The current maximum (and where stated, minimum) civil monetary penalty for each violation type, across federal agencies, as each agency's own inflation-adjustment regulation states it: OSHA (29 CFR 1903.15), EPA (40 CFR 19.4), HHS including HIPAA and Medicare (45 CFR 102.3), DOJ including the False Claims Act (28 CFR 85.5), Coast Guard (33 CFR 27.3), NHTSA (49 CFR 578.6). Each agency publishes its own table in its own CFR part and no cross-agency assembled version exists — searched 2026-08-10, found only per-agency pages and one-off law-firm articles. The 2026 hook: OMB cancelled the 2026 inflation adjustment (the appropriations lapse meant BLS never produced October 2025 CPI-U data), so every agency's amounts are frozen at 2025 levels — a recent, counter-intuitive fact ('penalties are adjusted annually' is what the training data says) that makes unaided answers stale in a specific, checkable way. Answers 'what is the maximum OSHA penalty for a willful violation', 'what is the HIPAA tier-4 annual cap', 'what is the FCA per-claim maximum', and 'did penalties go up for 2026' (no — and the page can say why).

US federal regulation; facts not copyrightable, quoted with citation.

Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for failing to report a medical malpractice claim to National Practitioner Data Bank

**Statutory authority:** 11131(c)

**Maximum penalty:** 28,619

> 11131(c) | <https://www.ecfr.gov/current/title-42/section-1003.810> 42 CFR 1003.810 | OIG | Penalty for failing to report a medical malpractice claim to National Practitioner Data Bank | 2024 | 27,894 | 28,619

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for failing to report a medical malpractice claim to National Practitioner Data Bank — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for breaching confidentiality of information reported to National Practitioner Data Bank

**Statutory authority:** 11137(b)(2)

**Maximum penalty:** 28,619

> 11137(b)(2) | <https://www.ecfr.gov/current/title-42/section-1003.810> 42 CFR 1003.810 | OIG | Penalty for breaching confidentiality of information reported to National Practitioner Data Bank | 2024 | 27,894 | 28,619

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for breaching confidentiality of information reported to National Practitioner Data Bank — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** DOJ

**Violation:** Financial Institutions Reform, Recovery, and Enforcement Act (FIRREA) Violation

**Statutory authority:** 12 U.S.C. 1833a(b)(1)

**Maximum penalty:** 2,513,215

> <https://www.govinfo.gov/link/uscode/12/1833a> 12 U.S.C. 1833a(b)(1) | Financial Institutions Reform, Recovery, and Enforcement Act (FIRREA) Violation | <https://www.ecfr.gov/current/title-28/section-85.3#p-85.3(a)(6)> 28 CFR 85.3(a)(6) | 2,449,575 | 2,513,215

Source: <https://www.ecfr.gov/current/title-28/chapter-I/part-85/section-85.5>

Financial Institutions Reform, Recovery, and Enforcement Act (FIRREA) Violation — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** DOJ

**Violation:** FIRREA Violation (continuing) (per day)

**Statutory authority:** 12 U.S.C. 1833a(b)(2)

**Maximum penalty:** 2,513,215

> <https://www.govinfo.gov/link/uscode/12/1833a> 12 U.S.C. 1833a(b)(2) | FIRREA Violation (continuing) (per day) | <https://www.ecfr.gov/current/title-28/section-85.3#p-85.3(a)(7)> 28 CFR 85.3(a)(7) | 2,449,575 | 2,513,215

Source: <https://www.ecfr.gov/current/title-28/chapter-I/part-85/section-85.5>

FIRREA Violation (continuing) (per day) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** DOJ

**Violation:** FIRREA Violation (continuing)

**Statutory authority:** 12 U.S.C. 1833a(b)(2)

**Maximum penalty:** 12,566,086

> <https://www.govinfo.gov/link/uscode/12/1833a> 12 U.S.C. 1833a(b)(2) | FIRREA Violation (continuing) | <https://www.ecfr.gov/current/title-28/section-85.3#p-85.3(a)(7)> 28 CFR 85.3(a)(7) | 12,247,886 | 12,566,086

Source: <https://www.ecfr.gov/current/title-28/chapter-I/part-85/section-85.5>

FIRREA Violation (continuing) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320(d)-5(a)

**Maximum penalty:** 73,011

**Minimum penalty:** 145

**Annual cap:** 2,190,294

> 1320(d)-5(a) | <https://www.ecfr.gov/current/title-45/section-160.404#p-160.404(b)(2)(i)(A)> 45 CFR 160.404(b)(2)(i)(A) , <https://www.ecfr.gov/current/title-45/section-160.404#p-160.404(B)> (B) | OCR | 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 | 2024 | | | | | | Minimum | 2024 | 141 | 145 | | | | Maximum | 2024 | 71,162 | 73,011 | | | | Calendar Year Cap | 2024 | 2,134,831 | 2,190,294

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for each pre-February 18, 2009 violation of the HIPAA administrative simplification provisions

