devices,
prosthetics, orthotics, or supplies, that knowingly and willfully fails to make refunds in a
timely manner to Medicare beneficiaries under
certain conditions. (42 U.S.C. 1395(m)(18)
sanctions apply here in the same manner,
which is under 1395u(j)(2) and 1320a–7a(a)).
Penalty for any person that issues a Medicare
supplemental policy that has not been approved by the State regulatory program or
does not meet Federal standards after a statutorily defined effective date.
Penalty for someone other than issuer that sells
or issues a Medicare supplemental policy to
beneficiary without a disclosure statement.
Penalty for an issuer that sells or issues a Medicare supplemental policy without disclosure
statement.
Penalty for someone other than issuer that sells
or issues a Medicare supplemental policy without acknowledgement form.
Penalty for issuer that sells or issues a Medicare
supplemental policy without an acknowledgement form.
Penalty for any person that sells or issues Medicare supplemental polices after a given date
that fail to conform to the NAIC or Federal
standards established by statute.
Penalty for any person that sells or issues Medicare supplemental polices after a given date
that fail to conform to the NAIC or Federal
standards established by statute.
Penalty for any person that sells a Medicare
supplemental policy and fails to make available for sale the core group of basic benefits
when selling other Medicare supplemental
policies with additional benefits or fails to provide the individual, before selling the policy, an
outline of coverage describing benefits.
Penalty for any person that sells a Medicare
supplemental policy and fails to make available for sale the core group of basic benefits
when selling other Medicare supplemental
policies with additional benefits or fails to provide the individual, before selling the policy, an
outline of coverage describing benefits.
Penalty for any person that fails to suspend the
policy of a policyholder made eligible for medical assistance or automatically reinstates the
policy of a policyholder who has lost eligibility
for medical assistance, under certain circumstances.
Penalty for any person that fails to provide refunds or credits as required by section
1882(r)(1)(B).
Penalty for any issuer of a Medicare supplemental policy that does not waive listed time
periods if they were already satisfied under a
proceeding Medicare supplemental policy, or
denies a policy, or conditions the issuances or
effectiveness of the policy, or discriminates in
the pricing of the policy base on health status
or other specified criteria.
Penalty for any issuer of a Medicare supplemental policy that fails to fulfill listed responsibilities.
Penalty someone other than issuer who sells,
issues, or renews a medigap Rx policy to an
individual who is a Part D enrollee.
Penalty for an issuer who sells, issues, or renews a Medigap Rx policy who is a Part D enrollee.
Penalty for any individual who notifies or causes
to be notified a home health agency of the
time or date on which a survey of such agency
is to be conducted.
1395pp(h) ............................
42 CFR 402.1(c)(23),
402.105(d)(2)(xv).
CMS ...
1395ss(a)(2) ........................
42 CFR 402.1(c)(24),
405.105(f)(1).
CMS ...
1395ss(d)(3)(A)(vi) (II) ........
.......................................
CMS ...
1395ss(d)(3)(B)(iv) ..............
1395ss(p)(8) ........................
.......................................
CMS ...
42 CFR 402.1(c)(25),
402.105(e).
CMS ...
42 CFR 402.1(c)(25),
405.105(f)(2)
CMS ...
42 CFR 402.1(c)(26),
402.105(e).
CMS ...
42 CFR 402.1(c)(26),
405.105(f)(3), (4)
............
1395ss(q)(5)(C) ...................
42 CFR 402.1(c)(27),
405.105(f)(5).
CMS ...
1395ss(r)(6)(A) ....................
42 CFR 402.1(c)(28),
405.105(f)(6).
CMS ...
1395ss(s)(4) ........................
42 CFR 402.1(c)(29),
405.105(c).
CMS ...
1395ss(t)(2) .........................
42 CFR 402.1(c)(30),
405.105(f)(7).
CMS ...
1395ss(v)(4)(A) ...................
.......................................
CMS ...
asabaliauskas on DSK3SPTVN1PROD with RULES
1395ss(p)(9)(C) ...................
1395bbb(c)(1) .....................
VerDate Sep<11>2014
42 CFR 488.725(c) .......
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E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
15,024
15,270
2016
51,569
52,413
2016
26,723
27,160
2016
44,539
45,268
2016
26,723
27,160
2016
44,539
45,268
2016
26,723
27,160
2016
44,539
45,268
2016
26,723
27,160
2016
44,539
45,268
2016
44,539
45,268
2016
44,539
45,268
2016
18,908
19,217
2016
44,539
45,268
2016
19,284
19,599
2016
32,140
32,666
2016
4,126
4,194
9187
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
CFR 1
U.S.C.
1395bbb(f)(2)(A)(i) ..............
42 CFR
488.845(b)(2)(iii) 42
CFR 488.845(b)(3)–
(6); and 42 CFR
488.845(d)(1)(ii).
42 CFR 488.845(b)(3)
HHS
agency
Description 2
CMS ...
Maximum daily penalty amount for each day a
home health agency is not in compliance with
statutory requirements.
............
Penalty per day for home health agency’s noncompliance (Upper Range):
Minimum ...............................................................
Maximum ..............................................................
Penalty for a home health agency’s deficiency or
deficiencies that cause immediate jeopardy
and result in actual harm.
Penalty for a home health agency’s deficiency or
deficiencies that cause immediate jeopardy
and result in potential for harm.
Penalty for an isolated incident of noncompliance
in violation of established HHA policy.
Penalty for a repeat and/or condition-level deficiency that does not constitute immediate
jeopardy, but is directly related to poor quality
patient care outcomes (Lower Range):
Minimum ...............................................................
Maximum ..............................................................
Penalty for a repeat and/or condition-level deficiency that does not constitute immediate
jeopardy and that is related predominately to
structure or process-oriented conditions
(Lower Range):
Minimum ...............................................................
Maximum ..............................................................
Penalty imposed for instance of noncompliance
that may be assessed for one or more singular
events of condition-level noncompliance that
are identified and where the noncompliance
was corrected during the onsite survey:
Minimum ...............................................................
Maximum ..............................................................
Penalty for each day of noncompliance (Maximum).
Penalty for each day of noncompliance (Maximum).
Penalty for PACE organization’s practice that
would reasonably be expected to have the effect of denying or discouraging enrollment:
Minimum ...............................................................
Maximum ..............................................................
Penalty for a PACE organization that charges
excessive premiums.
Penalty for a PACE organization misrepresenting
or falsifying information to CMS, the State, or
an individual or other entity.
Penalty for each determination the CMS makes
that the PACE organization has failed to provide medically necessary items and services
of the failure has adversely affected (or has
the substantial likelihood of adversely affecting) a PACE participant.
Penalty for involuntarily disenrolling a participant.
Penalty for discriminating or discouraging enrollment or disenrollment of participants on the
basis of an individual’s health status or need
for health care services.
Penalty per day for a nursing facility’s failure to
meet a Category 2 Certification:
Minimum ...............................................................
Maximum ..............................................................
Penalty per instance for a nursing facility’s failure
to meet Category 2 certification:
Minimum ...............................................................
Maximum ..............................................................
Penalty per day for a nursing facility’s failure to
meet Category 3 certification:
Minimum ...............................................................
Maximum ..............................................................
Penalty per instance for a nursing facility’s failure
to meet Category 3 certification:
Minimum ...............................................................
42 CFR 488.845(b)(3)(i)
............
42 CFR 488.845(b)(3)(ii)
............
42 CFR
488.845(b)(3)(iii)
42 CFR 488.845(b)(4)
............
42 CFR 488.845(b)(5)
42 CFR 488.845(b)(6)
............
............
............
42 CFR 488.845(d)(1)(ii)
1396b(m)(5)(B) ....................
asabaliauskas on DSK3SPTVN1PROD with RULES
1396r(h)(3)(C)(ii)(I) ..............
............
42 CFR 460.46 .............
CMS ...
42 CFR
488.408(d)(1)(iii).
42 CFR 488.408(d)
(1)(iv)
42 CFR 488.408(e)
(1)(iii)
42 CFR 488.408(e)
(1)(iv)
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CMS ...
CMS ...
CMS ...
CMS ...
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E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
19,787
20,111
2016
2016
2016
16,819
19,787
19,787
17,094
20,111
20,111
2016
17,808
18,099
2016
16,819
17,094
2016
2016
2,968
16,819
3,017
17,094
2016
2016
989
7,915
1,005
8,044
2016
2016
2016
1,979
19,787
19,787
2,011
20,111
20,111
2016
19,787
20,111
2016
2016
2016
22,077
147,177
36,794
22,438
149,585
37,396
2016
147,177
149,585
2016
36,794
37,396
2016
2016
36,794
36,794
37,396
37,396
2016
2016
103
6,188
105
6,289
2016
2016
2,063
20,628
2,097
20,965
2016
2016
6,291
20,628
6,394
20,965
2016
2,063
2,097
9188
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Date of last
penalty figure or adjustment 3
Citation
CFR 1
HHS
agency
42 CFR 488.408(e)(2)(ii)
CMS ...
U.S.C.
42 CFR 488.438(a)(1)(i)
42 CFR 488.438(a)(1)(ii)
42 CFR 488.438(a)(2)
CMS ...
CMS ...
CMS ...
1396r(f)(2)(B)(iii)(I)(c) ..........
42 CFR 483.151(b)(2)
(iv) and (b)(3)(iii).
CMS ...
1396r(h)(3)(C)(ii)(I) ..............
42 CFR 483.151(c)(2) ...
CMS ...
1396t(j)(2)(C) .......................
.......................................
CMS ...
1396u–2(e)(2)(A)(i) .............
1396u–2(e)(2)(A)(ii) .............
42 CFR 438.704 ...........
42 CFR 438.704 ...........
CMS ...
CMS ...
42 CFR 438.704 ...........
CMS ...
1396u(h)(2) .........................
42 CFR Part 441, Subpart I.
CMS ...
1396w–2(c)(1) .....................
asabaliauskas on DSK3SPTVN1PROD with RULES
1396u–2(e)(2)(A)(iv) ............
.......................................
CMS ...
18041(c)(2) ..........................
45 CFR 150.315; 45
CFR 156.805(c).
CMS ...
18081(h)(1)(A)(i)(II) .............
42 CFR 155.285 ...........
CMS ...
18081(h)(1)(B) .....................
42 CFR 155.285 ...........
CMS ...
VerDate Sep<11>2014
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Description 2
Maximum ..............................................................
