42 C.F.R. § 1003.410

Current through October 31, 2024
Section 1003.410 - Amount of penalties and assessments for Contracting Organization
(a)Penalties.
(1) The OIG may impose a penalty of up to $25,000 for each individual violation under § 1001.400 , except as provided in this section.
(2) The OIG may impose a penalty of up to $100,000 for each individual violation under § 1003.400(a)(3), (a)(5), or (e) .
(b)Additional penalties. In addition to the penalties described in paragraph (a) of this section, the OIG may impose-
(1) An additional penalty equal to double the amount of excess premium charged by the contracting organization for each individual violation of § 1003.400(a)(2) . The excess premium amount will be deducted from the penalty and returned to the enrollee.
(2) An additional $15,000 penalty for each individual expelled or not enrolled in violation of § 1003.400(a)(3) or (e) .
(c)Assessments. The OIG may impose an assessment against a contracting organization with a contract under section 1857 or 1860D-12 of the Act (Medicare Advantage or Part D) of not more than the amount claimed in violation of § 1003.400(a)(4) or (a)(5) on the basis of the misrepresentation or falsified information involved.
(d) The OIG may impose a penalty or, when applicable, an assessment, against a contracting organization with a contract under section 1857 or 1860D-12 of the Act (Medicare Advantage or Part D) if any of its employees, agents, or contracting providers or suppliers engages in any of the conduct described in § 1003.400(a) through (d) .

42 C.F.R. §1003.410

81 FR 88357 , Dec. 7, 2016, as amended at 88 FR 42841 , July 3, 2023
81 FR 88357 , 1/6/2017; 88 FR 42841 , 8/2/2023