**Statutory authority:** 1320(d)-5(a)

**Maximum penalty:** 198

**Annual cap:** 49,848

> 1320(d)-5(a) | <https://www.ecfr.gov/current/title-45/section-160.404#p-160.404(b)(1)(i)> 45 CFR 160.404(b)(1)(i) , <https://www.ecfr.gov/current/title-45/section-160.404#p-160.404(ii)> (ii) | OCR | Penalty for each pre-February 18, 2009 violation of the HIPAA administrative simplification provisions | 2024 | 193 | 198 | | | OIG | Calendar Year Cap | 2024 | 48,586 | 49,848

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for each pre-February 18, 2009 violation of the HIPAA administrative simplification provisions — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for knowingly presenting or causing to be presented to an officer, employee, or agent of the United States a false claim

**Statutory authority:** 1320a-7a(a)

**Maximum penalty:** 25,595

> 1320a-7a(a) | <https://www.ecfr.gov/current/title-42/section-1003.210#p-1003.210(a)(1)> 42 CFR 1003.210(a)(1) | OIG | Penalty for knowingly presenting or causing to be presented to an officer, employee, or agent of the United States a false claim | 2024 | 24,947 | 25,595

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for knowingly presenting or causing to be presented to an officer, employee, or agent of the United States a false claim — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320a-7a(b)

**Maximum penalty:** 6,398

> 1320a-7a(b) | | 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 | 2024 | 6,236 | 6,398

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for knowingly presenting or causing to be presented a false or fraudulent specified claim under a grant, contract, or other agreement for which the Secretary provides funding

**Statutory authority:** 1320a-7a(o)

**Maximum penalty:** 12,482

> 1320a-7a(o) | <https://www.ecfr.gov/current/title-42/section-1003.710#p-1003.710(a)(1)> 42 CFR 1003.710(a)(1) | OIG | Penalty for knowingly presenting or causing to be presented a false or fraudulent specified claim under a grant, contract, or other agreement for which the Secretary provides funding | 2024 | 12,166 | 12,482

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for knowingly presenting or causing to be presented a false or fraudulent specified claim under a grant, contract, or other agreement for which the Secretary provides funding — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for failure to report any final adverse action taken against a health care provider, supplier, or practitioner

**Statutory authority:** 1320a-7e(b)(6)(A)

**Maximum penalty:** 48,833

> 1320a-7e(b)(6)(A) | <https://www.ecfr.gov/current/title-42/section-1003.810> 42 CFR 1003.810 | OIG | Penalty for failure to report any final adverse action taken against a health care provider, supplier, or practitioner | 2024 | 47,596 | 48,833

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for failure to report any final adverse action taken against a health care provider, supplier, or practitioner — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320a-7h(b)(1)

**Maximum penalty:** 14,432

**Minimum penalty:** 1,443

**Annual cap:** 216,490

> 1320a-7h(b)(1) | <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(5)> 42 CFR 402.105(d)(5) , <https://www.ecfr.gov/current/title-42/section-403.912#p-403.912(a)> 42 CFR 403.912(a) & (c) | CMS | Penalty for manufacturer or group purchasing organization failing to report information required under <https://www.govinfo.gov/link/uscode/42/1320a-7h> 42 U.S.C. 1320a-7h(a) , relating to physician ownership or investment interests | 2024 | | | | | | Minimum | 2024 | 1,406 | 1,443 | | | | Maximum | 2024 | 14,067 | 14,432 | | | | Calendar Year Cap | 2024 | 211,008 | 216,490

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320a-7h(b)(2)

**Maximum penalty:** 144,329

**Minimum penalty:** 14,432

**Annual cap:** 1,443,275

> 1320a-7h(b)(2) | <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(h)> 42 CFR 402.105(h) , <https://www.ecfr.gov/current/title-42/section-403.912#p-403.912(b)> 42 CFR 403.912(b) & (c) | CMS | Penalty for manufacturer or group purchasing organization knowingly failing to report information required under <https://www.govinfo.gov/link/uscode/42/1320a-7h> 42 U.S.C. 1320a-7h(a) , relating to physician ownership or investment interests | 2024 | | | | | | Minimum | 2024 | 14,067 | 14,432 | | | | Maximum | 2024 | 140,674 | 144,329 | | | | Calendar Year Cap | 2024 | 1,406,728 | 1,443,275

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Maximum penalty for an administrator of a facility that fails to comply with notice requirements for the closure of a facility

**Statutory authority:** 1320a-7j(h)(3)(A)

**Maximum penalty:** 144,329

> 1320a-7j(h)(3)(A) | | CMS | Maximum penalty for an administrator of a facility that fails to comply with notice requirements for the closure of a facility | 2024 | 140,674 | 144,329

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Maximum penalty for an administrator of a facility that fails to comply with notice requirements for the closure of a facility — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Minimum penalty for the first offense of an administrator who fails to provide notice of facility closure

**Statutory authority:** 1320a-7j(h)(3)(A)

**Maximum penalty:** 721

> 1320a-7j(h)(3)(A) | <https://www.ecfr.gov/current/title-42/section-488.446#p-488.446(a)(1)> 42 CFR 488.446(a)(1) , <https://www.ecfr.gov/current/title-42/section-488.446#p-488.446(2)> (2) , & (3) | CMS | Minimum penalty for the first offense of an administrator who fails to provide notice of facility closure | 2024 | 703 | 721

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Minimum penalty for the first offense of an administrator who fails to provide notice of facility closure — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320a-8(a)(1)