Penalty per instance for a nursing facility’s failure
to meet Category 3 certification, which results
in immediate jeopardy:
Minimum ...............................................................
Maximum ..............................................................
Penalty per day for nursing facility’s failure to
meet certification (Upper Range):
Minimum ...............................................................
Maximum ..............................................................
Penalty per day for nursing facility’s failure to
meet certification (Lower Range):
Minimum ...............................................................
Maximum ..............................................................
Penalty per instance for nursing facility’s failure
to meet certification:
Minimum ...............................................................
Maximum ..............................................................
Grounds to prohibit approval of Nurse Aide
Training Program—if assessed a penalty in
1819(h)(2)(B)(i) or 1919(h)(2)(A)(ii) of ‘‘not less
than $5,000’’ [Not CMP authority, but a specific CMP amount (CMP at this level) that is
the triggering condition for disapproval].
Grounds to waive disapproval of nurse aide
training program—reference to disapproval
based on imposition of CMP ‘‘not less than
$5,000’’ [Not CMP authority but CMP imposition at this level determines eligibility to seek
waiver of disapproval of nurse aide training
program].
Penalty for each day of noncompliance for a
home or community care provider that no
longer meets the minimum requirements for
home and community care:
Minimum ...............................................................
Maximum ..............................................................
Penalty for a Medicaid managed care organization that fails substantially to provide medically
necessary items and services.
Penalty for Medicaid managed care organization
that imposes premiums or charges on enrollees in excess of the premiums or charges permitted.
Penalty for a Medicaid managed care organization that misrepresents or falsifies information
to another individual or entity.
Penalty for a Medicaid managed care organization that fails to comply with the applicable
statutory requirements for such organizations.
Penalty for a Medicaid managed care organization that misrepresents or falsifies information
to the HHS Secretary.
Penalty for Medicaid managed care organization
that acts to discriminate among enrollees on
the basis of their health status.
Penalty for each individual that does not enroll
as a result of a Medicaid managed care organization that acts to discriminate among enrollees on the basis of their health status.
Penalty for a provider not meeting one of the requirements relating to the protection of the
health, safety, and welfare of individuals receiving community supported living arrangements services.
Penalty for disclosing information related to eligibility determinations for medical assistance
programs.
Failure to comply with requirements of the Public
Health Services Act; Penalty for violations of
rules or standards of behavior associated with
issuer participation in the Federally-facilitated
Exchange. (42 U.S.C. 300gg–22(b)(2)(C)).
Penalty for providing false information on Exchange application.
Penalty for knowingly or willfully providing false
information on Exchange application.
Fmt 4700
Sfmt 4700
E:\FR\FM\03FER1.SGM
03FER1
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
2016
20,628
20,965
2016
2016
2,063
20,628
2,097
20,965
2016
2016
6,291
20,628
6,394
20,965
2016
2016
103
6,188
105
6,289
2016
2016
2016
2,063
20,628
10,314
2,097
20,965
10,483
2016
10,314
10,483
2016
2016
2016
2
17,816
36,794
2
18,107
37,396
2016
36,794
37,396
2016
36,794
37,396
2016
36,794
37,396
2016
147,177
149,585
2016
147,177
149,585
2016
22,077
22,438
2016
20,628
20,965
2016
11,002
11,182
2016
150
152
2016
27,186
27,631
2016
271,862
276,310
9189
Federal Register / Vol. 82, No. 22 / Friday, February 3, 2017 / Rules and Regulations
CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS AGENCIES AND PENALTY AMOUNTS—Continued
[Effective February 3, 2017]
Citation
Date of last
penalty figure or adjustment 3
2016
Maximum
adjusted
penalty ($)
2017
Maximum
adjusted
penalty ($) 4
Description 2
CFR 1
HHS
agency
18081(h)(2) .........................
42 CFR 155.260 ...........
CMS ...
Penalty for knowingly or willfully disclosing protected information from Exchange.
2016
27,186
27,631
31 U.S.C.
1352 ....................................
45 CFR 93.400(e) .........
HHS ...
Penalty for the first time an individual makes an
expenditure prohibited by regulations regarding lobbying disclosure, absent aggravating
circumstances.
Penalty for second and subsequent offenses by
individuals who make an expenditure prohibited by regulations regarding lobbying disclosure:
Minimum ...............................................................
Maximum ..............................................................
Penalty for the first time an individual fails to file
or amend a lobbying disclosure form, absent
aggravating circumstances.
Penalty for second and subsequent offenses by
individuals who fail to file or amend a lobbying
disclosure form, absent aggravating circumstances:
Minimum ...............................................................
Maximum ..............................................................
Penalty for failure to provide certification regarding lobbying in the award documents for all
sub-awards of all tiers:
Minimum ...............................................................
Maximum ..............................................................
Penalty for failure to provide statement regarding
lobbying for loan guarantee and loan insurance transactions:
Minimum ...............................................................
Maximum ..............................................................
Penalty against any individual who—with knowledge or reason to know—makes, presents or
submits a false, fictitious or fraudulent claim to
the Department.
Penalty against any individual who—with knowledge or reason to know—makes, presents or
submits a false, fictitious or fraudulent claim to
the Department.
2016
18,936
19,246
2016
2016
2016
18,936
189,361
18,936
19,246
192,459
19,246
2016
2016
18,936
189,361
19,246
192,459
2016
2016
18,936
189,361
19,246
192,459
2016
2016
2016
18,936
189,361
9,894
19,246
192,459
10,056
2016
9,894
10,056
U.S.C.
.........................................
3801–3812 ..........................
45 CFR Part 93, Appendix A
HHS ...
45 CFR 79.3(a)(1)(iv) ....
HHS ...
45 CFR 79.3(b)(1)(ii)
............
1 Some
HHS components have not promulgated regulations regarding their civil monetary penalty-specific statutory authorities.
2 The description is not intended to be a comprehensive explanation of the underlying violation; the statute and corresponding regulation, if applicable should be
consulted.
3 Statutory or Inflation Act Adjustment.
3 Statutory or Inflation Act Adjustment.
4 The cost of living multiplier for 2017, based on the Consumer Price Index (CPI–U) for the month of October 2016, not seasonally adjusted, is 1.01636, as indicated in OMB Memorandum M–17–11, ‘‘Implementation of the 2017 annual adjustment pursuant to the Federal Civil Penalties Adjustment Act Improvements Act of
2015’’ (December 16, 2016).
Dated: January 30, 2017.
Norris Cochran,
Acting Secretary, Department of Health and
Human Services.
[FR Doc. 2017–02300 Filed 2–2–17; 8:45 am]
BILLING CODE 4150–24–P
ACTION:
National Oceanic and Atmospheric
Administration
SUMMARY:
50 CFR Part 622
[Docket No. 101206604–1758–02]
asabaliauskas on DSK3SPTVN1PROD with RULES
RIN 0648–XF179
Fisheries of the Caribbean, Gulf of
Mexico, and South Atlantic; Coastal
Migratory Pelagic Resources of the
Gulf of Mexico and South Atlantic;
Commercial Trip Limit Reduction for
Spanish Mackerel
National Marine Fisheries
Service (NMFS), National Oceanic and
Atmospheric Administration (NOAA),
Commerce.
AGENCY:
VerDate Sep<11>2014
21:08 Feb 02, 2017
Jkt 241001
Temporary rule; trip limit
reduction.
DEPARTMENT OF COMMERCE
PO 00000
Frm 00063
Fmt 4700
Sfmt 4700
NMFS reduces the
commercial trip limit of Atlantic
migratory group Spanish mackerel in or
from the exclusive economic zone (EEZ)
in the Atlantic migratory group southern
zone to 1,500 lb (680 kg), round weight,
per day. This trip limit reduction is
necessary to maximize the
socioeconomic benefits of the quota.
DATES: Effective 6:00 a.m., local time,
February 6, 2017, until 12:01 a.m., local
time, March 1, 2017.
FOR FURTHER INFORMATION CONTACT:
Mary Vara, NMFS Southeast Regional
Office, telephone: 727–824–5305, or
email: mary.vara@noaa.gov.
SUPPLEMENTARY INFORMATION: The
fishery for coastal migratory pelagic fish
E:\FR\FM\03FER1.SGM
03FER1
Agencies
[Federal Register Volume 82, Number 22 (Friday, February 3, 2017)]
[Rules and Regulations]
[Pages 9174-9189]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-02300]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
45 CFR Part 102
RIN 0991-AC0
Annual Civil Monetary Penalties Inflation Adjustment
AGENCY: Department of Health and Human Services, Office of the
Assistant Secretary for Financial Resources.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Health and Human Services (HHS) is updating
its regulations to reflect required annual inflation-related increases
to the civil monetary penalties in its regulations, pursuant to the
Federal Civil Penalties Inflation Adjustment Act Improvement Act of
2015.
DATES: This rule is effective February 3, 2017.
FOR FURTHER INFORMATION CONTACT: Andrea Brandon, Deputy Assistant
Secretary for Grants and Acquisitions, Office of the Assistant
Secretary for Financial Resources, Room 514-G, Hubert Humphrey
Building, 200 Independence Avenue SW., Washington DC 20201; 202-690-
6396; FAX 202-690-5405.
SUPPLEMENTARY INFORMATION:
I. Background
The Federal Civil Penalties Inflation Adjustment Act Improvements
Act of 2015 (Sec. 701 of Pub. L. 114-74) (the ``Act''), which is
intended to improve the effectiveness of civil monetary penalties
(``CMPs'') and to maintain the deterrent effect of such penalties,
requires agencies to adjust the civil monetary penalties for inflation
annually.
The Department of Health and Human Services (HHS) lists the civil
monetary penalties and the penalty amounts administered by all of its
agencies in tabular form in 45 CFR 102.3.
II. Calculation of Adjustment
The annual inflation adjustment for each applicable civil monetary
penalty is determined using the percent increase in the Consumer Price
Index for all Urban Consumers (CPI-U) for the month of October of the
year in which the amount of each civil penalty was most recently
established or modified. In the December 16, 2016, OMB Memorandum for
the Heads of Executive Agencies and Departments, M-17-11,
Implementation of the 2017 annual adjustment pursuant to the Federal
Civil Penalties Inflation Adjustment Act Improvements Act of 2015, OMB
published the multiplier for the required annual adjustment. The cost-
of-living adjustment multiplier for 2017, based on the CPI-U for the
month of October 2016, not seasonally adjusted, is 1.01636.
Using the 2017 multiplier, HHS adjusted all its applicable monetary
penalties in 45 CFR 102.3.
