OIG final rule beefs up civil monetary penalties

Last week, the Health and Human Services Office of Inspector General (OIG) released its final rule revising the agency’s exclusion and civil monetary penalty (CMP) authority for providers who commit fraud and abuse.

Essentially the same as the proposed rule published in the Federal Register on Sept. 2, 1998, the final rule codifies provisions set forth in the Balanced Budget Act of 1997.

The revised exclusion and CMP authorities under the rule include:

- Expanding the OIG’s power to exclude providers beyond Medicare and the state health care programs to all health care programs.

- Establishing permanent exclusions for individuals convicted of three or more health care-related crimes and 10-year exclusions for individuals convicted of two health care-related crimes.

- Assessing CMPs of up to $10,000 against institutional providers that knowingly employ or enter into contracts for medical services with excluded individuals.

- Establishing a new CMP of up to $25,000 for health plans that fail to report information to the Healthcare Integrity and Protection Data Bank.

- Creating CMPs of up to $50,000 for providers who violate the anti-kickback statute, including a maximum penalty of not more than three times the amount of remuneration offered, paid, solicited, or received in the kickback scheme.

The final rule went into effect July 22.