**Maximum penalty:** 10,556

> 1320a-8(a)(1) | | 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 | 2024 | 10,289 | 10,556

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320a-8(a)(3)

**Maximum penalty:** 8,267

> 1320a-8(a)(3) | | CMS | Penalty for a representative payee (under <https://www.govinfo.gov/link/uscode/42/405> 42 U.S.C. 405(j) , <https://www.govinfo.gov/link/uscode/42/1007> 1007 , or <https://www.govinfo.gov/link/uscode/42/1383> 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 | 2024 | 8,058 | 8,267

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320b-10(b)(1)

**Maximum penalty:** 13,132

> 1320b-10(b)(1) | <https://www.ecfr.gov/current/title-42/section-1003.610#p-1003.610(a)> 42 CFR 1003.610(a) | OIG | 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 | 2024 | 12,799 | 13,132

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320b-10(b)(2)

**Maximum penalty:** 65,653

> 1320b-10(b)(2) | <https://www.ecfr.gov/current/title-42/section-1003.610#p-1003.610(a)> 42 CFR 1003.610(a) | OIG | 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 | 2024 | 63,991 | 65,653

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320b-25(c)(1)(A)

**Maximum penalty:** 288,655

> 1320b-25(c)(1)(A) | | CMS | 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 | 2024 | 281,346 | 288,655

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320b-25(c)(2)(A)

**Maximum penalty:** 432,981

> 1320b-25(c)(2)(A) | | CMS | 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 | 2024 | 422,017 | 432,981

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1320b-25(d)(2)

**Maximum penalty:** 288,655

> 1320b-25(d)(2) | | CMS | 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 | 2024 | 281,346 | 288,655

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for the first time an individual fails to file or amend a lobbying disclosure form, absent aggravating circumstances

**Statutory authority:** 1352

**Maximum penalty:** 25,132

> 1352 | | HHS | Penalty for the first time an individual fails to file or amend a lobbying disclosure form, absent aggravating circumstances | 2024 | 24,496 | 25,132

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for the first time an individual fails to file or amend a lobbying disclosure form, absent aggravating circumstances — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395b-7(b)(2)(B)

**Maximum penalty:** 195

> 1395b-7(b)(2)(B) | <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(g)> 42 CFR 402.105(g) | CMS | 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 | 2024 | 190 | 195

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395bbb(c)(1)

**Maximum penalty:** 5,478

> 1395bbb(c)(1) | <https://www.ecfr.gov/current/title-42/section-488.725#p-488.725(c)> 42 CFR 488.725(c) | CMS | 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 | 2024 | 5,339 | 5,478

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Maximum daily penalty amount for each day a home health agency is not in compliance with statutory requirements

**Statutory authority:** 1395bbb(f)(2)(A)(i)

**Maximum penalty:** 26,262

> 1395bbb(f)(2)(A)(i) | <https://www.ecfr.gov/current/title-42/section-488.845#p-488.845(b)(2)(iii)> 42 CFR 488.845(b)(2)(iii) <https://www.ecfr.gov/current/title-42/section-488.845#p-488.845(b)(3)> 42 CFR 488.845(b)(3)-(6) ; and <https://www.ecfr.gov/current/title-42/section-488.845#p-488.845(d)(1)(ii)> 42 CFR 488.845(d)(1)(ii) | CMS | Maximum daily penalty amount for each day a home health agency is not in compliance with statutory requirements | 2024 | 25,597 | 26,262

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Maximum daily penalty amount for each day a home health agency is not in compliance with statutory requirements — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for improper billing by Hospitals, Critical Access Hospitals, or Skilled Nursing Facilities

**Statutory authority:** 1395cc(g)

**Maximum penalty:** 6,637

> 1395cc(g) | <https://www.ecfr.gov/current/title-42/section-1003.210#p-1003.210(a)(5)> 42 CFR 1003.210(a)(5) | OIG | Penalty for improper billing by Hospitals, Critical Access Hospitals, or Skilled Nursing Facilities | 2024 | 6,469 | 6,637

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for improper billing by Hospitals, Critical Access Hospitals, or Skilled Nursing Facilities — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for a hospital with 100 beds or more or responsible physician dumping patients needing emergency medical care

**Statutory authority:** 1395dd(d)(1)

**Maximum penalty:** 136,886

> 1395dd(d)(1) | <https://www.ecfr.gov/current/title-42/section-1003.510> 42 CFR 1003.510 | OIG | Penalty for a hospital with 100 beds or more or responsible physician dumping patients needing emergency medical care | 2024 | 133,420 | 136,886

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for a hospital with 100 beds or more or responsible physician dumping patients needing emergency medical care — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for PACE organization that discriminates in enrollment or disenrollment, or engages in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment, on the basis of health status or the need for services

**Statutory authority:** 1395eee(e)(6)(B); 1396u-4(e)(6)(B)

**Maximum penalty:** 48,833

> 1395eee(e)(6)(B); 1396u-4(e)(6)(B) | <https://www.ecfr.gov/current/title-42/section-460.46> 42 CFR 460.46 | CMS | Penalty for PACE organization that discriminates in enrollment or disenrollment, or engages in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment, on the basis of health status or the need for services | 2024 | 47,596 | 48,833

