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Current as of January 02, 2025 | Updated by Findlaw Staff
(a) Penalties. 3
3 The penalty amounts in this section are adjusted for inflation annually. Adjusted amounts are published at 45 CFR part 102.
(1) The OIG may impose a penalty of up to $25,000 for each individual violation under § 1001.400, except as provided in this section.
(2) The OIG may impose a penalty of up to $100,000 for each individual violation under § 1003.400(a)(3), (a)(5), or (e).
(b) Additional penalties. In addition to the penalties described in paragraph (a) of this section, the OIG may impose—
(1) An additional penalty equal to double the amount of excess premium charged by the contracting organization for each individual violation of § 1003.400(a)(2). The excess premium amount will be deducted from the penalty and returned to the enrollee.
(2) An additional $15,000 4 penalty for each individual expelled or not enrolled in violation of § 1003.400(a)(3) or (e).
4 This penalty amount is adjusted for inflation annually. Adjusted amounts are published at 45 CFR part 102.
(c) Assessments. The OIG may impose an assessment against a contracting organization with a contract under section 1857 or 1860D–12 of the Act (Medicare Advantage or Part D) of not more than the amount claimed in violation of § 1003.400(a)(4) or (a)(5) on the basis of the misrepresentation or falsified information involved.
(d) The OIG may impose a penalty or, when applicable, an assessment, against a contracting organization with a contract under section 1857 or 1860D–12 of the Act (Medicare Advantage or Part D) if any of its employees, agents, or contracting providers or suppliers engages in any of the conduct described in § 1003.400(a) through (d).
Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.1003.410 Amount of penalties and assessments for Contracting Organization - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-1003-410/
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