Federal Register, Volume 91 Issue 18 (Wednesday, January 28, 2026)

[Federal Register Volume 91, Number 18 (Wednesday, January 28, 2026)]
[Rules and Regulations]
[Pages 3665-3682]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2026-01688]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

45 CFR Part 102

RIN 0991-AC38

Annual Civil Monetary Penalties Inflation Adjustment

AGENCY: Office of the Assistant Secretary for Financial Resources,
Department of Health and Human Services.

ACTION: Final rule.

-----------------------------------------------------------------------

SUMMARY: The Department of Health and Human Services (HHS) is updating
its regulations to reflect required annual inflation-related increases
to the civil monetary penalty (CMP) amounts in its statutes and
regulations, under the Federal Civil Penalties Inflation Adjustment Act
Improvements Act of 2015.

DATES:
Effective date: This final rule is effective upon publication to
the Federal Register.
Applicability date: The adjusted civil monetary penalty amounts
apply to penalties assessed on or after the date of publication to the
Federal Register, if the violation occurred on or after November 2,
2015.

FOR FURTHER INFORMATION CONTACT: Jennifer Johnson, Acting, Deputy
Assistant Secretary, Office of Acquisitions, Office of the Assistant
Secretary for Financial Resources, Room 536-H, Hubert Humphrey
Building, 200 Independence Avenue SW, Washington, DC 20201; (771) 215-
0133.

SUPPLEMENTARY INFORMATION:

I. Background

The Federal Civil Penalties Inflation Adjustment Act Improvements
Act of 2015 (section 701 of Pub. L. 114-74) (the ``2015 Act'') amended
the Federal Civil Penalties Inflation Adjustment Act of 1990 (Pub. L.
101-410, 104 Stat. 890 (1990)), which is intended to improve the
effectiveness of CMPs and to maintain the deterrent effect of such
penalties, requires agencies to adjust the CMPs for inflation annually.
HHS lists the CMP authorities and the amounts administered by all
of its agencies in tabular form in 45 CFR 102.3, which was issued in an
interim final rule published in the September 6, 2016, Federal Register
(81 FR 61538). Annual adjustments were subsequently published on
February 3, 2017 (82 FR 9175), October 11, 2018 (83 FR 51369), November
5, 2019 (84 FR 59549), January 17, 2020 (85 FR 2869), November 15, 2021
(86 FR 62928), March 17, 2022 (87 FR 15100), October 6, 2023 (88 FR
69531), and August 8, 2024 (89 FR 64815).

II. Calculation of Annual Inflation Adjustment and Other Updates

The annual inflation adjustment for each applicable CMP is
determined using the percent increase in the Consumer Price Index for
all Urban Consumers (CPI-U) for the month of October of the year in
which the amount of each CMP was most recently established or modified.
In the December 17, 2024, Office of Management and Budget (OMB)
Memorandum for the Heads of Executive Departments and Agencies, M-25-
02, ``Implementation of Penalty Inflation Adjustments for 2025,
Pursuant to the Federal Civil Penalties Inflation Adjustment Act
Improvements Act of 2015,'' OMB published the multiplier for the
required annual adjustment. The cost-of-living adjustment multiplier
for 2025, based on the CPI-U for the month of October 2024, not
seasonally adjusted, is 1.02598. The multiplier is applied to each
applicable penalty amount that was updated and published for fiscal
year (FY) 2024 and is rounded to the nearest dollar.
In addition to the inflation adjustments for 2025, this final rule
corrects several technical errors and updates descriptions for
clarification and accuracy. The following non-substantive technical
errors were identified and are corrected and following descriptions are
updated in the table in 45 CFR 102.3:
The description of 42 U.S.C. 1320a-7j(h)(3)(A) is revised
to add the word ``Maximum'' to accurately reflect the statutory maximum
penalty amount.
The regulatory cite associated with ``Penalty against
hospital identified by CMS as noncompliant according to Sec. 182.50
with respect to price transparency requirements regarding diagnostic
tests for COVID-19'' was corrected from 45 CFR 180.90 to 45 CFR 182.70.
The 2024 maximum penalty associated with 45 CFR
180.90(c)(2)(ii)(C) was revised as it was cited incorrectly as $3,021
but should have been $6,118 in the last adjustment. In the 2024
adjustment, the amount reflected in the 2023 Maximum Adjusted Penalty
column should have been $5,926, which was the actual adjusted amount in
2023 (see 88 FR at 69541). However, this amount was inadvertently
mistyped as $2,926 in the last adjustment (see 89 FR at 64823).
Applying the 2024 multiplier to the correct amount would have resulted
in

[[Page 3666]]

$6,118 ($5,926 x 1.03241). Therefore, the 2024 Maximum Adjusted Penalty
was revised in this rule to $6,118.