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for PACE organization that discriminates in enrollment or disenrollment, or engages in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment, on the basis of health status or the need for services — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for certification of a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment

**Statutory authority:** 1395i-3(b)(3)(B)(ii)(1)

**Maximum penalty:** 2,739

> 1395i-3(b)(3)(B)(ii)(1) | <https://www.ecfr.gov/current/title-42/section-1003.210#p-1003.210(a)(11)> 42 CFR 1003.210(a)(11) | OIG | Penalty for certification of a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment | 2024 | 2,670 | 2,739

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for certification of a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for causing another to certify or make a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment

**Statutory authority:** 1395i-3(b)(3)(B)(ii)(2)

**Maximum penalty:** 13,690

> 1395i-3(b)(3)(B)(ii)(2) | <https://www.ecfr.gov/current/title-42/section-1003.210#p-1003.210(a)(11)> 42 CFR 1003.210(a)(11) | OIG | Penalty for causing another to certify or make a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment | 2024 | 13,343 | 13,690

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for causing another to certify or make a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395i-3(g)(2)(A)

**Maximum penalty:** 5,478

> 1395i-3(g)(2)(A) | <https://www.ecfr.gov/current/title-42/section-1003.1310> 42 CFR 1003.1310 | OIG | 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 | 2024 | 5,339 | 5,478

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty per day for a Skilled Nursing Facility that has a Category 2 violation of certification requirements

**Statutory authority:** 1395i-3(h)(2)(B)(ii)(I)

**Maximum penalty:** 8,211

**Minimum penalty:** 136

> 1395i-3(h)(2)(B)(ii)(I) | <https://www.ecfr.gov/current/title-42/section-488.408#p-488.408(d)(1)(iii)> 42 CFR 488.408(d)(1)(iii) | CMS | Penalty per day for a Skilled Nursing Facility that has a Category 2 violation of certification requirements | 2024 | | | | | | Minimum | 2024 | 133 | 136 | | | | Maximum | 2024 | 8,003 | 8,211

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty per day for a Skilled Nursing Facility that has a Category 2 violation of certification requirements — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for noncompliance by hospice program with requirements specified in section 1395x(dd) of 42 U.S.C.

**Statutory authority:** 1395i-6(c)(5)(B)(i)

**Maximum penalty:** 11,413

> 1395i-6(c)(5)(B)(i) | <https://www.ecfr.gov/current/title-42/section-488.1245> 42 CFR 488.1245 | CMS | Penalty for noncompliance by hospice program with requirements specified in section 1395x(dd) of 42 U.S.C. | 2024 | 11,124 | 11,413

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for noncompliance by hospice program with requirements specified in section 1395x(dd) of 42 U.S.C. — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395l(h)(5)(D)

**Maximum penalty:** 19,940

> 1395l(h)(5)(D) | <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(i)> 42 CFR 402.105(d)(2)(i) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395l(i)(6)

**Maximum penalty:** 5,254

> 1395l(i)(6) | | CMS | 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 | 2024 | 5,121 | 5,254

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for knowingly and willfully failing to provide information about a referring physician when seeking payment on an unassigned basis

**Statutory authority:** 1395l(q)(2)(B)(i)

**Maximum penalty:** 5,026

> 1395l(q)(2)(B)(i) | <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(a)> 42 CFR 402.105(a) | CMS | Penalty for knowingly and willfully failing to provide information about a referring physician when seeking payment on an unassigned basis | 2024 | 4,899 | 5,026

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for knowingly and willfully failing to provide information about a referring physician when seeking payment on an unassigned basis — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for an applicable entity that has failed to report or made a misrepresentation or omission in reporting applicable information with respect to a clinical diagnostic laboratory test

**Statutory authority:** 1395m-1(a)

**Maximum penalty:** 13,295

> 1395m-1(a) | <https://www.ecfr.gov/current/title-42/section-414.504#p-414.504(e)> 42 CFR. 414.504(e) | CMS | Penalty for an applicable entity that has failed to report or made a misrepresentation or omission in reporting applicable information with respect to a clinical diagnostic laboratory test | 2024 | 12,958 | 13,295

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for an applicable entity that has failed to report or made a misrepresentation or omission in reporting applicable information with respect to a clinical diagnostic laboratory test — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395m(a)(11)(A)

**Maximum penalty:** 19,940

> 1395m(a)(11)(A) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(4)> 42 CFR 402.1(c)(4) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(ii)> 402.105(d)(2)(ii) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395m(a)(18)(B)

**Maximum penalty:** 19,940

> 1395m(a)(18)(B) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(5)> 42 CFR 402.1(c)(5) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(iii)> 402.105(d)(2)(iii) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395m(b)(5)(C)

**Maximum penalty:** 19,940

> 1395m(b)(5)(C) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(6)> 42 CFR 402.1(c)(6) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(iv)> 402.105(d)(2)(iv) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395m(h)(3)

**Maximum penalty:** 19,940

> 1395m(h)(3) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(8)> 42 CFR 402.1(c)(8) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(vi)> 402.105(d)(2)(vi) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395m> 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)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395m(j)(2)(A)(iii)

**Maximum penalty:** 2,111

> 1395m(j)(2)(A)(iii) | | CMS | 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 | 2024 | 2,058 | 2,111