III. Statutory and Executive Order Reviews
The 2015 Act Requires Federal Agencies To Publish Annual Penalty
Inflation Adjustments Notwithstanding Section 553 of the Administrative
Procedure Act
A. Executive Order 12866: Regulatory Planning and Review and Executive
Order 13563: Improving Regulation and Regulatory Review
Section 4 of the 2015 Act directs federal agencies to publish
annual adjustments no later than January 15, 2017. In accordance with
section 553 of the Administrative Procedure Act (APA), most rules are
subject to notice and comment and are effective no earlier than 30 days
after publication in the Federal Register. However, Section 4(b)(2) of
the 2015 Act provides that each agency shall make the annual inflation
adjustments ``notwithstanding section 553'' of the APA. According to
OMB's Memorandum M-17-11, Memorandum of the Heads of Executive
Departments and Agencies (December 16, 2016) the phrase
``notwithstanding section 553'' means that ``the public procedure the
APA generally provides--notice, an opportunity for comment, and a delay
in effective date--is not required for agencies to issue regulations
implementing the annual adjustment.'' Consistent with the language of
the 2015 Act and OMB's implementation guidance, this rule is not
subject to notice and an opportunity for public comment and will be
effective immediately upon publication.
B. Review Under Procedural Statutes and Executive Orders
Pursuant to OMB Memorandum for the Heads of Executive Departments
and Agencies, M-17-11, HHS has determined that making technical changes
to the amount of civil monetary penalties in its regulations does not
trigger any requirements under procedural statutes and Executive Orders
that govern rulemaking procedures.
IV. Effective Date
This rule is effective February 3, 2017. The adjusted civil penalty
amounts apply to civil penalties assessed on or after February 3, 2017,
when the
[[Page 9175]]
violation occurred after November 2, 2015. If the violation occurred
prior to November 2, 2015, or a penalty was assessed prior to September
6, 2016, the pre-adjustment civil penalty amounts in effect prior to
September 6, 2016 will apply.
List of Subjects in 45 CFR Part 102
Administrative practice and procedure, Penalties.
For reasons discussed in the preamble, the Department of Health and
Human Services amends subtitle A, title 45 of the Code of Federal
Regulations as follows:
PART 102--ADJUSTMENT OF CIVIL MONETARY PENALTIES FOR INFLATION
0
1. The authority citation for part 102 continues to read as follows:
Authority: Public Law 101-410, Sec. 701 of Public Law 114-74,
31 U.S.C. 3801-3812.
0
2. Amend Sec. 102.3 by revising the table to read as follows:
Sec. 102.3 Penalty adjustment and table.
* * * * *
Civil Monetary Penalty Authorities Administered by HHS Agencies and Penalty Amounts
[Effective February 3, 2017]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Citation Date of
------------------------------------------------------------------- last 2016 2017
penalty Maximum Maximum
HHS agency Description \2\ figure or adjusted adjusted
U.S.C. CFR \1\ adjustment penalty ($) penalty ($)
\3\ \4\
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 U.S.C.:
333(b)(2)(A)......................... ....................... FDA............. Penalty for violations 2016 98,935 100,554
related to drug samples
resulting in a conviction
of any representative of
manufacturer or
distributor in any 10-year
period.
333(b)(2)(B)......................... ....................... FDA............. Penalty for violation 2016 1,978,690 2,011,061
related to drug samples
resulting in a conviction
of any representative of
manufacturer or
distributor after the
second conviction in any
10-yr period.
333(b)(3)............................ ....................... FDA............. Penalty for failure to make 2016 197,869 201,106
a report required by 21
U.S.C. 353(d)(3)(E)
relating to drug samples.
333(f)(1)(A)......................... ....................... FDA............. Penalty for any person who 2016 26,723 27,160
violates a requirement
related to devices for
each such violation.
Penalty for aggregate of 2016 1,781,560 1,810,706
all violations related to
devices in a single
proceeding.
333(f)(2)(A)......................... ....................... FDA............. Penalty for any individual 2016 75,123 76,352
who introduces or delivers
for introduction into
interstate commerce food
that is adulterated per 21
U.S.C. 342(a)(2)(B) or any
individual who does not
comply with a recall order
under 21 U.S.C. 350l.
Penalty in the case of any 2016 375,613 381,758
other person other than an
individual) for such
introduction or delivery
of adulterated food.
Penalty for aggregate of 2016 751,225 763,515
all such violations
related to adulterated
food adjudicated in a
single proceeding.
333(f)(3)(A)......................... ....................... FDA............. Penalty for all violations 2016 11,383 11,569
adjudicated in a single
proceeding for any person
who violates 21 U.S.C.
331(jj)(1) by failing to
submit the certification
required by 42 U.S.C.
282(j)(5)(B) or knowingly
submitting a false
certification; by failing
to submit clinical trial
information under 42
U.S.C. 282(j); or by
submitting clinical trial
information under 42
U.S.C. 282(j) that is
false or misleading in any
particular under 42 U.S.C.
282(j)(5)(D).
333(f)(3)(B)......................... ....................... FDA............. Penalty for each day any 2016 11,383 11,569
above violation is not
corrected after a 30-day
period following
notification until the
violation is corrected.
333(f)(4)(A)(i)...................... ....................... FDA............. Penalty for any responsible 2016 284,583 289,239
person that violates a
requirement of 21 U.S.C.
355(o) (post-marketing
studies, clinical trials,
labeling), 21 U.S.C.
355(p) (risk evaluation
and mitigation (REMS)), or
21 U.S.C. 355-1 (REMS).
Penalty for aggregate of 2016 1,138,330 1,156,953
all such above violations
in a single proceeding.
333(f)(4)(A)(ii)..................... ....................... FDA............. Penalty for REMS violation 2016 284,583 289,239
that continues after
written notice to the
responsible person for the
first 30-day period (or
any portion thereof) the
responsible person
continues to be in
violation.
Penalty for REMS violation 2016 1,138,330 1,156,953
that continues after
written notice to
responsible person doubles
for every 30-day period
thereafter the violation
continues, but may not
exceed penalty amount for
any 30-day period.
Penalty for aggregate of 2016 11,383,300 11,569,531
all such above violations
adjudicated in a single
proceeding.
333(f)(9)(A)......................... ....................... FDA............. Penalty for any person who 2016 16,503 16,773
violates a requirement
which relates to tobacco
products for each such
violation.
[[Page 9176]]
Penalty for aggregate of 2016 1,100,200 1,118,199
all such violations of
tobacco product
requirement adjudicated in
a single proceeding.
333(f)(9)(B)(i)(I)................... ....................... FDA............. Penalty per violation 2016 275,050 279,550
related to violations of
tobacco requirements.
Penalty for aggregate of 2016 1,100,200 1,118,199
all such violations of
tobacco product
requirements adjudicated
in a single proceeding.
333(f)(9)(B)(i)(II).................. ....................... FDA............. Penalty in the case of a 2016 275,050 279,550
violation of tobacco
product requirements that
continues after written
notice to such person, for
the first 30-day period
(or any portion thereof)
the person continues to be
in violation.
Penalty for violation of 2016 1,100,200 1,118,199
tobacco product
requirements that
continues after written
notice to such person
shall double for every 30-
day period thereafter the
violation continues, but
may not exceed penalty
amount for any 30-day
period.
Penalty for aggregate of 2016 11,002,000 11,181,993
all such violations
related to tobacco product
requirements adjudicated
in a single proceeding.
333(f)(9)(B)(ii)(I).................. ....................... FDA............. Penalty for any person who 2016 275,050 279,550
either does not conduct
post-market surveillance
and studies to determine
impact of a modified risk
tobacco product for which
the HHS Secretary has
provided them an order to
sell, or who does not
submit a protocol to the
HHS Secretary after being
notified of a requirement
to conduct post-market
surveillance of such
tobacco products.
Penalty for aggregate of 2016 1,100,200 1,118,199
for all such above
violations adjudicated in
a single proceeding.
333(f)(9)(B)(ii)(II)................. ....................... FDA............. Penalty for violation of 2016 275,050 279,550
modified risk tobacco
product post-market
surveillance that
continues after written
notice to such person for
the first 30-day period
(or any portion thereof)
that the person continues
to be in violation.
Penalty for post-notice 2016 1,100,200 1,118,199
violation of modified risk
tobacco product post-
market surveillance shall
double for every 30-day
period thereafter that the
tobacco product
requirement violation
continues for any 30-day
period, but may not exceed
penalty amount for any 30-
day period.
Penalty for aggregate above 2016 11,002,000 11,181,993
tobacco product
requirement violations
adjudicated in a single
proceeding.
333(g)(1)............................ ....................... FDA............. Penalty for any person who 2016 284,583 289,239
disseminates or causes
another party to
disseminate a direct-to-
consumer advertisement
that is false or
misleading for the first
such violation in any 3-
year period.
Penalty for each subsequent 2016 569,165 578,477
above violation in any 3-
year period.
333 note............................. ....................... FDA............. Penalty to be applied for 2016 275 279
violations of restrictions
on the sale or
distribution of tobacco
products promulgated under
21 U.S.C. 387f(d) (e.g.,
violations of regulations
in 21 CFR part 1140) with
respect to a retailer with
an approved training
program in the case of a
second regulation
violation within a 12-
month period.
Penalty in the case of a 2016 550 559
third tobacco product
regulation violation
within a 24-month period.
Penalty in the case of a 2016 2,200 2,236
fourth tobacco product
regulation violation
within a 24-month period.
Penalty in the case of a 2016 5,501 5,591
fifth tobacco product
regulation violation
within a 36-month period.
Penalty in the case of a 2016 11,002 11,182
sixth or subsequent
tobacco product regulation
violation within a 48-
month period as determined
on a case-by-case basis.
[[Page 9177]]
Penalty to be applied for 2016 275 279
violations of restrictions
on the sale or
distribution of tobacco
products promulgated under
21 U.S.C. 387f(d) (e.g.,
violations of regulations
in 21 CFR part 1140) with
respect to a retailer that
does not have an approved
training program in the
case of the first
regulation violation.
Penalty in the case of a 2016 550 559
second tobacco product
regulation violation
within a 12-month period.
Penalty in the case of a 2016 1,100 1,118
third tobacco product
regulation violation
within a 24-month period.
Penalty in the case of a 2016 2,200 2,236
fourth tobacco product
regulation violation
within a 24-month period.