III. Statutory and Executive Order Reviews and Waiver of Proposed
Rulemaking

The 2015 Act requires Federal agencies to publish annual penalty
inflation adjustments notwithstanding section 553 of the Administrative
Procedure Act (APA). Section 4(a) of the 2015 Act directs Federal
agencies to publish annual adjustments no later than January 15th of
each year thereafter. In accordance with section 553 of the APA, most
rules are subject to notice and comment and are effective no earlier
than 30 days after publication in the Federal Register. However,
section 4(b)(2) of the 2015 Act provides that each agency shall make
the annual inflation adjustments ``notwithstanding section 553'' of the
APA. According to OMB's Memorandum M-25-02, the phrase
``notwithstanding section 553'' in section 4(b)(2) of the 2015 Act
means that ``the notice and comment process the APA generally
requires--i.e., notice, an opportunity for comment, and a delay in
effective date--is not required for agencies to issue regulations
implementing the annual adjustment.''
Consistent with the language of the 2015 Act and OMB's
implementation guidance, the inflation adjustments set out in this rule
are not subject to notice and an opportunity for public comment and
will be effective immediately upon publication. Also, HHS finds that
notice and comment procedures would be impracticable and unnecessary
under the APA for the ministerial and technical changes in this rule.
In addition, HHS is waiving notice and comment for the non-substantive
technical corrections set out in this final rule. HHS finds good cause
for issuing these changes as a final rule without prior notice and
comment because these changes make technical clarifying edits to
descriptions and corrections to inadvertent typographical errors from
the last update. For these same reasons, HHS also finds good cause to
make the final rule effective upon publication.
Pursuant to OMB Memorandum M-25-02, HHS has determined that the
annual inflation adjustment to the civil monetary penalties in its
regulations does not trigger any requirements under procedural statutes
and Executive Orders that govern rulemaking procedures.

IV. Effective and Applicability Dates

This rule is effective on the date specified in the DATES section
of this final rule. The adjusted civil monetary penalty amounts apply
to penalties assessed on or after the date specified in the DATES
section of this final rule, if the violation occurred on or after
November 2, 2015 (i.e., the date of enactment of the 2015 Act). If the
violation occurred before November 2, 2015, or a penalty was assessed
before September 6, 2016, the pre-adjustment civil penalty amounts in
effect before September 6, 2016, will apply.

List of Subjects in 45 CFR Part 102

Administrative practice and procedure, Penalties.

For reasons discussed in the preamble, the Department of Health and
Human Services amends subtitle A, title 45 of the Code of Federal
Regulations as follows:

PART 102--ADJUSTMENT OF CIVIL MONETARY PENALTIES FOR INFLATION

0
1. The authority citation for part 102 continues to read as follows:

Authority: Pub. L. 101-410, Sec. 701 of Pub. L. 114-74, 31
U.S.C. 3801-3812.

0
2. Amend Sec. 102.3 by revising table 1 to read as follows:

Sec. 102.3 Penalty adjustment and table.

* * * * *

[[Page 3667]]

Table 1 to Sec. 102.3--Civil Monetary Penalty Authorities Administered By HHS
--------------------------------------------------------------------------------------------------------------------------------------------------------
Date of
last 2024 2025
penalty Maximum Maximum
U.S.C. section(s) CFR \1\ HHS agency Description \2\ figure or adjusted adjusted
adjustment penalty ($) penalty ($)
\3\ \4\
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 U.S.C.:
333(b)(2)(A).............. ...................... FDA........... Penalty for violations related to drug 2024 127,983 131,308
samples resulting in a conviction of any
representative of manufacturer or
distributor in any 10-year period.
333(b)(2)(B).............. ...................... FDA........... Penalty for violation related to drug 2024 2,559,636 2,626,135
samples resulting in a conviction of any
representative of manufacturer or
distributor after the second conviction
in any 10-yr period.
333(b)(3)................. ...................... FDA........... Penalty for failure to make a report 2024 255,964 262,614
required by 21 U.S.C. 353(d)(3)(E)
relating to drug samples.
333(f)(1)(A).............. ...................... FDA........... Penalty for any person who violates a 2024 34,568 35,466
requirement related to devices for each
such violation.
FDA........... Penalty for aggregate of all violations 2024 2,304,629 2,364,503
related to devices in a single
proceeding.
333(f)(2)(A).............. ...................... FDA........... Penalty for any individual who introduces 2024 97,179 99,704
or delivers for introduction into
interstate commerce food that is
adulterated per 21 U.S.C. 342(a)(2)(B)
or any individual who does not comply
with a recall order under 21 U.S.C. 350l.
FDA........... Penalty in the case of any other person 2024 485,893 498,517
(other than an individual) for such
introduction or delivery of adulterated
food.
FDA........... Penalty for aggregate of all such 2024 971,787 997,034
violations related to adulterated food
adjudicated in a single proceeding.
333(f)(3)(A).............. ...................... FDA........... Penalty for all violations adjudicated in 2024 14,724 15,107
a single proceeding for any person who
violates 21 U.S.C. 331(jj) by failing to
submit the certification required by 42
U.S.C. 282(j)(5)(B) or knowingly
submitting a false certification; by
failing to submit clinical trial
information under 42 U.S.C. 282(j); or
by submitting clinical trial information
under 42 U.S.C. 282(j) that is false or
misleading in any particular under 42
U.S.C. 282(j)(5)(D).
333(f)(3)(B).............. ...................... FDA........... Penalty for each day any above violation 2024 14,724 15,107
is not corrected after a 30-day period
following notification until the
violation is corrected.
333(f)(4)(A)(i)........... ...................... FDA........... Penalty for any responsible person that 2024 368,137 377,701
violates a requirement of 21 U.S.C.
355(o) (post-marketing studies, clinical
trials, labeling), 21 U.S.C. 355(p)
(risk evaluation and mitigation (REMS)),
or 21 U.S.C. 355-1 (REMS).
FDA........... Penalty for aggregate of all such above 2024 1,472,546 1,510,803
violations in a single proceeding.
333(f)(4)(A)(ii).......... ...................... FDA........... Penalty for REMS violation that continues 2024 368,137 377,701
after written notice to the responsible
person for the first 30-day period (or
any portion thereof) the responsible
person continues to be in violation.
FDA........... Penalty for REMS violation that continues 2024 1,472,546 1,510,803
after written notice to responsible
person doubles for every 30-day period
thereafter the violation continues, but
may not exceed penalty amount for any 30-
day period.
FDA........... Penalty for aggregate of all such above 2024 14,725,456 15,108,023
violations adjudicated in a single
proceeding.
333(f)(9)(A).............. ...................... FDA........... Penalty for any person who violates a 2024 21,348 21,903
requirement which relates to tobacco
products for each such violation.
FDA........... Penalty for aggregate of all such 2024 1,423,220 1,460,195
violations of tobacco product
requirement adjudicated in a single
proceeding.
333(f)(9)(B)(i)(I)........ ...................... FDA........... Penalty per violation related to 2024 355,806 365,050
violations of tobacco requirements.
FDA........... Penalty for aggregate of all such 2024 1,423,220 1,460,195
violations of tobacco product
requirements adjudicated in a single
proceeding.
333(f)(9)(B)(i)(II)....... ...................... FDA........... Penalty in the case of a violation of 2024 355,806 365,050
tobacco product requirements that
continues after written notice to such
person, for the first 30-day period (or
any portion thereof) the person
continues to be in violation.
FDA........... Penalty for violation of tobacco product 2024 1,423,220 1,460,195
requirements that continues after
written notice to such person shall
double for every 30-day period
thereafter the violation continues, but
may not exceed penalty amount for any 30-
day period.
FDA........... Penalty for aggregate of all such 2024 14,232,205 14,601,958
violations related to tobacco product
requirements adjudicated in a single
proceeding.