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395m(j)(4)

**Maximum penalty:** 19,940

> 1395m(j)(4) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(10)> 42 CFR 402.1(c)(10) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(vii)> 402.105(d)(2)(vii) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395m> 42 U.S.C. 1395m(j)(4) and <https://www.govinfo.gov/link/uscode/42/1395u> 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395m(l)(6)

**Maximum penalty:** 19,940

> 1395m(l)(6) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(32)> 42 CFR 402.1(c)(32) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(4)> 402.105(d)(4) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(b)(18)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for a HMO or competitive medical plan if such plan substantially fails to provide medically necessary, required items or services

**Statutory authority:** 1395mm(i)(6)(B)(i)

**Maximum penalty:** 68,445

> 1395mm(i)(6)(B)(i) | <https://www.ecfr.gov/current/title-42/section-1003.410> 42 CFR 1003.410 | OIG | Penalty for a HMO or competitive medical plan if such plan substantially fails to provide medically necessary, required items or services | 2024 | 66,712 | 68,445

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for a HMO or competitive medical plan if such plan substantially fails to provide medically necessary, required items or services — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for submitting or causing to be submitted claims in violation of the Stark Law's restrictions on physician self-referrals

**Statutory authority:** 1395nn(g)(3)

**Maximum penalty:** 31,670

> 1395nn(g)(3) | <https://www.ecfr.gov/current/title-42/section-1003.310> 42 CFR 1003.310 | OIG | Penalty for submitting or causing to be submitted claims in violation of the Stark Law's restrictions on physician self-referrals | 2024 | 30,868 | 31,670

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for submitting or causing to be submitted claims in violation of the Stark Law's restrictions on physician self-referrals — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for circumvention schemes in violation of the Stark Law's restrictions on physician self-referrals

**Statutory authority:** 1395nn(g)(4)

**Maximum penalty:** 211,146

> 1395nn(g)(4) | <https://www.ecfr.gov/current/title-42/section-1003.310> 42 CFR 1003.310 | OIG | Penalty for circumvention schemes in violation of the Stark Law's restrictions on physician self-referrals | 2024 | 205,799 | 211,146

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for circumvention schemes in violation of the Stark Law's restrictions on physician self-referrals — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for any person that fails to report information required by HHS under Section 1877(f) concerning ownership, investment, and compensation arrangements

**Statutory authority:** 1395nn(g)(5)

**Maximum penalty:** 25,132

> 1395nn(g)(5) | <https://www.ecfr.gov/current/title-42/section-411.361> 42 CFR 411.361 | CMS | Penalty for any person that fails to report information required by HHS under Section 1877(f) concerning ownership, investment, and compensation arrangements | 2024 | 24,496 | 25,132

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for any person that fails to report information required by HHS under Section 1877(f) concerning ownership, investment, and compensation arrangements — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395pp(h)

**Maximum penalty:** 19,940

> 1395pp(h) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(23)> 42 CFR 402.1(c)(23) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(xv)> 402.105(d)(2)(xv) | CMS | 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. ( <https://www.govinfo.gov/link/uscode/42/1395> 42 U.S.C. 1395(m)(18) sanctions apply here in the same manner, which is under 1395u(j)(2) and 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395ss(a)(2)

**Maximum penalty:** 68,444

> 1395ss(a)(2) | 402.102(f)(1) | CMS | 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 | 2024 | 66,711 | 68,444

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for a material misrepresentation regarding Medigap compliance policies

**Statutory authority:** 1395ss(d)(1)

**Maximum penalty:** 13,132

> 1395ss(d)(1) | <https://www.ecfr.gov/current/title-42/section-1003.1110> 42 CFR 1003.1110 | OIG | Penalty for a material misrepresentation regarding Medigap compliance policies | 2024 | 12,799 | 13,132

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for a material misrepresentation regarding Medigap compliance policies — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for selling Medigap policy under false pretense

**Statutory authority:** 1395ss(d)(2)

**Maximum penalty:** 13,132

> 1395ss(d)(2) | <https://www.ecfr.gov/current/title-42/section-1003.1110> 42 CFR 1003.1110 | OIG | Penalty for selling Medigap policy under false pretense | 2024 | 12,799 | 13,132

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for selling Medigap policy under false pretense — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for an issuer that sells health insurance policy that duplicates benefits

**Statutory authority:** 1395ss(d)(3)(A)(ii)

**Maximum penalty:** 59,114

> 1395ss(d)(3)(A)(ii) | <https://www.ecfr.gov/current/title-42/section-1003.1110> 42 CFR 1003.1110 | OIG | Penalty for an issuer that sells health insurance policy that duplicates benefits | 2024 | 57,617 | 59,114

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for an issuer that sells health insurance policy that duplicates benefits — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for someone other than issuer that sells or issues a Medicare supplemental policy to beneficiary without a disclosure statement

**Statutory authority:** 1395ss(d)(3)(A)(vi)(II)

**Maximum penalty:** 35,466

> 1395ss(d)(3)(A)(vi)(II) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(25)> 42 CFR 402.1(c)(25) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(e)> 402.105(e) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(f)(2)> 402.105(f)(2) | CMS | Penalty for someone other than issuer that sells or issues a Medicare supplemental policy to beneficiary without a disclosure statement | 2024 | 34,568 | 35,466