Penalty in the case of a 2016 5,501 5,591
fifth tobacco product
regulation violation
within a 36-month period.
Penalty in the case of a 2016 11,002 11,182
sixth or subsequent
tobacco product regulation
violation within a 48-
month period as determined
on a case-by-case basis.
335b(a).............................. ....................... FDA............. Penalty for each violation 2016 419,320 426,180
for any individual who
made a false statement or
misrepresentation of a
material fact, bribed,
destroyed, altered,
removed, or secreted, or
procured the destruction,
alteration, removal, or
secretion of, any material
document, failed to
disclose a material fact,
obstructed an
investigation, employed a
consultant who was
debarred, debarred
individual provided
consultant services.
Penalty in the case of any 2016 1,677,280 1,704,720
other person (other than
an individual) per above
violation.
360pp(b)(1).......................... ....................... FDA............. Penalty for any person who 2016 2,750 2,795
violates any such
requirements for
electronic products, with
each unlawful act or
omission constituting a
separate violation.
Penalty imposed for any 2016 937,500 952,838
related series of
violations of requirements
relating to electronic
products.
42 U.S.C.
262(d)............................... ....................... FDA............. Penalty per day for 2016 215,628 219,156
violation of order of
recall of biological
product presenting
imminent or substantial
hazard.
263b(h)(3)........................... ....................... FDA............. Penalty for failure to 2016 16,773 17,047
obtain a mammography
certificate as required.
300aa-28(b)(1)....................... ....................... FDA............. Penalty per occurrence for 2016 215,628 219,156
any vaccine manufacturer
that intentionally
destroys, alters,
falsifies, or conceals any
record or report required.
256b(d)(1)(B)(vi).................... ....................... HRSA............ Penalty for each instance 2016 5,437 5,526
of overcharging a 340B
covered entity.
299c-(3)(d).......................... ....................... AHRQ............ Penalty for an 2016 14,140 14,371
establishment or person
supplying information
obtained in the course of
activities for any purpose
other than the purpose for
which it was supplied.
653(l)(2)............................ 45 CFR 303.21(f)....... ACF............. Penalty for Misuse of 2016 1,450 1,474
Information in the
National Directory of New
Hires.
262a(i)(1)........................... 42 CFR 1003.910........ OIG............. Penalty for each individual 2016 327,962 333,327
who violates safety and
security procedures
related to handling
dangerous biological
agents and toxins.
Penalty for any other 2016 655,925 666,656
person who violates safety
and security procedures
related to handling
dangerous biological
agents and toxins.
300jj-51............................. ....................... OIG............. Penalty per violation for 2016 1,000,000 1,016,360
committing information
blocking.
1320a-7a(a).......................... 42 CFR 1003.210(a)(1).. OIG............. Penalty for knowingly 2016 15,024 15,270
presenting or causing to
be presented to an
officer, employee, or
agent of the United States
a false claim.
Penalty for knowingly 2016 15,024 15,270
presenting or causing to
be presented a request for
payment which violates the
terms of an assignment,
agreement, or PPS
agreement.
42 CFR 1003.210(a)(2) ................ Penalty for knowingly 2016 22,537 22,906
giving or causing to be
presented to a
participating provider or
supplier false or
misleading information
that could reasonably be
expected to influence a
discharge decision.
42 CFR 1003.210(a)(3) ................ Penalty for an excluded 2016 15,024 15,270
party retaining ownership
or control interest in a
participating entity.
[[Page 9178]]
42 CFR 1003.1010 ................ Penalty for remuneration 2016 15,024 15,270
offered to induce program
beneficiaries to use
particular providers,
practitioners, or
suppliers.
42 CFR 1003.210(a)(4) ................ Penalty for employing or 2016 14,718 14,959
contracting with an
excluded individual.
42 CFR 1003.310(a)(3) ................ Penalty for knowing and 2016 73,588 74,792
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.
42 CFR 1003.210(a)(1) Penalty for ordering or 2016 10,874 11,052
prescribing medical or
other item or service
during a period in which
the person was excluded.
42 CFR 1003.210(a)(6) Penalty for knowingly 2016 54,372 55,262
making or causing to be
made a false statement,
omission or
misrepresentation of a
material fact in any
application, bid, or
contract to participate or
enroll as a provider or
supplier.
42 CFR 1003.210(a)(8) ................ Penalty for knowing of an 2016 10,874 11,052
overpayment and failing to
report and return.
42 CFR 1003.210(a)(7) ................ Penalty for making or using 2016 54,372 55,262
a false record or
statement that is material
to a false or fraudulent
claim.
42 CFR 1003.210(a)(9) ................ Penalty for failure to 2016 16,312 16,579
grant timely access to HHS
OIG for audits,
investigations,
evaluations, and other
statutory functions of HHS
OIG.
1320a-7a(b).......................... ....................... OIG............. Penalty for payments by a 2016 4,313 4,384
hospital or critical
access hospital to induce
a physician to reduce or
limit services to
individuals under direct
care of physician or who
are entitled to certain
medical assistance
benefits.
Penalty for physicians who 2016 4,313 4,384
knowingly receive payments
from a hospital or
critical access hospital
to induce such physician
to reduce or limit
services to individuals
under direct care of
physician or who are
entitled to certain
medical assistance
benefits.
42 CFR 1003.210(a)(10) Penalty for a physician who 2016 7,512 7,635
executes a document that
falsely certifies home
health needs for Medicare
beneficiaries.
1320a-7e(b)(6)(A).................... 42 CFR 1003.810........ OIG............. Penalty for failure to 2016 36,794 37,396
report any final adverse
action taken against a
health care provider,
supplier, or practitioner.
1320b-10(b)(1)....................... 42 CFR 1003.610(a)..... OIG............. Penalty for the misuse of 2016 9,893 10,055
words, symbols, or emblems
in communications in a
manner in which a person
could falsely construe
that such item is
approved, endorsed, or
authorized by HHS.
1320b-10(b)(2)....................... 42 CFR 1003.610(a)..... OIG............. Penalty for the misuse of 2016 49,467 50,276
words, symbols, or emblems
in a broadcast or telecast
in a manner in which a
person could falsely
construe that such item is
approved, endorsed, or
authorized by HHS.
1395i-3(b)(3)(B)(ii)(1).............. 42 CFR 1003.210(a)(11). OIG............. Penalty for certification 2016 2,063 2,097
of a false statement in
assessment of functional
capacity of a Skilled
Nursing Facility resident
assessment.
1395i-3(b)(3)(B)(ii)(2).............. 42 CFR 1003.210(a)(11). OIG............. Penalty for causing another 2016 10,314 10,483
to certify or make a false
statement in assessment of
functional capacity of a
Skilled Nursing Facility
resident assessment.
1395i-3(g)(2)(A)..................... 42 CFR 1003.1310....... OIG............. Penalty for any individual 2016 4,126 4,194
who notifies or causes to
be notified a Skilled
Nursing Facility of the
time or date on which a
survey is to be conducted.
1395w-27(g)(2)(A).................... 42 CFR 1003.410........ OIG............. Penalty for a Medicare 2016 37,561 38,175
Advantage organization
that substantially fails
to provide medically
necessary, required items
and services.
Penalty for a Medicare 2016 36,794 37,396
Advantage organization
that charges excessive
premiums.
Penalty for a Medicare 2016 36,794 37,396
Advantage organization
that improperly expels or
refuses to reenroll a
beneficiary.
Penalty for a Medicare 2016 147,177 149,585
Advantage organization
that engages in practice
that would reasonably be
expected to have the
effect of denying or
discouraging enrollment.
[[Page 9179]]
Penalty per individual who 2016 22,077 22,438
does not enroll as a
result of a Medicare
Advantage organization's
practice that would
reasonably be expected to
have the effect of denying
or discouraging
enrollment.
Penalty for a Medicare 2016 147,177 149,585
Advantage organization
misrepresenting or
falsifying information to
Secretary.
Penalty for a Medicare 2016 36,794 37,396
Advantage organization
misrepresenting or
falsifying information to
individual or other
entity.
Penalty for Medicare 2016 36,794 37,396
Advantage organization
interfering with
provider's advice to
enrollee and non-MCO
affiliated providers that
balance bill enrollees.
Penalty for a Medicare 2016 36,794 37,396
Advantage organization
that employs or contracts
with excluded individual
or entity.
Penalty for a Medicare 2016 36,794 37,396
Advantage organization
enrolling an individual in
without prior written
consent.
Penalty for a Medicare 2016 36,794 37,396
Advantage organization
transferring an enrollee
to another plan without
consent or solely for the
purpose of earning a
commission.
Penalty for a Medicare 2016 36,794 37,396
Advantage organization
failing to comply with
marketing restrictions or
applicable implementing
regulations or guidance.
Penalty for a Medicare 2016 36,794 37,396
Advantage organization
employing or contracting
with an individual or
entity who violates 1395w-
27(g)(1)(A)-(J).
1395w-141(i)(3)...................... ....................... OIG............. Penalty for a prescription 2016 12,856 13,066
drug card sponsor that
falsifies or misrepresents
marketing materials,
overcharges program
enrollees, or misuse
transitional assistance
funds.
1395cc(g)............................ ....................... OIG............. Penalty for improper 2016 5,000 5,082
billing by Hospitals,
Critical Access Hospitals,
or Skilled Nursing
Facilities.
1395dd(d)(1)......................... 42 CFR 1003.510........ OIG............. Penalty for a hospital or 2016 103,139 104,826
responsible physician
dumping patients needing
emergency medical care, if
the hospital has 100 beds
or more.
Penalty for a hospital or 2016 51,570 52,414
responsible physician
dumping patients needing
emergency medical care, if
the hospital has less than
100 beds.
1395mm(i)(6)(B)(i)................... 42 CFR 1003.410........ OIG............. Penalty for a HMO or 2016 51,570 52,414
competitive plan is such
plan substantially fails
to provide medically
necessary, required items
or services.
Penalty for HMOs/ 2016 51,570 52,414
competitive medical plans
that charge premiums in
excess of permitted
amounts.
Penalty for a HMO or 2016 51,570 52,414
competitive medical plan
that expels or refuses to
reenroll an individual per
prescribed conditions.
Penalty for a HMO or 2016 206,278 209,653
competitive medical plan
that implements practices
to discourage enrollment
of individuals needing
services in future.
Penalty per individual not 2016 29,680 30,166
enrolled in a plan as a
result of a HMO or
competitive medical plan
that implements practices
to discourage enrollment
of individuals needing
services in the future.