[[Page 3668]]

333(f)(9)(B)(ii)(I)....... ...................... FDA........... Penalty for any person who either does 2024 355,806 365,050
not conduct post-market surveillance and
studies to determine impact of a
modified risk tobacco product for which
the HHS Secretary has provided them an
order to sell, or who does not submit a
protocol to the HHS Secretary after
being notified of a requirement to
conduct post-market surveillance of such
tobacco products.
FDA........... Penalty for aggregate of for all such 2024 1,423,220 1,460,195
above violations adjudicated in a single
proceeding.
333(f)(9)(B)(ii)(II)...... ...................... FDA........... Penalty for violation of modified risk 2024 355,806 365,050
tobacco product post-market surveillance
that continues after written notice to
such person for the first 30-day period
(or any portion thereof) that the person
continues to be in violation.
FDA........... Penalty for post-notice violation of 2024 1,423,220 1,460,195
modified risk tobacco product post-
market surveillance shall double for
every 30-day period thereafter that the
tobacco product requirement violation
continues for any 30-day period, but may
not exceed penalty amount for any 30-day
period.
Penalty for aggregate above tobacco 2024 14,232,205 14,601,958
product requirement violations
adjudicated in a single proceeding.
333(g)(1)................. FDA........... Penalty for any person who disseminates 2024 368,137 377,701
or causes another party to disseminate a
direct-to-consumer advertisement that is
false or misleading for the first such
violation in any 3-year period.
Penalty for each subsequent above 2024 736,274 755,402
violation in any 3-year period.
333 note.................. ...................... FDA........... Penalty to be applied for violations of 2024 356 365
21 U.S.C. 387f(d)(5) or of violations of
restrictions on the sale or distribution
of tobacco products promulgated under 21
U.S.C. 387f(d) (e.g., violations of
regulations in 21 CFR part 1140) with
respect to a retailer with an approved
training program in the case of a second
regulation violation within a 12-month
period..
FDA........... Penalty in the case of a third violation 2024 709 727
of 21 U.S.C. 387f(d)(5) or of the
tobacco product regulations within a 24-
month period.
FDA........... Penalty in the case of a fourth violation 2024 2,846 2,920
of 21 U.S.C. 387f(d)(5) or of the
tobacco product regulations within a 24-
month period.
FDA........... Penalty in the case of a fifth violation 2024 7,115 7,300
of 21 U.S.C. 387f(d)(5) or of the
tobacco product regulations within a 36-
month period.
FDA........... Penalty in the case of a sixth or 2024 14,232 14,602
subsequent violation of 21 U.S.C.
387f(d)(5) or of the tobacco product
regulations within a 48-month period as
determined on a case-by-case basis.
FDA........... Penalty to be applied for violations of 2024 356 365
21 U.S.C. 387f(d)(5) or of violations of
restrictions on the sale or distribution
of tobacco products promulgated under 21
U.S.C. 387f(d) (e.g., violations of
regulations in 21 CFR part 1140) with
respect to a retailer that does not have
an approved training program in the case
of the first regulation violation.
FDA........... Penalty in the case of a second violation 2024 709 727
of 21 U.S.C. 387f(d)(5) or of the
tobacco product regulations within a 12-
month period.
FDA........... Penalty in the case of a third violation 2024 1,424 1,461
of 21 U.S.C. 387f(d)(5) or of the
tobacco product regulations within a 24-
month period.
FDA........... Penalty in the case of a fourth violation 2024 2,846 2,920
of 21 U.S.C. 387f(d)(5) or of the
tobacco product regulations within a 24-
month period.
FDA........... Penalty in the case of a fifth violation 2024 7,115 7,300
of 21 U.S.C. 387f(d)(5) or of the
tobacco product regulations within a 36-
month period.
FDA........... Penalty in the case of a sixth or 2024 14,232 14,602
subsequent violation of 21 U.S.C.
387f(d)(5) or of the tobacco product
regulations within a 48-month period as
determined on a case-by-case basis.
335b(a)................... ...................... FDA........... Penalty for each violation for any 2024 542,434 556,526
individual who made a false statement or
misrepresentation of a material fact,
bribed, destroyed, altered, removed, or
secreted, or procured the destruction,
alteration, removal, or secretion of,
any material document, failed to
disclose a material fact, obstructed an
investigation, employed a consultant who
was debarred, debarred individual
provided consultant services.