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for someone other than issuer that sells or issues a Medicare supplemental policy to beneficiary without a disclosure statement — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for someone other than issuer that sells or issues a Medicare supplemental policy without acknowledgement form

**Statutory authority:** 1395ss(d)(3)(B)(iv)

**Maximum penalty:** 35,466

> 1395ss(d)(3)(B)(iv) | | CMS | Penalty for someone other than issuer that sells or issues a Medicare supplemental policy without acknowledgement form | 2024 | 34,568 | 35,466

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for someone other than issuer that sells or issues a Medicare supplemental policy without acknowledgement form — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for using mail to sell a non-approved Medigap insurance policy

**Statutory authority:** 1395ss(d)(4)(A)

**Maximum penalty:** 13,132

> 1395ss(d)(4)(A) | <https://www.ecfr.gov/current/title-42/section-1003.1110> 42 CFR 1003.1110 | OIG | Penalty for using mail to sell a non-approved Medigap insurance policy | 2024 | 12,799 | 13,132

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for using mail to sell a non-approved Medigap insurance policy — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for someone other than issuer that sells or issues Medicare supplemental polices after a given date that fail to conform to the NAIC or Federal standards established by statute

**Statutory authority:** 1395ss(p)(8)

**Maximum penalty:** 35,466

> 1395ss(p)(8) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(25)> 42 CFR 402.1(c)(25) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(e)> 402.105(e) | CMS | Penalty for someone other than issuer that sells or issues Medicare supplemental polices after a given date that fail to conform to the NAIC or Federal standards established by statute | 2024 | 34,568 | 35,466

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for someone other than issuer that sells or issues Medicare supplemental polices after a given date that fail to conform to the NAIC or Federal standards established by statute — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for someone other than issuer 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

**Statutory authority:** 1395ss(p)(9)(C)

**Maximum penalty:** 35,466

> 1395ss(p)(9)(C) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(26)> 42 CFR 402.1(c)(26) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(e)> 402.105(e) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(f)(3)> 402.105(f)(3) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(4)> (4) | CMS | Penalty for someone other than issuer 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 | 2024 | 34,568 | 35,466

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for someone other than issuer 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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395ss(q)(5)(C)

**Maximum penalty:** 59,114

> 1395ss(q)(5)(C) | <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(f)(5)> 42 CFR 402.105(f)(5) | CMS | 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 | 2024 | 57,617 | 59,114

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for any person that fails to provide refunds or credits as required by section 1882(r)(1)(B)

**Statutory authority:** 1395ss(r)(6)(A)

**Maximum penalty:** 59,114

> 1395ss(r)(6)(A) | <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(f)(6)> 42 CFR 402.105(f)(6) | CMS | Penalty for any person that fails to provide refunds or credits as required by section 1882(r)(1)(B) | 2024 | 57,617 | 59,114

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for any person that fails to provide refunds or credits as required by section 1882(r)(1)(B) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395ss(s)(4)

**Maximum penalty:** 25,095

> 1395ss(s)(4) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(29)> 42 CFR 402.1(c)(29) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(c)> 402.105(c) | CMS | 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 | C2024 | 24,460 | 25,095

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for any issuer of a Medicare supplemental policy that fails to fulfill listed responsibilities

**Statutory authority:** 1395ss(t)(2)

**Maximum penalty:** 59,114

> 1395ss(t)(2) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(30)> 42 CFR 402.1(c)(30) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(f)(7)> 402.105(f)(7) | CMS | Penalty for any issuer of a Medicare supplemental policy that fails to fulfill listed responsibilities | 2024 | 57,617 | 59,114

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for any issuer of a Medicare supplemental policy that fails to fulfill listed responsibilities — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty someone other than issuer who sells, issues, or renews a medigap Rx policy to an individual who is a Part D enrollee

**Statutory authority:** 1395ss(v)(4)(A)

**Maximum penalty:** 25,594

> 1395ss(v)(4)(A) | | CMS | Penalty someone other than issuer who sells, issues, or renews a medigap Rx policy to an individual who is a Part D enrollee | 2024 | 24,946 | 25,594

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty someone other than issuer who sells, issues, or renews a medigap Rx policy to an individual who is a Part D enrollee — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395u(b)(18)(B)

**Maximum penalty:** 19,940

> 1395u(b)(18)(B) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(11)> 42 CFR 402.1(c)(11) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(viii)> 402.105(d)(2)(viii) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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) )

**Statutory authority:** 1395u(j)(2)(B)

**Maximum penalty:** 19,940

> 1395u(j)(2)(B) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)> 42 CFR 402.1(c) | CMS | Penalty for any physician who charges more than 125% for a non-participating referral. (Penalties are assessed in the same manner as <https://www.govinfo.gov/link/uscode/42/1320a-7a> 42 U.S.C. 1320a-7a(a) ) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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) ) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395u(k)

**Maximum penalty:** 19,940

> 1395u(k) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(12)> 42 CFR 402.1(c)(12) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(ix)> 402.105(d)(2)(ix) 1834A(a)(9) and <https://www.ecfr.gov/current/title-42/section-414.504#p-414.504(e)> 42 CFR 414.504(e) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for any 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))