Penalty for a HMO or 2016 206,278 209,653
competitive medical plan
that misrepresents or
falsifies information to
the Secretary.
Penalty for a HMO or 2016 51,570 52,414
competitive medical plan
that misrepresents or
falsifies information to
an individual or any other
entity.
Penalty for failure by HMO 2016 51,570 52,414
or competitive medical
plan to assure prompt
payment of Medicare risk
sharing contracts or
incentive plan provisions.
Penalty for HMO that 2016 47,340 48,114
employs or contracts with
excluded individual or
entity.
1395nn(g)(3)......................... 42 CFR 1003.310........ OIG............. Penalty for submitting or 2016 23,863 24,253
causing to be submitted
claims in violation of the
Stark Law's restrictions
on physician self-
referrals.
[[Page 9180]]
1395nn(g)(4)......................... 42 CFR 1003.310........ OIG............. Penalty for circumventing 2016 159,089 161,692
Stark Law's restrictions
on physician self-
referrals.
1395ss(d)(1)......................... 42 CFR 1003.1110....... OIG............. Penalty for a material 2016 9,893 10,055
misrepresentation
regarding Medigap
compliance policies.
1395ss(d)(2)......................... 42 CFR 1003.1110....... OIG............. Penalty for selling Medigap 2016 9,893 10,055
policy under false
pretense.
1395ss(d)(3)(A)(ii).................. 42 CFR 1003.1110....... OIG............. Penalty for an issuer that 2016 44,539 45,268
sells health insurance
policy that duplicates
benefits.
Penalty for someone other 2016 26,723 27,160
than issuer that sells
health insurance that
duplicates benefits.
1395ss(d)(4)(A)...................... 42 CFR 1003.1110....... OIG............. Penalty for using mail to 2016 9,893 10,055
sell a non-approved
Medigap insurance policy.
1396b(m)(5)(B)(i).................... 42 CFR 1003.410........ OIG............. Penalty for a Medicaid MCO 2016 49,467 50,276
that substantially fails
to provide medically
necessary, required items
or services.
Penalty for a Medicaid MCO 2016 49,467 50,276
that charges excessive
premiums.
Penalty for a Medicaid MCO 2016 197,869 201,106
that improperly expels or
refuses to reenroll a
beneficiary.
Penalty per individual who 2016 29,680 30,166
does not enroll as a
result of a Medicaid MCO's
practice that would
reasonably be expected to
have the effect of denying
or discouraging
enrollment.
Penalty for a Medicaid MCO 2016 197,869 201,106
misrepresenting or
falsifying information to
the Secretary.
Penalty for a Medicaid MCO 2016 49,467 50,276
misrepresenting or
falsifying information to
an individual or another
entity.
Penalty for a Medicaid MCO 2016 44,539 45,268
that fails to comply with
contract requirements with
respect to physician
incentive plans.
1396r(b)(3)(B)(ii)(I)................ 42 CFR 1003.210(a)(11). OIG............. Penalty for willfully and 2016 2,063 2,097
knowingly certifying a
material and false
statement in a Skilled
Nursing Facility resident
assessment.
1396r(b)(3)(B)(ii)(II)............... 42 CFR 1003.210(a)(11). OIG............. Penalty for willfully and 2016 10,314 10,483
knowingly causing another
individual to certify a
material and false
statement in a Skilled
Nursing Facility resident
assessment.
1396r(g)(2)(A)(i).................... 42 CFR 1003.1310....... OIG............. Penalty for notifying or 2016 4,126 4,194
causing to be notified a
Skilled Nursing Facility
of the time or date on
which a survey is to be
conducted.
1396r-8(b)(3)(B)..................... 42 CFR 1003.1210....... OIG............. Penalty for the knowing 2016 178,156 181,071
provision of false
information or refusing to
provide information about
charges or prices of a
covered outpatient drug.
1396r-8(b)(3)(C)(i).................. 42 CFR 1003.1210....... OIG............. Penalty per day for failure 2016 17,816 18,107
to timely provide
information by drug
manufacturer with rebate
agreement.
1396r-8(b)(3)(C)(ii)................. 42 CFR 1003.1210....... OIG............. Penalty for knowing 2016 178,156 181,071
provision of false
information by drug
manufacturer with rebate
agreement.
1396t(i)(3)(A)....................... 42 CFR 1003.1310....... OIG............. Penalty for notifying home 2016 3,563 3,621
and community-based
providers or settings of
survey.
11131(c)............................. 42 CFR 1003.810........ OIG............. Penalty for failing to 2016 21,563 21,916
report a medical
malpractice claim to
National Practitioner Data
Bank.
11137(b)(2).......................... 42 CFR 1003.810........ OIG............. Penalty for breaching 2016 21,563 21,916
confidentiality of
information reported to
National Practitioner Data
Bank.
299b-22(f)(1)........................ 42 CFR 3.404........... OCR............. Penalty for violation of 2016 11,940 12,135
confidentiality provision
of the Patient Safety and
Quality Improvement Act.
45 CFR OCR............. Penalty for each pre- 2016 150 152
160.404(b)(1)(i), (ii) February 18, 2009
violation of the HIPAA
administrative
simplification provisions.
Calendar Year Cap.......... 2016 37,561 38,175
1320(d)-5(a)......................... 45 CFR OCR............. Penalty for each February
160.404(b)(2)(i)(A), 18, 2009 or later
(B). violation of a HIPAA
administrative
simplification provision
in which it is established
that the covered entity or
business associate did not
know and by exercising
reasonable diligence,
would not have known that
the covered entity or
business associate
violated such a provision:
Minimum.................... 2016 110 112
Maximum.................... 2016 55,010 55,910
Calendar Year Cap.......... 2016 1,650,300 1,677,299
[[Page 9181]]
45 CFR OCR............. Penalty for each February
160.404(b)(2)(ii)(A), 18, 2009 or later
(B) violation of a HIPAA
administrative
simplification provision
in which it is established
that the violation was due
to reasonable cause and
not to willful neglect:
Minimum.................... 2016 1,100 1,118
Maximum.................... 2016 55,010 55,910
Calendar Year Cap.......... 2016 1,650,300 1,677,299
45 CFR OCR............. Penalty for each February
160.404(b)(2)(iii)(A), 18, 2009 or later
(B) violation of a HIPAA
administrative
simplification provision
in which it is established
that the violation was due
to willful neglect and was
corrected during the 30-
day period beginning on
the first date the covered
entity or business
associate knew, or, by
exercising reasonable
diligence, would have
known that the violation
occurred:
Minimum.................... 2016 11,002 11,182
Maximum.................... 2016 55,010 55,910
Calendar Year Cap.......... 2016 1,650,300 1,677,299
45 CFR OCR............. Penalty for each February
160.404(b)(2)(iv)(A), 18, 2009 or later
(B) violation of a HIPAA
administrative
simplification provision
in which it is established
that the violation was due
to willful neglect and was
not corrected during the
30-day period beginning on
the first date the covered
entity or business
associate knew, or by
exercising reasonable
diligence, would have
known that the violation
occurred:
Minimum.................... 2016 55,010 55,910
Maximum.................... 2016 1,650,300 1,677,299
Calendar Year Cap.......... 2016 1,650,300 1,677,299
263a(h)(2)(B) & 1395w-2(b)(2)(A)(ii). 42 CFR CMS............. Penalty for a clinical
493.1834(d)(2)(i). laboratory's failure to
meet participation and
certification requirements
and poses immediate
jeopardy:
Minimum.................... 2016 6,035 6,134
Maximum.................... 2016 19,787 20,111
42 CFR CMS............. Penalty for a clinical
493.1834(d)(2)(ii). laboratory's failure to
meet participation and
certification requirements
and the failure does not
pose immediate jeopardy:
Minimum.................... 2016 99 101
Maximum.................... 2016 5,936 6,033
300gg-15(f).......................... 45 CFR 147.200(e)...... CMS............. Failure to provide the 2016 1,087 1,105
Summary of Benefits and
Coverage.
300gg-18............................. 45 CFR 158.606......... CMS............. Penalty for violations of 2016 109 111
regulations related to the
medical loss ratio
reporting and rebating.
1320a-7h(b)(1)....................... 42 CFR 402.105(d)(5), CMS............. Penalty for manufacturer or
42 CFR 403.912(a) & group purchasing
(c). organization failing to
report information
required under 42 U.S.C.
1320a-7h(a), relating to
physician ownership or
investment interests:
Minimum.................... 2016 1,087 1,105
Maximum.................... 2016 10,874 11,052
Calendar Year Cap.......... 2016 163,117 165,786
1320a-7h(b)(2)....................... 42 CFR 402.105(h), 42 CMS............. Penalty for manufacturer or
CFR 403.912(b) & (c). group purchasing
organization knowingly
failing to report
information required under
42 U.S.C. 1320a-7h(a),
relating to physician
ownership or investment
interests:
Minimum.................... 2016 10,874 11,052
Maximum.................... 2016 108,745 110,524
Calendar Year Cap.......... 2016 1,087,450 1,105,241
CMS Penalty for an 2016 108,745 110,524
administrator of a
facility that fails to
comply with notice
requirements for the
closure of a facility.
1320a-7j(h)(3)(A).................... 42 CFR 488.446(a)(1), CMS............. Minimum penalty for the 2016 544 553
(2), & (3). first offense of an
administrator who fails to
provide notice of facility
closure.
Minimum penalty for the 2016 1,631 1,658
second offense of an
administrator who fails to
provide notice of facility
closure.
Minimum penalty for the 2016 3,262 3,315
third and subsequent
offenses of an
administrator who fails to
provide notice of facility
closure.
[[Page 9182]]
1320a-8(a)(1)........................ ....................... CMS............. Penalty for an entity 2016 7,954 8,084
knowingly making a false
statement or
representation of material
fact in the determination
of the amount of benefits
or payments related to old-
age, survivors, and
disability insurance
benefits, special benefits
for certain World War II
veterans, or supplemental
security income for the
aged, blind, and disabled.
Penalty for violation of 42 2016 7,500 7,623
U.S.C. 1320a-8(a)(1) if
the violator is a person
who receives a fee or
other income for services
performed in connection
with determination of the
benefit amount or the
person is a physician or
other health care provider
who submits evidence in
connection with such a
determination.
1320a-8(a)(3)........................ ....................... CMS............. Penalty for a 2016 6,229 6,331
representative payee
(under 42 U.S.C. 405(j),
1007, or 1383(a)(2))
converting any part of a
received payment from the
benefit programs described
in the previous civil
monetary penalty to a use
other than for the benefit
of the beneficiary.