[[Page 3669]]

FDA........... Penalty in the case of any other person 2024 2,169,731 2,226,101
(other than an individual) per above
violation.
360pp(b)(1)............... ...................... FDA........... Penalty for any person who violates any 2024 3,558 3,650
such requirements for electronic
products, with each unlawful act or
omission constituting a separate
violation.
FDA........... Penalty imposed for any related series of 2024 1,212,751 1,244,258
violations of requirements relating to
electronic products.
42 U.S.C.................. ...................... .............. ......................................... 2024 ........... ...........
262(d).................... ...................... FDA........... Penalty per day for violation of order of 2024 278,937 286,184
recall of biological product presenting
imminent or substantial hazard.
263b(h)(3)................ ...................... FDA........... Penalty for failure to obtain a 2024 21,699 22,263
mammography certificate as required.
300aa-28(b)(1)............ ...................... FDA........... Penalty per occurrence for any vaccine 2024 278,937 286,184
manufacturer that intentionally
destroys, alters, falsifies, or conceals
any record or report required.
56b(d)(1)(B)(vi).......... ...................... HRSA.......... Penalty for each instance of overcharging 2024 7,034 7,217
a 340B covered entity.
299c-3(d)................. ...................... AHRQ.......... Penalty for using or disclosing 2024 18,291 18,766
identifiable information obtained in the
course of activities undertaken pursuant
to Title IX of the Public Health Service
Act, for a purpose other than that for
which the information was supplied,
without consent to do so.
653(l)(2)................. 45 CFR 303.21(f)...... ACF........... Penalty for Misuse of Information in the 2024 1,877 1,926
National Directory of New Hires.
262a(i)(1)................ 42 CFR 1003.910....... OIG........... Penalty for each individual who violates 2024 424,250 435,272
safety and security procedures related
to handling dangerous biological agents
and toxins.
42 CFR 1003.1410...... OIG........... Penalty for any other person who violates 2024 848,505 870,549
safety and security procedures related
to handling dangerous biological agents
and toxins.
300jj-51.................. OIG........... Penalty per violation for committing 2024 1,293,601 1,327,209
information blocking.
1320a-7a(a)............... 42 CFR 1003.210(a)(1). OIG........... Penalty for knowingly presenting or 2024 24,947 25,595
causing to be presented to an officer,
employee, or agent of the United States
a false claim.
OIG........... Penalty for knowingly presenting or 2024 24,947 25,595
causing to be presented a request for
payment which violates the terms of an
assignment, agreement, or PPS agreement.
42 CFR 1003.210(a)(2). OIG........... Penalty for knowingly giving or causing 2024 37,421 38,393
to be presented to a participating
provider or supplier false or misleading
information that could reasonably be
expected to influence a discharge
decision.
42 CFR 1003.210(a)(3). OIG........... Penalty for an excluded party retaining 2024 24,947 25,595
ownership or control interest in a
participating entity.
42 CFR 1003.1010...... OIG........... Penalty for remuneration offered to 2024 24,947 25,595
induce program beneficiaries to use
particular providers, practitioners, or
suppliers.
42 CFR 1003.210(a)(4). OIG........... Penalty for employing or contracting with 2024 24,947 25,595
an excluded individual.
42 CFR 1003.310(a)(3). OIG........... Penalty for knowing and willful 2024 124,732 127,973
solicitation, receipt, offer, or payment
of remuneration for referring an
individual for a service or for
purchasing, leasing, or ordering an item
to be paid for by a Federal health care
program.
42 CFR 1003.210(a)(1). OIG........... Penalty for ordering or prescribing 2024 24,947 25,595
medical or other item or service during
a period in which the person was
excluded.
42 CFR 1003.210(a)(6). OIG........... Penalty for knowingly making or causing 2024 124,732 127,973
to be made a false statement, omission
or misrepresentation of a material fact
in any application, bid, or contract to
participate or enroll as a provider or
supplier.
42 CFR 1003.210(a)(8). OIG........... Penalty for knowing of an overpayment and 2024 24,947 25,595
failing to report and return.
42 CFR 1003.210(a)(7). OIG........... Penalty for making or using a false 2024 70,336 72,163
record or statement that is material to
a false or fraudulent claim.
42 CFR 1003.210(a)(9). OIG........... Penalty for failure to grant timely 2024 37,421 38,393
access to HHS OIG for audits,
investigations, evaluations, and other
statutory functions of HHS OIG.
1320a-7a(b)............... ...................... OIG........... Penalty for payments by a hospital or 2024 6,236 6,398
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.
OIG........... Penalty for physicians who knowingly 2024 6,236 6,398
receive payments from a hospital or
critical access hospital to induce such
physician to reduce or limit services to
individuals under direct care of
physician or who are entitled to certain
medical assistance benefits.
42 CFR 1003.210(a)(10) OIG........... Penalty for a physician who executes a 2024 12,473 12,797
document that falsely certifies home
health needs for Medicare beneficiaries.
1320a-7a(o)............... 42 CFR 1003.710(a)(1). OIG........... Penalty for knowingly presenting or 2024 12,166 12,482
causing to be presented a false or
fraudulent specified claim under a
grant, contract, or other agreement for
which the Secretary provides funding.