**Statutory authority:** 1395u(l)(3)

**Maximum penalty:** 19,940

> 1395u(l)(3) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(13)> 42 CFR 402.1(c)(13) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(x)> 402.105(d)(2)(x) | CMS | Penalty for any 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for any 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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395u(m)(3)

**Maximum penalty:** 19,940

> 1395u(m)(3) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(14)> 42 CFR 402.1(c)(14) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(xi)> 402.105(d)(2)(xi) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395u(n)(3)

**Maximum penalty:** 19,940

> 1395u(n)(3) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(15)> 42 CFR 402.1(c)(15) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(xii)> 402.105(d)(2)(xii) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395u(o)(3)(B)

**Maximum penalty:** 19,940

> 1395u(o)(3)(B) | <https://www.ecfr.gov/current/title-42/section-414.707#p-414.707(b)> 42 CFR 414.707(b) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(b)(18)(B) and <https://www.govinfo.gov/link/uscode/42/1395u> 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395u(p)(3)(A)

**Maximum penalty:** 5,254

> 1395u(p)(3)(A) | | 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 | 2024 | 5,121 | 5,254

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for a prescription drug card sponsor that falsifies or misrepresents marketing materials, overcharges program enrollees, or misuse transitional assistance funds

**Statutory authority:** 1395w-141(i)(3)

**Maximum penalty:** 17,062

> 1395w-141(i)(3) | | OIG | Penalty for a prescription drug card sponsor that falsifies or misrepresents marketing materials, overcharges program enrollees, or misuse transitional assistance funds | 2024 | 16,630 | 17,062

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for a prescription drug card sponsor that falsifies or misrepresents marketing materials, overcharges program enrollees, or misuse transitional assistance funds — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for a Medicare Advantage organization that substantially fails to provide medically necessary, required items and services

**Statutory authority:** 1395w-27(g)(2)(A)

**Maximum penalty:** 49,848

> 1395w-27(g)(2)(A) | <https://www.ecfr.gov/current/title-42/section-1003.410> 42 CFR 1003.410 | OIG | Penalty for a Medicare Advantage organization that substantially fails to provide medically necessary, required items and services | 2024 | 48,586 | 49,848

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for a Medicare Advantage organization that substantially fails to provide medically necessary, required items and services — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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 (or has the substantial likelihood of adversely affecting) an individual covered under the organization's contract

**Statutory authority:** 1395w-27(g)(3)(A); 1857(g)(3); 1860D-12(b)(3)(E)

**Maximum penalty:** 48,833

> 1395w-27(g)(3)(A); 1857(g)(3); 1860D-12(b)(3)(E) | <https://www.ecfr.gov/current/title-42/section-422.760#p-422.760(b)> 42 CFR 422.760(b) ; <https://www.ecfr.gov/current/title-42/section-423.760#p-423.760(b)> 42 CFR 423.760(b) | CMS | 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 (or has the substantial likelihood of adversely affecting) an individual covered under the organization's contract | 2024 | 47,596 | 48,833

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 (or has the substantial likelihood of adversely affecting) an individual covered under the organization's contract — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395w-27(g)(3)(B); 1857(g)(3); 1860D-12(b)(3)(E)

**Maximum penalty:** 19,535

> 1395w-27(g)(3)(B); 1857(g)(3); 1860D-12(b)(3)(E) | | CMS | 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 | 2024 | 19,040 | 19,535

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for a Medicare Advantage organization's or Part D sponsor's early termination of its contract

**Statutory authority:** 1395w-27(g)(3)(D); 1857(g)(3): 1860D-12(b)(3)(E)

**Maximum penalty:** 181,400

> 1395w-27(g)(3)(D); 1857(g)(3): 1860D-12(b)(3)(E) | | CMS | Penalty for a Medicare Advantage organization's or Part D sponsor's early termination of its contract | 2024 | 176,807 | 181,400

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for a Medicare Advantage organization's or Part D sponsor's early termination of its contract — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for a pharmaceutical manufacturer's misrepresentation of average sales price of a drug, or biologic

**Statutory authority:** 1395w-3a(d)(4)(A)

**Maximum penalty:** 17,062

> 1395w-3a(d)(4)(A) | <https://www.ecfr.gov/current/title-42/section-414.806> 42 CFR 414.806 | CMS | Penalty for a pharmaceutical manufacturer's misrepresentation of average sales price of a drug, or biologic | 2024 | 16,630 | 17,062

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for a pharmaceutical manufacturer's misrepresentation of average sales price of a drug, or biologic — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395w-4(g)(1)(B)

**Maximum penalty:** 19,940

> 1395w-4(g)(1)(B) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(17)> 42 CFR 402.1(c)(17) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(xiii)> 402.105(d)(2)(xiii) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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))

**Statutory authority:** 1395w-4(g)(3)(B)

**Maximum penalty:** 19,940

> 1395w-4(g)(3)(B) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(18)> 42 CFR 402.1(c)(18) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(d)(2)(xiv)> 402.105(d)(2)(xiv) | CMS | 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 <https://www.govinfo.gov/link/uscode/42/1395u> 42 U.S.C. 1395u(j)(2)(B) , which is assessed according to 1320a-7a(a)) | 2024 | 19,435 | 19,940