1320b-25(c)(1)(A).................... ....................... CMS............. Penalty for failure of 2016 217,490 221,048
covered individuals to
report to the Secretary
and 1 or more law
enforcement officials any
reasonable suspicion of a
crime against a resident,
or individual receiving
care, from a long-term
care facility.
1320b-25(c)(2)(A).................... ....................... CMS............. Penalty for failure of 2016 326,235 331,572
covered individuals to
report to the Secretary
and 1 or more law
enforcement officials any
reasonable suspicion of a
crime against a resident,
or individual receiving
care, from a long-term
care facility if such
failure exacerbates the
harm to the victim of the
crime or results in the
harm to another individual.
1320b-25(d)(2)....................... ....................... CMS............. Penalty for a long-term 2016 217,490 221,048
care facility that
retaliates against any
employee because of lawful
acts done by the employee,
or files a complaint or
report with the State
professional disciplinary
agency against an employee
or nurse for lawful acts
done by the employee or
nurse.
1395b-7(b)(2)(B)..................... 42 CFR 402.105(g)...... CMS............. Penalty for any person who 2016 147 149
knowingly and willfully
fails to furnish a
beneficiary with an
itemized statement of
items or services within
30 days of the
beneficiary's request.
1395i-3(h)(2)(B)(ii)(I).............. 42 CFR CMS............. Penalty per day for a
488.408(d)(1)(iii). Skilled Nursing Facility
that has a Category 2
violation of certification
requirements:
Minimum.................... 2016 103 105
Maximum.................... 2016 6,188 6,289
42 CFR CMS............. Penalty per instance of
488.408(d)(1)(iv) Category 2 noncompliance
by a Skilled Nursing
Facility:
Minimum.................... 2016 2,063 2,097
Maximum.................... 2016 20,628 20,965
42 CFR CMS............. Penalty per day for a
488.408(e)(1)(iii) Skilled Nursing Facility
that has a Category 3
violation of certification
requirements:
Minimum.................... 2016 6,291 6,394
Maximum.................... 2016 20,628 20,965
42 CFR CMS............. Penalty per instance of
488.408(e)(1)(iv) Category 3 noncompliance
by a Skilled Nursing
Facility:
Minimum.................... 2016 2,063 2,097
Maximum.................... 2016 20,628 20,965
42 CFR CMS............. Penalty per day and per
488.408(e)(2)(ii) instance for a Skilled
Nursing Facility that has
Category 3 noncompliance
with Immediate Jeopardy:
Per Day (Minimum).......... 2016 6,291 6,394
Per Day (Maximum).......... 2016 20,628 20,965
Per Instance (Minimum)..... 2016 2,063 2,097
Per Instance (Maximum)..... 2016 20,628 20,965
42 CFR 488.438(a)(1)(i) CMS............. Penalty per day of a
Skilled Nursing Facility
that fails to meet
certification
requirements. These
amounts represent the
upper range per day:
Minimum.................... 2016 6,291 6,394
Maximum.................... 2016 20,628 20,965
42 CFR CMS............. Penalty per day of a
488.438(a)(1)(ii) Skilled Nursing Facility
that fails to meet
certification
requirements. These
amounts represent the
lower range per day:
[[Page 9183]]
Minimum.................... 2016 103 105
Maximum.................... 2016 6,188 6,289
42 CFR 488.438(a)(2) CMS............. Penalty per instance of a
Skilled Nursing Facility
that fails to meet
certification
requirements:
Minimum.................... 2016 2,063 2,097
Maximum.................... 2016 20,628 20,965
1395l(h)(5)(D)....................... 42 CFR 402.105(d)(2)(i) CMS............. Penalty for knowingly, 2016 15,024 15,270
willfully, and repeatedly
billing for a clinical
diagnostic laboratory test
other than on an
assignment-related basis.
(Penalties are assessed in
the same manner as 42
U.S.C. 1395u(j)(2)(B),
which is assessed
according to 1320a-7a(a)).
1395l(i)(6).......................... ....................... CMS............. Penalty for knowingly and 2016 3,957 4,022
willfully presenting or
causing to be presented a
bill or request for
payment for an intraocular
lens inserted during or
after cataract surgery for
which the Medicare payment
rate includes the cost of
acquiring the class of
lens involved.
1395l(q)(2)(B)(i).................... 42 CFR 402.105(a)...... CMS............. Penalty for knowingly and 2016 3,787 3,849
willfully failing to
provide information about
a referring physician when
seeking payment on an
unassigned basis.
1395m(a)(11)(A)...................... 42 CFR 402.1(c)(4), CMS............. Penalty for any durable 2016 15,024 15,270
402.105(d)(2)(ii). medical equipment supplier
that knowingly and
willfully charges for a
covered service that is
furnished on a rental
basis after the rental
payments may no longer be
made. (Penalties are
assessed in the same
manner as 42 U.S.C.
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395m(a)(18)(B)...................... 42 CFR 402.1(c)(5), CMS............. Penalty for any 2016 15,024 15,270
402.105(d)(2)(iii). nonparticipating durable
medical equipment supplier
that knowingly and
willfully fails to make a
refund to Medicare
beneficiaries for a
covered service for which
payment is precluded due
to an unsolicited
telephone contact from the
supplier. (Penalties are
assessed in the same
manner as 42 U.S.C.
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395m(b)(5)(C)....................... 42 CFR 402.1(c)(6), CMS............. Penalty for any 2016 15,024 15,270
402.105(d)(2)(iv). nonparticipating physician
or supplier that knowingly
and willfully charges a
Medicare beneficiary more
than the limiting charge
for radiologist services.
(Penalties are assessed in
the same manner as 42
U.S.C. 1395u(j)(2)(B),
which is assessed
according to 1320a-7a(a)).
1395m(h)(3).......................... 42 CFR 402.1(c)(8), CMS............. Penalty for any supplier of 2016 15,024 15,270
402.105(d)(2)(vi). prosthetic devices,
orthotics, and prosthetics
that knowing and willfully
charges for a covered
prosthetic device,
orthotic, or prosthetic
that is furnished on a
rental basis after the
rental payment may no
longer be made. (Penalties
are assessed in the same
manner as 42 U.S.C.
1395m(a)(11)(A), that is
in the same manner as
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395m(j)(2)(A)(iii).................. ....................... CMS............. Penalty for any supplier of 2016 1,591 1,617
durable medical equipment
including a supplier of
prosthetic devices,
prosthetics, orthotics, or
supplies that knowingly
and willfully distributes
a certificate of medical
necessity in violation of
Section 1834(j)(2)(A)(i)
of the Act or fails to
provide the information
required under Section
1834(j)(2)(A)(ii) of the
Act.
1395m(j)(4).......................... 42 CFR 402.1(c)(10), CMS............. Penalty for any supplier of 2016 15,024 15,270
402.105(d)(2)(vii). durable medical equipment,
including a supplier of
prosthetic devices,
prosthetics, orthotics, or
supplies that knowingly
and willfully fails to
make refunds in a timely
manner to Medicare
beneficiaries for series
billed other than on as
assignment-related basis
under certain conditions.
(Penalties are assessed in
the same manner as 42
U.S.C. 1395m(j)(4) and
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
[[Page 9184]]
1395m(k)(6).......................... 42 CFR 402.1(c)(31), CMS............. Penalty for any person or 2016 15,024 15,270
402.105(d)(3). entity who knowingly and
willfully bills or
collects for any
outpatient therapy
services or comprehensive
outpatient rehabilitation
services on other than an
assignment-related basis.
(Penalties are assessed in
the same manner as 42
U.S.C. 1395m(k)(6) and
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395m(l)(6).......................... 42 CFR 402.1(c)(32), CMS............. Penalty for any supplier of 2016 15,024 15,270
402.105(d)(4). ambulance services who
knowingly and willfully
fills or collects for any
services on other than an
assignment-related basis.
(Penalties are assessed in
the same manner as 42
U.S.C. 1395u(b)(18)(B),
which is assessed
according to 1320a-7a(a)).
1395u(b)(18)(B)...................... 42 CFR 402.1(c)(11), CMS............. Penalty for any 2016 15,024 15,270
402.105(d)(2)(viii). practitioner specified in
Section 1842(b)(18)(C) of
the Act or other person
that knowingly and
willfully bills or
collects for any services
by the practitioners on
other than an assignment-
related basis. (Penalties
are assessed in the same
manner as 42 U.S.C.
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395u(j)(2)(B)....................... 42 CFR 402.1(c)........ CMS............. Penalty for any physician 2016 15,024 15,270
who charges more than 125%
for a non-participating
referral. (Penalties are
assessed in the same
manner as 42 U.S.C. 1320a-
7a(a)).
1395u(k)............................. 42 CFR 402.1(c)(12), CMS............. Penalty for any physician 2016 15,024 15,270
402.105(d)(2)(ix). who knowingly and
willfully presents or
causes to be presented a
claim for bill for an
assistant at a cataract
surgery performed on or
after March 1, 1987, for
which payment may not be
made because of section
1862(a)(15). (Penalties
are assessed in the same
manner as 42 U.S.C.
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395u(l)(3).......................... 42 CFR 402.1(c)(13), CMS............. Penalty for any 2016 15,024 15,270
402.105(d)(2)(x). nonparticipating physician
who does not accept
payment on an assignment-
related basis and who
knowingly and willfully
fails to refund on a
timely basis any amounts
collected for services
that are not reasonable or
medically necessary or are
of poor quality under
1842(l)(1)(A). (Penalties
are assessed in the same
manner as 42 U.S.C.
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395u(m)(3).......................... 42 CFR 402.1(c)(14), CMS............. Penalty for any 2016 15,024 15,270
402.105(d)(2)(xi). nonparticipating physician
charging more than $500
who does not accept
payment for an elective
surgical procedure on an
assignment related basis
and who knowingly and
willfully fails to
disclose the required
information regarding
charges and coinsurance
amounts and fails to
refund on a timely basis
any amount collected for
the procedure in excess of
the charges recognized and
approved by the Medicare
program. (Penalties are
assessed in the same
manner as 42 U.S.C.
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395u(n)(3).......................... 42 CFR 402.1(c)(15), CMS............. Penalty for any physician 2016 15,024 15,270
402.105(d)(2)(xii). who knowingly, willfully,
and repeatedly bills one
or more beneficiaries for
purchased diagnostic tests
any amount other than the
payment amount specified
by the Act. (Penalties are
assessed in the same
manner as 42 U.S.C.
