Industry News

HHS Proposes Revisions to the OIG’s Civil Monetary Penalty Rules.

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a proposed rule that amends the Civil Monetary Penalty (CMP) rules to include new CMP authorities, clarifies existing authorities, and reorganizes regulations on CMPs, assessment, and exclusions.  The proposed rule would codify changes pursuant to the Patient Protection and Affordable Care Act and the Medicare Prescription Drug, Improvement, and Modernization Act.  The updated regulations would subject an individual to penalties, assessments, and/or exclusion from participation in federal health care programs for the following:

  • Failing to grant OIG timely access to records;
  • Ordering or prescribing while excluded;
  • Making false statements, misrepresentations, or omissions in an enrollment application;
  • Failing to report and return a known overpayment; and/or
  • Making or using a false record or statement that is material to a false or fraudulent claim.

The proposed rule also lists factors that the OIG will consider in determining the amount of penalties and assessments and the period of exclusion.

The OIG is accepting comments on the proposed rule until July 11.

The proposed rule is available at:

Medicare and State Health Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Civil Monetary Penalties; Proposed Rule, 79 Fed. Reg. 91 (May 12, 2014).