Civil and criminal penalties increased for fraud and abuse

The Bipartisan Budget Act of 2018 (BBA 2018) significantly increased civil and criminal penalties for federal health care program fraud and abuse. Below is a summary of some of the BBA 2018 changes to the maximum penalty amounts, which apply for acts committed after February 9, 2018.

Civil Monetary Penalties

• $5,000
  • A hospital or physician that gives or receives a payment to reduce/limit medically necessary services to Medicare/Medicaid beneficiaries
• $10,000
  • A physician who signs a home health certification knowing all the requirements are not met
• $20,000
  • False claims
  • Requesting payment in violation of assignment agreement
  • Excluded party retaining ownership/controlling interest in a participating entity (per day)
  • Beneficiary inducements
  • Employing/contracting with an excluded individual
  • Ordering/prescribing while excluded
  • Failure to report and return an overpayment
• $30,000
  • Giving/causing to be presented false or misleading information to influence a hospital discharge decision
  • Failure to grant timely access to OIG (per day)
• $100,000
  • Violating the Anti-Kickback Statute
  • Making/causing to be made false statements, omission or misrepresentation of a material fact in an application, bid or contract to participate/enroll as a provider/supplier

Criminal Penalties

• $100,000 plus 10 years imprisonment (a felony) for persons who commit any of the acts listed below in connection with the furnishing of items/services reimbursable by federal health care programs:
  • Violating the Anti-Kickback Statute
  • Making/causing to be made a false statement or representation of a material fact:
    • In an application for or payment under a federal health care program
    • For use in determining rights to such payment
  • Concealing/failing to disclose knowledge of the occurrence of an event affecting the initial/continuing right to any payment with an intent to fraudulently secure such payment
  • Presenting/causing to be presented a claim for a physician service knowing the individual is not a licensed physician
• $20,000 plus one year imprisonment (a misdemeanor) for the same offenses listed above where the conduct is by the same person who furnishes the items/services payable under federal health care programs
• $4,000 plus imprisonment of up to six months (misdemeanor)
  • Repeatedly violating the terms of the assignment agreement