[[Page 3670]]

42 CFR 1003.710(a)(2). OIG........... Penalty for knowingly making, using, or 2024 60,831 62,411
causing to be made or used any false
statement, omission, or
misrepresentation of a material fact in
any application, proposal, bid, progress
report, or other document required to
directly or indirectly receive or retain
funds provided pursuant to grant,
contract, or other agreement.
42 CFR 1003.710(a)(3). OIG........... Penalty for Knowingly making, using, or 2024 60,831 62,411
causing to be made or used, a false
record or statement material to a false
or fraudulent specified claim under
grant, contract, or other agreement.
42 CFR 1003.710(a)(4). OIG........... Penalty for knowingly making, using, or 2024 63,450 65,098
causing to be made or used, a false
record or statement material to an
obligation to pay or transmit funds or
property with respect to grant,
contract, or other agreement, or
knowingly conceals or improperly avoids
or decreases any such obligation, per
each false record or statement.
Penalty for knowingly making, using, or 2024 12,707 13,037
causing to be made or used, a false
record or statement material to an
obligation to pay or transmit funds or
property with respect to grant,
contract, or other agreement, or
knowingly conceals or improperly avoids
or decreases any such obligation, per
day.
42 CFR 1003.710(a)(5). OIG........... Penalty for failure to grant timely 2024 18,250 18,724
access, upon reasonable request, to the
I.G. for purposes of audits,
investigations, evaluations, or other
statutory functions of I.G. in matters
involving grants, contracts, or other
agreements.
1320a-7e(b)(6)(A)......... 42 CFR 1003.810....... OIG........... Penalty for failure to report any final 2024 47,596 48,833
adverse action taken against a health
care provider, supplier, or practitioner.
1320b-10(b)(1)............ 42 CFR 1003.610(a).... OIG........... Penalty for the misuse of words, symbols, 2024 12,799 13,132
or emblems in communications in a manner
in which a person could falsely construe
that such item is approved, endorsed, or
authorized by HHS.
1320b-10(b)(2)............ 42 CFR 1003.610(a).... OIG........... Penalty for the misuse of words, symbols, 2024 63,991 65,653
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.
1395i-3(b)(3)(B)(ii)(1)... 42 CFR 1003.210(a)(11) OIG........... Penalty for certification of a false 2024 2,670 2,739
statement in assessment of functional
capacity of a Skilled Nursing Facility
resident assessment.
1395i-3(b)(3)(B)(ii)(2)... 42 CFR 1003.210(a)(11) OIG........... Penalty for causing another to certify or 2024 13,343 13,690
make a false statement in assessment of
functional capacity of a Skilled Nursing
Facility resident assessment.
1395i-3(g)(2)(A).......... 42 CFR 1003.1310...... OIG........... Penalty for any individual who notifies 2024 5,339 5,478
or causes to be notified a Skilled
Nursing Facility of the time or date on
which a survey is to be conducted.
1395w-27(g)(2)(A)......... 42 CFR 1003.410....... OIG........... Penalty for a Medicare Advantage 2024 48,586 49,848
organization that substantially fails to
provide medically necessary, required
items and services.
OIG........... Penalty for a Medicare Advantage 2024 47,596 48,833
organization that charges excessive
premiums.
OIG........... Penalty for a Medicare Advantage 2024 47,596 48,833
organization that improperly expels or
refuses to reenroll a beneficiary.
OIG........... Penalty for a Medicare Advantage 2024 190,389 195,335
organization that engages in practice
that would reasonably be expected to
have the effect of denying or
discouraging enrollment.
OIG........... Penalty per individual who does not 2024 28,557 29,299
enroll as a result of a Medicare
Advantage organization's practice that
would reasonably be expected to have the
effect of denying or discouraging
enrollment.
OIG........... Penalty for a Medicare Advantage 2024 190,389 195,335
organization misrepresenting or
falsifying information to Secretary.
OIG........... Penalty for a Medicare Advantage 2024 47,596 48,833
organization misrepresenting or
falsifying information to individual or
other entity.
OIG........... Penalty for Medicare Advantage 2024 47,596 48,833
organization interfering with provider's
advice to enrollee and non-MCO
affiliated providers that balance bill
enrollees.
OIG........... Penalty for a Medicare Advantage 2024 47,596 48,833
organization that employs or contracts
with excluded individual or entity.

[[Page 3671]]

