OIG Proposed Rule Expands Civil Monetary Penalties

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This week, the Office of Inspector General (“OIG”) issued a proposed rule which would amend the Civil Monetary Penalties (“CMP”) law.  The OIG is authorized to seek CMPs for various violations such as submitting false or fraudulent claims or for Anti-Kickback Statute (“AKS”) violations.  The CMPs assessed range from $10,000 per improper claim to $50,000 for each improper violation of the AKS.
The revised regulations would allow for additional penalties for the following:

  • Timely access to records not granted to the OIG;

  • Ordering or prescribing covered services while excluded from a Federal program;
  • Making false statements, omissions, or misrepresentations in an enrollment application;
  • Failure to report and return overpayments; and
  • Making or using a false record or statement that is material to a false or fraudulent claim.
These changes stemmed from the authorities under the Affordable Care Act (“ACA”).  Since the enactment of the ACA, the government has increasingly focused on strengthening fraud and abuse regulations and increasing funding to deter fraud.  This change in regulations is one of the additional steps the government is taking in stepping up its efforts to deter fraud in healthcare.  Comments to the proposed rule must be submitted no later than July 11, 2014.
If you have any questions about the proposed CMPs or if you would like to submit a comment, please feel free to contact Robert A. Wade at (574) 485-2002 or Alex T. Krouse at (574) 485-2003.