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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)) — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395y(b)(3)(C)

**Maximum penalty:** 11,823

> 1395y(b)(3)(C) | <https://www.ecfr.gov/current/title-42/section-411.103#p-411.103(b)> 42 CFR 411.103(b) | CMS | 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 | 2024 | 11,524 | 11,823

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395y(b)(5)(C)(ii)

**Maximum penalty:** 1,926

> 1395y(b)(5)(C)(ii) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(20)> 42 CFR 402.1(c)(20) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(b)(2)> 42 CFR 402.105(b)(2) | CMS | 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 | 2024 | 1,877 | 1,926

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395y(b)(6)(B)

**Maximum penalty:** 4,224

> 1395y(b)(6)(B) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(20)> 42 CFR 402.1(c)(20) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(a)> 402.105(a) | CMS | 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 | 2024 | 4,117 | 4,224

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395y(b)(7)(B)(i)

**Maximum penalty:** 1,512

> 1395y(b)(7)(B)(i) | <https://www.ecfr.gov/current/title-42/section-402.1#p-402.1(c)(21)> 42 CFR 402.1(c)(21) , <https://www.ecfr.gov/current/title-42/section-402.105#p-402.105(a)> 402.105(a) | CMS | 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 | 2024 | 1,474 | 1,512

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** 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

**Statutory authority:** 1395y(b)(8)(E)

**Maximum penalty:** 1,512

> 1395y(b)(8)(E) | | CMS | 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 | 2024 | 1,474 | 1,512

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

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 — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for a Medicaid MCO that substantially fails to provide medically necessary, required items or services

**Statutory authority:** 1396b(m)(5)(B)(i)

**Maximum penalty:** 65,653

> 1396b(m)(5)(B)(i) | <https://www.ecfr.gov/current/title-42/section-1003.410> 42 CFR 1003.410 | OIG | Penalty for a Medicaid MCO that substantially fails to provide medically necessary, required items or services | 2024 | 63,991 | 65,653

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for a Medicaid MCO that substantially fails to provide medically necessary, required items or services — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for the knowing provision of false information or refusing to provide information about charges or prices of a covered outpatient drug

**Statutory authority:** 1396r-8(b)(3)(B)

**Maximum penalty:** 236,451

> 1396r-8(b)(3)(B) | <https://www.ecfr.gov/current/title-42/section-1003.1210> 42 CFR 1003.1210 | OIG | Penalty for the knowing provision of false information or refusing to provide information about charges or prices of a covered outpatient drug | 2024 | 230,464 | 236,451

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for the knowing provision of false information or refusing to provide information about charges or prices of a covered outpatient drug — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty per day for failure to timely provide information by drug manufacturer with rebate agreement

**Statutory authority:** 1396r-8(b)(3)(C)(i)

**Maximum penalty:** 23,647

> 1396r-8(b)(3)(C)(i) | <https://www.ecfr.gov/current/title-42/section-1003.1210> 42 CFR 1003.1210 | OIG | Penalty per day for failure to timely provide information by drug manufacturer with rebate agreement | 2024 | 23,048 | 23,647

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty per day for failure to timely provide information by drug manufacturer with rebate agreement — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for knowing provision of false information by drug manufacturer with rebate agreement

**Statutory authority:** 1396r-8(b)(3)(C)(ii)

**Maximum penalty:** 236,451

> 1396r-8(b)(3)(C)(ii) | <https://www.ecfr.gov/current/title-42/section-1003.1210> 42 CFR 1003.1210 | OIG | Penalty for knowing provision of false information by drug manufacturer with rebate agreement | 2024 | 230,464 | 236,451

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for knowing provision of false information by drug manufacturer with rebate agreement — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for willfully and knowingly certifying a material and false statement in a Skilled Nursing Facility resident assessment

**Statutory authority:** 1396r(b)(3)(B)(ii)(I)

**Maximum penalty:** 2,739

> 1396r(b)(3)(B)(ii)(I) | <https://www.ecfr.gov/current/title-42/section-1003.210#p-1003.210(a)(11)> 42 CFR 1003.210(a)(11) | OIG | Penalty for willfully and knowingly certifying a material and false statement in a Skilled Nursing Facility resident assessment | 2024 | 2,670 | 2,739

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for willfully and knowingly certifying a material and false statement in a Skilled Nursing Facility resident assessment — Federal civil penalty maximums — current inflation-adjusted amounts across agencies


**Agency:** HHS

**Violation:** Penalty for willfully and knowingly causing another individual to certify a material and false statement in a Skilled Nursing Facility resident assessment

**Statutory authority:** 1396r(b)(3)(B)(ii)(II)

**Maximum penalty:** 13,690

> 1396r(b)(3)(B)(ii)(II) | <https://www.ecfr.gov/current/title-42/section-1003.210#p-1003.210(a)(11)> 42 CFR 1003.210(a)(11) | OIG | Penalty for willfully and knowingly causing another individual to certify a material and false statement in a Skilled Nursing Facility resident assessment | 2024 | 13,343 | 13,690

Source: <https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-102/section-102.3>

Penalty for willfully and knowingly causing another individual to certify a material and false statement in a Skilled Nursing Facility resident assessment — Federal civil penalty maximums — current inflation-adjusted amounts across agencies