OIG........... Penalty for a Medicare Advantage 2024 47,596 48,833
organization enrolling an individual in
without prior written consent.
OIG........... Penalty for a Medicare Advantage 2024 47,596 48,833
organization transferring an enrollee to
another plan without consent or solely
for the purpose of earning a commission.
OIG........... Penalty for a Medicare Advantage 2024 47,596 48,833
organization failing to comply with
marketing restrictions or applicable
implementing regulations or guidance.
OIG........... Penalty for a Medicare Advantage 2024 47,596 48,833
organization employing or contracting
with an individual or entity who
violates 1395w-27(g)(1)(A)-(J).
1395w-141(i)(3)........... ...................... OIG........... Penalty for a prescription drug card 2024 16,630 17,062
sponsor that falsifies or misrepresents
marketing materials, overcharges program
enrollees, or misuse transitional
assistance funds.
1395cc(g)................. 42 CFR 1003.210(a)(5). OIG........... Penalty for improper billing by 2024 6,469 6,637
Hospitals, Critical Access Hospitals, or
Skilled Nursing Facilities.
1395dd(d)(1).............. 42 CFR 1003.510....... OIG........... Penalty for a hospital with 100 beds or 2024 133,420 136,886
more or responsible physician dumping
patients needing emergency medical care.
OIG........... Penalty for a hospital with less than 100 2024 66,712 68,445
beds dumping patients needing emergency
medical care.
1395mm(i)(6)(B)(i)........ 42 CFR 1003.410....... OIG........... Penalty for a HMO or competitive medical 2024 66,712 68,445
plan if such plan substantially fails to
provide medically necessary, required
items or services.
OIG........... Penalty for HMOs/competitive medical 2024 66,712 68,445
plans that charge premiums in excess of
permitted amounts.
OIG........... Penalty for a HMO or competitive medical 2024 66,712 68,445
plan that expels or refuses to reenroll
an individual per prescribed conditions.
OIG........... Penalty for a HMO or competitive medical 2024 266,841 273,774
plan that implements practices to
discourage enrollment of individuals
needing services in future.
OIG........... Penalty per individual not enrolled in a 2024 38,395 39,393
plan as a result of a HMO or competitive
medical plan that implements practices
to discourage enrollment of individuals
needing services in the future.
OIG........... Penalty for a HMO or competitive medical 2024 266,841 273,774
plan that misrepresents or falsifies
information to the Secretary.
OIG........... Penalty for a HMO or competitive medical 2024 66,712 68,445
plan that misrepresents or falsifies
information to an individual or any
other entity.
OIG........... Penalty for failure by HMO or competitive 2024 66,712 68,445
medical plan to assure prompt payment of
Medicare risk sharing contracts or
incentive plan provisions.
OIG........... Penalty for HMO that employs or contracts 2024 61,238 62,829
with excluded individual or entity.
1395nn(g)(3).............. 42 CFR 1003.310....... OIG........... Penalty for submitting or causing to be 2024 30,868 31,670
submitted claims in violation of the
Stark Law's restrictions on physician
self-referrals.
1395nn(g)(4).............. 42 CFR 1003.310....... OIG........... Penalty for circumvention schemes in 2024 205,799 211,146
violation of the Stark Law's
restrictions on physician self-referrals.
1395ss(d)(1).............. 42 CFR 1003.1110...... OIG........... Penalty for a material misrepresentation 2024 12,799 13,132
regarding Medigap compliance policies.
1395ss(d)(2).............. 42 CFR 1003.1110...... OIG........... Penalty for selling Medigap policy under 2024 12,799 13,132
false pretense.
1395ss(d)(3)(A)(ii)....... 42 CFR 1003.1110...... OIG........... Penalty for an issuer that sells health 2024 57,617 59,114
insurance policy that duplicates
benefits.
OIG........... Penalty for someone other than issuer 2024 34,568 35,466
that sells health insurance that
duplicates benefits.
1395ss(d)(4)(A)........... 42 CFR 1003.1110...... OIG........... Penalty for using mail to sell a non- 2024 12,799 13,132
approved Medigap insurance policy.
1396b(m)(5)(B)(i)......... 42 CFR 1003.410....... OIG........... Penalty for a Medicaid MCO that 2024 63,991 65,653
substantially fails to provide medically
necessary, required items or services.
OIG........... Penalty for a Medicaid MCO that charges 2024 63,991 65,653
excessive premiums.
OIG........... Penalty for a Medicaid MCO that 2024 255,964 262,614
improperly expels or refuses to reenroll
a beneficiary.
OIG........... Penalty per individual who does not 2024 38,395 39,393
enroll as a result of a Medicaid MCO's
practice that would reasonably be
expected to have the effect of denying
or discouraging enrollment.
OIG........... Penalty for a Medicaid MCO 2024 255,964 262,614
misrepresenting or falsifying
information to the Secretary.
OIG........... Penalty for a Medicaid MCO 2024 63,991 65,653
misrepresenting or falsifying
information to an individual or another
entity.
OIG........... Penalty for a Medicaid MCO that fails to 2024 57,617 59,114
comply with contract requirements with
respect to physician incentive plans.
1396r(b)(3)(B)(ii)(I)..... 42 CFR 1003.210(a)(11) OIG........... Penalty for willfully and knowingly 2024 2,670 2,739
certifying a material and false
statement in a Skilled Nursing Facility
resident assessment.

[[Page 3672]]