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395u(o)(3)(B)....................... 42 CFR 414.707(b)...... CMS............. Penalty for any 2016 15,024 15,270
practitioner specified in
Section 1842(b)(18)(C) of
the Act or other person
that knowingly and
willfully bills or
collects for any services
pertaining to drugs or
biologics by the
practitioners on other
than an assignment-related
basis. (Penalties are
assessed in the same
manner as 42 U.S.C.
1395u(b)(18)(B) and
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
[[Page 9185]]
1395u(p)(3)(A)....................... ....................... CMS............. Penalty for any physician 2016 3,957 4,022
or practitioner who
knowingly and willfully
fails promptly to provide
the appropriate diagnosis
codes upon CMS or Medicare
administrative contractor
request for payment or
bill not submitted on an
assignment-related basis.
1395w-3a(d)(4)(A).................... 42 CFR 414.806......... CMS............. Penalty for a 2016 12,856 13,066
pharmaceutical
manufacturer's
misrepresentation of
average sales price of a
drug, or biologic.
1395w-4(g)(1)(B)..................... 42 CFR 402.1(c)(17), CMS............. Penalty for any 2016 15,024 15,270
402.105(d)(2)(xiii). nonparticipating
physician, supplier, or
other person that
furnishes physician
services not on an
assignment-related basis
who either knowingly and
willfully bills or
collects in excess of the
statutorily-defined
limiting charge or fails
to make a timely refund or
adjustment. (Penalties are
assessed in the same
manner as 42 U.S.C.
1395u(j)(2)(B), which is
assessed according to
1320a-7a(a)).
1395w-4(g)(3)(B)..................... 42 CFR 402.1(c)(18), CMS............. Penalty for any person that 2016 15,024 15,270
402.105(d)(2)(xiv). knowingly and willfully
bills for statutorily
defined State-plan
approved physicians'
services on any other
basis than an assignment-
related basis for a
Medicare/Medicaid dual
eligible beneficiary.
(Penalties are assessed in
the same manner as 42
U.S.C. 1395u(j)(2)(B),
which is assessed
according to 1320a-7a(a)).
1395w-27(g)(3)(A); 1857(g)(3)........ 42 CFR 422.760(b); 42 CMS............. Penalty for each 2016 36,794 37,396
CFR 423.760(b). termination determination
the Secretary makes that
is the result of actions
by a Medicare Advantage
organization or Part D
sponsor that has adversely
affected an individual
covered under the
organization's contract.
1395w-27(g)(3)(B); 1857(g)(3)........ ....................... CMS............. Penalty for each week 2016 14,718 14,959
beginning after the
initiation of civil money
penalty procedures by the
Secretary because a
Medicare Advantage
organization or Part D
sponsor has failed to
carry out a contract, or
has carried out a contract
inconsistently with
regulations.
1395w-27(g)(3)(D); 1857(g)(3)........ ....................... CMS............. Penalty for a Medicare 2016 136,689 138,925
Advantage organization's
or Part D sponsor's early
termination of its
contract.
1395y(b)(3)(C)....................... 42 CFR 411.103(b)...... CMS............. Penalty for an employer or 2016 8,908 9,054
other entity to offer any
financial or other
incentive for an
individual entitled to
benefits not to enroll
under a group health plan
or large group health plan
which would be a primary
plan.
1395y(b)(5)(C)(ii)................... 42 CFR 402.1(c)(20), 42 CMS............. Penalty for any non- 2016 1,450 1,474
CFR 402.105(b)(2). governmental employer
that, before October 1,
1998, willfully or
repeatedly failed to
provide timely and
accurate information
requested relating to an
employee's group health
insurance coverage.
1395y(b)(6)(B)....................... 42 CFR 402.1(c)(21), CMS............. Penalty for any entity that 2016 3,182 3,234
402.105(a). knowingly, willfully, and
repeatedly fails to
complete a claim form
relating to the
availability of other
health benefits in
accordance with statute or
provides inaccurate
information relating to
such on the claim form.
1395y(b)(7)(B)(i).................... ....................... CMS............. Penalty for any entity 2016 1,138 1,157
serving as insurer, third
party administrator, or
fiduciary for a group
health plan that fails to
provide information that
identifies situations
where the group health
plan is or was a primary
plan to Medicare to the
HHS Secretary.
1395y(b)(8)(E)....................... ....................... CMS............. Penalty for any non-group 2016 1,138 1,157
health plan that fails to
identify claimants who are
Medicare beneficiaries and
provide information to the
HHS Secretary to
coordinate benefits and
pursue any applicable
recovery claim.
1395nn(g)(5)......................... 42 CFR 411.361......... CMS............. Penalty for any person that 2016 18,936 19,246
fails to report
information required by
HHS under Section 1877(f)
concerning ownership,
investment, and
compensation arrangements.
[[Page 9186]]
1395pp(h)............................ 42 CFR 402.1(c)(23), CMS............. Penalty for any durable 2016 15,024 15,270
402.105(d)(2)(xv). medical equipment
supplier, including a
supplier of prosthetic
devices, prosthetics,
orthotics, or supplies,
that knowingly and
willfully fails to make
refunds in a timely manner
to Medicare beneficiaries
under certain conditions.
(42 U.S.C. 1395(m)(18)
sanctions apply here in
the same manner, which is
under 1395u(j)(2) and
1320a-7a(a)).
1395ss(a)(2)......................... 42 CFR 402.1(c)(24), CMS............. Penalty for any person that 2016 51,569 52,413
405.105(f)(1). issues a Medicare
supplemental policy that
has not been approved by
the State regulatory
program or does not meet
Federal standards after a
statutorily defined
effective date.
1395ss(d)(3)(A)(vi) (II)............. ....................... CMS............. Penalty for someone other 2016 26,723 27,160
than issuer that sells or
issues a Medicare
supplemental policy to
beneficiary without a
disclosure statement.
Penalty for an issuer that 2016 44,539 45,268
sells or issues a Medicare
supplemental policy
without disclosure
statement.
1395ss(d)(3)(B)(iv).................. ....................... CMS............. Penalty for someone other 2016 26,723 27,160
than issuer that sells or
issues a Medicare
supplemental policy
without acknowledgement
form.
Penalty for issuer that 2016 44,539 45,268
sells or issues a Medicare
supplemental policy
without an acknowledgement
form.
1395ss(p)(8)......................... 42 CFR 402.1(c)(25), CMS............. Penalty for any person that 2016 26,723 27,160
402.105(e). sells or issues Medicare
supplemental polices after
a given date that fail to
conform to the NAIC or
Federal standards
established by statute.
42 CFR 402.1(c)(25), CMS............. Penalty for any person that 2016 44,539 45,268
405.105(f)(2) sells or issues Medicare
supplemental polices after
a given date that fail to
conform to the NAIC or
Federal standards
established by statute.
1395ss(p)(9)(C)...................... 42 CFR 402.1(c)(26), CMS............. Penalty for any person that 2016 26,723 27,160
402.105(e). sells a Medicare
supplemental policy and
fails to make available
for sale the core group of
basic benefits when
selling other Medicare
supplemental policies with
additional benefits or
fails to provide the
individual, before selling
the policy, an outline of
coverage describing
benefits.
42 CFR 402.1(c)(26), ................ Penalty for any person that 2016 44,539 45,268
405.105(f)(3), (4) sells a Medicare
supplemental policy and
fails to make available
for sale the core group of
basic benefits when
selling other Medicare
supplemental policies with
additional benefits or
fails to provide the
individual, before selling
the policy, an outline of
coverage describing
benefits.
1395ss(q)(5)(C)...................... 42 CFR 402.1(c)(27), CMS............. Penalty for any person that 2016 44,539 45,268
405.105(f)(5). fails to suspend the
policy of a policyholder
made eligible for medical
assistance or
automatically reinstates
the policy of a
policyholder who has lost
eligibility for medical
assistance, under certain
circumstances.
1395ss(r)(6)(A)...................... 42 CFR 402.1(c)(28), CMS............. Penalty for any person that 2016 44,539 45,268
405.105(f)(6). fails to provide refunds
or credits as required by
section 1882(r)(1)(B).
1395ss(s)(4)......................... 42 CFR 402.1(c)(29), CMS............. Penalty for any issuer of a 2016 18,908 19,217
405.105(c). Medicare supplemental
policy that does not waive
listed time periods if
they were already
satisfied under a
proceeding Medicare
supplemental policy, or
denies a policy, or
conditions the issuances
or effectiveness of the
policy, or discriminates
in the pricing of the
policy base on health
status or other specified
criteria.
1395ss(t)(2)......................... 42 CFR 402.1(c)(30), CMS............. Penalty for any issuer of a 2016 44,539 45,268
405.105(f)(7). Medicare supplemental
policy that fails to
fulfill listed
responsibilities.
1395ss(v)(4)(A)...................... ....................... CMS............. Penalty someone other than 2016 19,284 19,599
issuer who sells, issues,
or renews a medigap Rx
policy to an individual
who is a Part D enrollee.
Penalty for an issuer who 2016 32,140 32,666
sells, issues, or renews a
Medigap Rx policy who is a
Part D enrollee.
1395bbb(c)(1)........................ 42 CFR 488.725(c)...... CMS............. Penalty for any individual 2016 4,126 4,194
who notifies or causes to
be notified a home health
agency of the time or date
on which a survey of such
agency is to be conducted.
[[Page 9187]]
1395bbb(f)(2)(A)(i).................. 42 CFR CMS............. Maximum daily penalty 2016 19,787 20,111
488.845(b)(2)(iii) 42 amount for each day a home
CFR 488.845(b)(3)-(6); health agency is not in
and 42 CFR compliance with statutory
488.845(d)(1)(ii). requirements.
42 CFR 488.845(b)(3) ................ Penalty per day for home
health agency's
noncompliance (Upper
Range):
Minimum.................... 2016 16,819 17,094
Maximum.................... 2016 19,787 20,111
42 CFR 488.845(b)(3)(i) ................ Penalty for a home health 2016 19,787 20,111
agency's deficiency or
deficiencies that cause
immediate jeopardy and
result in actual harm.
42 CFR ................ Penalty for a home health 2016 17,808 18,099
488.845(b)(3)(ii) agency's deficiency or
deficiencies that cause
immediate jeopardy and
result in potential for
harm.
