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The Bipartisan Budget Act of 2018 (BBA 2018) significantly increased civil and criminal penalties for federal health care program fraud and abuse. Below is a summary of some of the BBA 2018 changes to the maximum penalty amounts, which apply for acts committed after February 9, 2018.
Civil Monetary Penalties
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$5,000
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A hospital or physician that gives or receives a payment to reduce/limit medically necessary services to Medicare/Medicaid beneficiaries
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$10,000
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A physician who signs a home health certification knowing all the requirements are not met
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$20,000
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False claims
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Requesting payment in violation of assignment agreement
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Excluded party retaining ownership/controlling interest in a participating entity (per day)
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Beneficiary inducements
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Employing/contracting with an excluded individual
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Ordering/prescribing while excluded
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Failure to report and return an overpayment
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$30,000
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Giving/causing to be presented false or misleading information to influence a hospital discharge decision
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Failure to grant timely access to OIG (per day)
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$100,000
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Violating the Anti-Kickback Statute
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Making/causing to be made false statements, omission or misrepresentation of a material fact in an application, bid or contract to participate/enroll as a provider/supplier
Criminal Penalties
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$100,000 plus 10 years imprisonment (a felony) for persons who commit any of the acts listed below in connection with the furnishing of items/services reimbursable by federal health care programs:
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Violating the Anti-Kickback Statute
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Making/causing to be made a false statement or representation of a material fact:
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In an application for or payment under a federal health care program
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For use in determining rights to such payment
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Concealing/failing to disclose knowledge of the occurrence of an event affecting the initial/continuing right to any payment with an intent to fraudulently secure such payment
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Presenting/causing to be presented a claim for a physician service knowing the individual is not a licensed physician
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$20,000 plus one year imprisonment (a misdemeanor) for the same offenses listed above where the conduct is by the same person who furnishes the items/services payable under federal health care programs
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$4,000 plus imprisonment of up to six months (misdemeanor)
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Repeatedly violating the terms of the assignment agreement