1396r(b)(3)(B)(ii)(II).... 42 CFR 1003.210(a)(11) OIG........... Penalty for willfully and knowingly 2024 13,343 13,690
causing another individual to certify a
material and false statement in a
Skilled Nursing Facility resident
assessment.
1396r(g)(2)(A)(i)......... 42 CFR 1003.1310...... OIG........... Penalty for notifying or causing to be 2024 5,339 5,478
notified a Skilled Nursing Facility of
the time or date on which a survey is to
be conducted.
1396r-8(b)(3)(B).......... 42 CFR 1003.1210...... OIG........... Penalty for the knowing provision of 2024 230,464 236,451
false information or refusing to provide
information about charges or prices of a
covered outpatient drug.
1396r-8(b)(3)(C)(i)....... 42 CFR 1003.1210...... OIG........... Penalty per day for failure to timely 2024 23,048 23,647
provide information by drug manufacturer
with rebate agreement.
1396r-8(b)(3)(C)(ii)...... 42 CFR 1003.1210...... OIG........... Penalty for knowing provision of false 2024 230,464 236,451
information by drug manufacturer with
rebate agreement.
1396t(i)(3)(A)............ 42 CFR 1003.1310...... OIG........... Penalty for notifying home and community- 2024 4,610 4,730
based providers or settings of survey.
11131(c).................. 42 CFR 1003.810....... OIG........... Penalty for failing to report a medical 2024 27,894 28,619
malpractice claim to National
Practitioner Data Bank.
11137(b)(2)............... 42 CFR 1003.810....... OIG........... Penalty for breaching confidentiality of 2024 27,894 28,619
information reported to National
Practitioner Data Bank.
299b-22(f)(1)............. 42 CFR 3.404.......... OCR........... Penalty for violation of confidentiality 2024 15,445 15,846
provision of the Patient Safety and
Quality Improvement Act.
1320(d)-5(a).............. 45 CFR OCR........... Penalty for each pre-February 18, 2009 2024 193 198
160.404(b)(1)(i), violation of the HIPAA administrative
(ii). simplification provisions.
OIG........... Calendar Year Cap........................ 2024 48,586 49,848
1320(d)-5(a).............. 45 CFR OCR........... Penalty for each February 18, 2009 or 2024 ........... ...........
160.404(b)(2)(i)(A), later violation of a HIPAA
(B). 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.
Minimum.................................. 2024 141 145
Maximum.................................. 2024 71,162 73,011
Calendar Year Cap........................ 2024 2,134,831 2,190,294
45 CFR OCR........... Penalty for each February 18, 2009 or 2024 ........... ...........
160.404(b)(2)(ii)(A), later violation of a HIPAA
(B). administrative simplification provision
in which it is established that the
violation was due to reasonable cause
and not to willful neglect.
Minimum.................................. 2024 1,424 1,461
Maximum.................................. 2024 71,162 73,011
Calendar Year Cap........................ 2024 2,134,831 2,190,294
45 CFR OCR........... Penalty for each February 18, 2009 or 2024 ........... ...........
160.404(b)(2)(iii)(A) later violation of a HIPAA
, (B). administrative simplification provision
in which it is established that the
violation was due to willful neglect and
was corrected during the 30-day period
beginning on the first date the covered
entity or business associate knew, or,
by exercising reasonable diligence,
would have known that the violation
occurred.
Minimum.................................. 2024 14,232 14,602
Maximum.................................. 2024 71,162 73,011
Calendar Year Cap........................ 2024 2,134,831 2,190,294
45 CFR OCR........... Penalty for each February 18, 2009 or 2024 ........... ...........
160.404(b)(2)(iv)(A), later violation of a HIPAA
(B). administrative simplification provision
in which it is established that the
violation was due to willful neglect and
was not corrected during the 30-day
period beginning on the first date the
covered entity or business associate
knew, or, by exercising reasonable
diligence, would have known that the
violation occurred.
Minimum.................................. 2024 71,162 73,011
Maximum.................................. 2024 2,134,831 2,190,294
Calendar Year Cap........................ 2024 2,134,831 2,190,294
290dd-2(f)................ 42 CFR 2.3(a) and (c). OCR........... Penalty for each violation of a 42 CFR 2024 ........... ...........
part 2 provision in which it is
established that the person did not know
and by exercising reasonable diligence,
would not have known that the person
violated such a provision.
Minimum.................................. 2024 100 103

[[Page 3673]]

Maximum.................................. 2024 50,000 51,299
Calendar Year Cap........................ 2024 1,500,000 1,538,970
42 CFR 2.3(a) and (c). OCR........... Penalty for each violation of a 42 CFR 2024 ........... ...........
part 2 provision in which it is
established that the violation was due
to reasonable cause and not to willful
neglect.
Minimum.................................. 2024 1,000 1,026
Maximum.................................. 2024 50,000 51,299
Calendar Year Cap........................ 2024 1,500,000 1,538,970
42 CFR 2.3(a) and (c). OCR........... Penalty for each violation of a 42 CFR 2024 ........... ...........
part 2 provision in which it is
established that the violation was due
to willful neglect and was corrected
during the 30-day period beginning on
the first date the person knew, or, by
exercising reasonable diligence, would
have known that the violation occurred.
Minimum.................................. 2024 10,000 10,260
Maximum.................................. 2024 50,000 51,299
Calendar Year Cap........................ 2024 1,500,000 1,538,970
42 CFR 2.3(a) and (c). OCR........... Penalty for each violation of a 42 CFR 2024 ........... ...........
part 2 provision in which it is
established that the violation was due
to willful neglect and was not corrected
during the 30-day period beginning on
the first date the person knew, or, by
exercising reasonable diligence, would
have known that the violation occurred.
Minimum.................................. 2024 50,000 51,299
Maximum.................................. 2024 1,500,000 1,538,970
Calendar Year Cap........................ 2024 1,500,000 1,538,970
42 U.S.C. 300gg-18, 42 45 CFR 180.90......... CMS........... Penalty for a hospital's non-compliance 2024 333 342
U.S.C. 1302. with making public standard charges for
hospital items and services.
Per Day (Maximum)........................ 2024 6,118 6,277
45 CFR 180.90(c)(2)(i) CMS........... Applicable solely to CY 2021 penalties, 2024 339 348
per day penalty for a hospital's
noncompliance with making public
standard charges for hospital items and
services.
45 CFR CMS........... Per day penalty for hospitals with equal 2024 333 342
180.90(c)(2)(ii)(A). to or less than 30 beds.
45 CFR CMS........... Per day, per bed penalty for hospitals 2024 11 11
180.90(c)(2)(ii)(B). having at least 31 and up to and
including 550 beds.
45 CFR CMS........... Per day penalty for hospitals having 2024 6,118 6,277
180.90(c)(2)(ii)(C). greater than 550 beds.
CARES Act, Public Law 116- 45 CFR 182.70......... CMS........... Penalty for a provider's non-compliance 2024 ........... ...........
136, section 3202(b)(2). with price transparency requirements
regarding diagnostic tests for COVID-19.
Per Day (Maximum)........................ 2024 N/A N/A
263a(h)(2)(B) & 1395w- 42 CFR CMS........... Penalty for a clinical laboratory's 2024 ........... ...........
2(b)(2)(A)(ii). 493.1834(d)(2)(i). failure to meet participation and
certification requirements and poses
immediate jeopardy.
Minimum.................................. 2024 7,807 8,010
Maximum.................................. 2024 25,597 26,262
42 CFR CMS........... Penalty for a clinical laboratory's 2024 ........... ...........
493.1834(d)(2)(ii).. failure to meet participation and
certification requirements and the
failure does not pose immediate jeopardy.
Minimum.................................. 2024 129 132
Maximum.................................. 2024 7,678 7,877
42 CFR CMS........... Penalty for a clinical laboratory's 2024 ........... ...........
493.1834(d)(2)(iii). failure to meet SARS-CoV-2 test
reporting requirements.
First day of noncompliance............... 2024 ........... ...........
Each additional day of noncompliance..... 2024 ........... ...........
300gg-15(f)............... 45 CFR 147.200(e)..... CMS........... Failure to provide the Summary of 2024 1,406 1,443
Benefits and Coverage.
300gg-18.................. 45 CFR 158.606........ CMS........... Penalty for violations of regulations 2024 140 144
related to the medical loss ratio
reporting and rebating.
45 CFR 180.70......... CMS........... Penalty against hospital identified by 2024 ........... ...........
CMS as noncompliant according to Sec.
182.50 with respect to price
transparency requirements regarding
diagnostic tests for COVID-19.
42 U.S.C. 300gg-118 note, ...................... CMS........... Penalties for failure to comply with No 2024 11,816 12,123
300gg-134. Surprises Act requirements on providers,
facilities, providers of air ambulance
services.
1320a-7h(b)(1)............ 42 CFR 402.105(d)(5), CMS........... Penalty for manufacturer or group 2024 ........... ...........
42 CFR 403.912(a) & purchasing organization failing to
(c). report information required under 42
U.S.C. 1320a-7h(a), relating to
physician ownership or investment
interests.
Minimum.................................. 2024 1,406 1,443
Maximum.................................. 2024 14,067 14,432
Calendar Year Cap........................ 2024 211,008 216,490
1320a-7h(b)(2)............ 42 CFR 402.105(h), 42 CMS........... Penalty for manufacturer or group 2024 ........... ...........
CFR 403.912(b) & (c). purchasing organization knowingly
failing to report information required
under 42 U.S.C. 1320a-7h(a), relating to
physician ownership or investment
interests.