42 CFR ................ Penalty for an isolated 2016 16,819 17,094
488.845(b)(3)(iii) incident of noncompliance
in violation of
established HHA policy.
42 CFR 488.845(b)(4) ................ Penalty for a repeat and/or
condition-level deficiency
that does not constitute
immediate jeopardy, but is
directly related to poor
quality patient care
outcomes (Lower Range):
Minimum.................... 2016 2,968 3,017
Maximum.................... 2016 16,819 17,094
42 CFR 488.845(b)(5) ................ Penalty for a repeat and/or
condition-level deficiency
that does not constitute
immediate jeopardy and
that is related
predominately to structure
or process-oriented
conditions (Lower Range):
Minimum.................... 2016 989 1,005
Maximum.................... 2016 7,915 8,044
42 CFR 488.845(b)(6) ................ Penalty imposed for
instance of noncompliance
that may be assessed for
one or more singular
events of condition-level
noncompliance that are
identified and where the
noncompliance was
corrected during the
onsite survey:
Minimum.................... 2016 1,979 2,011
Maximum.................... 2016 19,787 20,111
Penalty for each day of 2016 19,787 20,111
noncompliance (Maximum).
42 CFR ................ Penalty for each day of 2016 19,787 20,111
488.845(d)(1)(ii) noncompliance (Maximum).
1396b(m)(5)(B)....................... 42 CFR 460.46.......... CMS............. Penalty for PACE
organization's practice
that would reasonably be
expected to have the
effect of denying or
discouraging enrollment:
Minimum.................... 2016 22,077 22,438
Maximum.................... 2016 147,177 149,585
Penalty for a PACE 2016 36,794 37,396
organization that charges
excessive premiums.
Penalty for a PACE 2016 147,177 149,585
organization
misrepresenting or
falsifying information to
CMS, the State, or an
individual or other
entity.
Penalty for each 2016 36,794 37,396
determination the CMS
makes that the PACE
organization has failed to
provide medically
necessary items and
services of the failure
has adversely affected (or
has the substantial
likelihood of adversely
affecting) a PACE
participant.
Penalty for involuntarily 2016 36,794 37,396
disenrolling a
participant.
Penalty for discriminating 2016 36,794 37,396
or discouraging enrollment
or disenrollment of
participants on the basis
of an individual's health
status or need for health
care services.
1396r(h)(3)(C)(ii)(I)................ 42 CFR CMS............. Penalty per day for a
488.408(d)(1)(iii). nursing facility's failure
to meet a Category 2
Certification:
Minimum.................... 2016 103 105
Maximum.................... 2016 6,188 6,289
42 CFR CMS............. Penalty per instance for a
488.408(d)(1)(iv) nursing facility's failure
to meet Category 2
certification:
Minimum.................... 2016 2,063 2,097
Maximum.................... 2016 20,628 20,965
42 CFR CMS............. Penalty per day for a
488.408(e)(1)(iii) nursing facility's failure
to meet Category 3
certification:
Minimum.................... 2016 6,291 6,394
Maximum.................... 2016 20,628 20,965
42 CFR CMS............. Penalty per instance for a
488.408(e)(1)(iv) nursing facility's failure
to meet Category 3
certification:
Minimum.................... 2016 2,063 2,097
[[Page 9188]]
Maximum.................... 2016 20,628 20,965
42 CFR CMS............. Penalty per instance for a
488.408(e)(2)(ii) nursing facility's failure
to meet Category 3
certification, which
results in immediate
jeopardy:
Minimum.................... 2016 2,063 2,097
Maximum.................... 2016 20,628 20,965
42 CFR 488.438(a)(1)(i) CMS............. Penalty per day for nursing
facility's failure to meet
certification (Upper
Range):
Minimum.................... 2016 6,291 6,394
Maximum.................... 2016 20,628 20,965
42 CFR CMS............. Penalty per day for nursing
488.438(a)(1)(ii) facility's failure to meet
certification (Lower
Range):
Minimum.................... 2016 103 105
Maximum.................... 2016 6,188 6,289
42 CFR 488.438(a)(2) CMS............. Penalty per instance for
nursing facility's failure
to meet certification:
Minimum.................... 2016 2,063 2,097
Maximum.................... 2016 20,628 20,965
1396r(f)(2)(B)(iii)(I)(c)............ 42 CFR CMS............. Grounds to prohibit 2016 10,314 10,483
483.151(b)(2)(iv) and approval of Nurse Aide
(b)(3)(iii). Training Program--if
assessed a penalty in
1819(h)(2)(B)(i) or
1919(h)(2)(A)(ii) of ``not
less than $5,000'' [Not
CMP authority, but a
specific CMP amount (CMP
at this level) that is the
triggering condition for
disapproval].
1396r(h)(3)(C)(ii)(I)................ 42 CFR 483.151(c)(2)... CMS............. Grounds to waive 2016 10,314 10,483
disapproval of nurse aide
training program--
reference to disapproval
based on imposition of CMP
``not less than $5,000''
[Not CMP authority but CMP
imposition at this level
determines eligibility to
seek waiver of disapproval
of nurse aide training
program].
1396t(j)(2)(C)....................... ....................... CMS............. Penalty for each day of
noncompliance for a home
or community care provider
that no longer meets the
minimum requirements for
home and community care:
Minimum.................... 2016 2 2
Maximum.................... 2016 17,816 18,107
1396u-2(e)(2)(A)(i).................. 42 CFR 438.704......... CMS............. Penalty for a Medicaid 2016 36,794 37,396
managed care organization
that fails substantially
to provide medically
necessary items and
services.
Penalty for Medicaid 2016 36,794 37,396
managed care organization
that imposes premiums or
charges on enrollees in
excess of the premiums or
charges permitted.
Penalty for a Medicaid 2016 36,794 37,396
managed care organization
that misrepresents or
falsifies information to
another individual or
entity.
Penalty for a Medicaid 2016 36,794 37,396
managed care organization
that fails to comply with
the applicable statutory
requirements for such
organizations.
1396u-2(e)(2)(A)(ii)................. 42 CFR 438.704......... CMS............. Penalty for a Medicaid 2016 147,177 149,585
managed care organization
that misrepresents or
falsifies information to
the HHS Secretary.
Penalty for Medicaid 2016 147,177 149,585
managed care organization
that acts to discriminate
among enrollees on the
basis of their health
status.
1396u-2(e)(2)(A)(iv)................. 42 CFR 438.704......... CMS............. Penalty for each individual 2016 22,077 22,438
that does not enroll as a
result of a Medicaid
managed care organization
that acts to discriminate
among enrollees on the
basis of their health
status.
1396u(h)(2).......................... 42 CFR Part 441, CMS............. Penalty for a provider not 2016 20,628 20,965
Subpart I. meeting one of the
requirements relating to
the protection of the
health, safety, and
welfare of individuals
receiving community
supported living
arrangements services.
1396w-2(c)(1)........................ ....................... CMS............. Penalty for disclosing 2016 11,002 11,182
information related to
eligibility determinations
for medical assistance
programs.
18041(c)(2).......................... 45 CFR 150.315; 45 CFR CMS............. Failure to comply with 2016 150 152
156.805(c). requirements of the Public
Health Services Act;
Penalty for violations of
rules or standards of
behavior associated with
issuer participation in
the Federally-facilitated
Exchange. (42 U.S.C. 300gg-
22(b)(2)(C)).
18081(h)(1)(A)(i)(II)................ 42 CFR 155.285......... CMS............. Penalty for providing false 2016 27,186 27,631
information on Exchange
application.
18081(h)(1)(B)....................... 42 CFR 155.285......... CMS............. Penalty for knowingly or 2016 271,862 276,310
willfully providing false
information on Exchange
application.
[[Page 9189]]
18081(h)(2).......................... 42 CFR 155.260......... CMS............. Penalty for knowingly or 2016 27,186 27,631
willfully disclosing
protected information from
Exchange.
31 U.S.C.
1352................................. 45 CFR 93.400(e)....... HHS............. Penalty for the first time 2016 18,936 19,246
an individual makes an
expenditure prohibited by
regulations regarding
lobbying disclosure,
absent aggravating
circumstances.
Penalty for second and
subsequent offenses by
individuals who make an
expenditure prohibited by
regulations regarding
lobbying disclosure:
Minimum.................... 2016 18,936 19,246
Maximum.................... 2016 189,361 192,459
Penalty for the first time 2016 18,936 19,246
an individual fails to
file or amend a lobbying
disclosure form, absent
aggravating circumstances.
Penalty for second and
subsequent offenses by
individuals who fail to
file or amend a lobbying
disclosure form, absent
aggravating circumstances:
Minimum.................... 2016 18,936 19,246
Maximum.................... 2016 189,361 192,459
45 CFR Part 93, HHS............. Penalty for failure to
Appendix A provide certification
regarding lobbying in the
award documents for all
sub-awards of all tiers:
Minimum.................... 2016 18,936 19,246
Maximum.................... 2016 189,361 192,459
Penalty for failure to
provide statement
regarding lobbying for
loan guarantee and loan
insurance transactions:
Minimum.................... 2016 18,936 19,246
Maximum.................... 2016 189,361 192,459
3801-3812............................ 45 CFR 79.3(a)(1)(iv).. HHS............. Penalty against any 2016 9,894 10,056
individual who--with
knowledge or reason to
know--makes, presents or
submits a false,
fictitious or fraudulent
claim to the Department.
45 CFR 79.3(b)(1)(ii) ................ Penalty against any 2016 9,894 10,056
individual who--with
knowledge or reason to
know--makes, presents or
submits a false,
fictitious or fraudulent
claim to the Department.
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Some HHS components have not promulgated regulations regarding their civil monetary penalty-specific statutory authorities.
\2\ The description is not intended to be a comprehensive explanation of the underlying violation; the statute and corresponding regulation, if
applicable should be consulted.
\3\ Statutory or Inflation Act Adjustment.
\4\ The cost of living multiplier for 2017, based on the Consumer Price Index (CPI-U) for the month of October 2016, not seasonally adjusted, is
1.01636, as indicated in OMB Memorandum M-17-11, ``Implementation of the 2017 annual adjustment pursuant to the Federal Civil Penalties Adjustment Act
Improvements Act of 2015'' (December 16, 2016).
Dated: January 30, 2017.
Norris Cochran,
Acting Secretary, Department of Health and Human Services.
[FR Doc. 2017-02300 Filed 2-2-17; 8:45 am]
BILLING CODE 4150-24-P