[[Page 3674]]

Minimum.................................. 2024 14,067 14,432
Maximum.................................. 2024 140,674 144,329
Calendar Year Cap........................ 2024 1,406,728 1,443,275
1320a-7j(h)(3)(A)......... ...................... CMS........... Maximum penalty for an administrator of a 2024 140,674 144,329
facility that fails to comply with
notice requirements for the closure of a
facility.
1320a-7j(h)(3)(A)......... 42 CFR 488.446(a)(1), CMS........... Minimum penalty for the first offense of 2024 703 721
(2), & (3). an administrator who fails to provide
notice of facility closure.
Minimum penalty for the second offense of 2024 2,111 2,166
an administrator who fails to provide
notice of facility closure.
Minimum penalty for the third and 2024 4,219 4,329
subsequent offenses of an administrator
who fails to provide notice of facility
closure.
1320a-8(a)(1)............. ...................... CMS........... Penalty for an entity knowingly making a 2024 10,289 10,556
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.
Penalty for violation of 42 U.S.C. 1320a- 2024 9,704 9,956
8(a)(1) if the violator is a person who
receives a fee or other income for
services performed in connection with
determination of the benefit amount or
the person is a physician or other
health care provider who submits
evidence in connection with such a
determination.
1320a-8(a)(3)............. ...................... CMS........... Penalty for a representative payee (under 2024 8,058 8,267
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.
1320b-25(c)(1)(A)......... ...................... CMS........... Penalty for failure of covered 2024 281,346 288,655
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.
1320b-25(c)(2)(A)......... ...................... CMS........... Penalty for failure of covered 2024 422,017 432,981
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.
11320b-25(d)(2)........... ...................... CMS........... Penalty for a long-term care facility 2024 281,346 288,655
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.
1395b-7(b)(2)(B).......... 42 CFR 402.105(g)..... CMS........... Penalty for any person who knowingly and 2024 190 195
willfully fails to furnish a beneficiary
with an itemized statement of items or
services within 30 days of the
beneficiary's request.
1395i-3(h)(2)(B)(ii)(I)... 42 CFR CMS........... Penalty per day for a Skilled Nursing 2024 ........... ...........
488.408(d)(1)(iii). Facility that has a Category 2 violation
of certification requirements.
Minimum.................................. 2024 133 136
Maximum.................................. 2024 8,003 8,211
42 CFR CMS........... Penalty per instance of Category 2 2024 ........... ...........
488.408(d)(1)(iv). noncompliance by a Skilled Nursing
Facility.
Minimum.................................. 2024 2,670 2,739
Maximum.................................. 2024 26,685 27,378
42 CFR CMS........... Penalty per day for a Skilled Nursing 2024 ........... ...........
488.408(e)(1)(iii). Facility that has a Category 3 violation
of certification requirements.
Minimum.................................. 2024 8,140 8,351
Maximum.................................. 2024 26,685 27,378
42 CFR CMS........... Penalty per instance of Category 3 2024 ........... ...........
488.408(e)(1)(iv). noncompliance by a Skilled Nursing
Facility.
Minimum.................................. 2024 2,670 2,739
Maximum.................................. 2024 26,685 27,378

[[Page 3675]]

42 CFR CMS........... Penalty per day and per instance for a 2024 ........... 0
488.408(e)(2)(ii). Skilled Nursing Facility that has
Category 3 noncompliance with Immediate
Jeopardy.
Per Day (Minimum)........................ 2024 8,140 8,351
Per Day (Maximum)........................ 2024 26,685 27,378
Per Instance (Minimum)................... 2024 2,670 2,739
Per Instance (Maximum)................... 2024 26,685 27,378
42 CFR CMS........... Penalty per day of a Skilled Nursing 2024 ........... 0
488.438(a)(1)(i). Facility that fails to meet
certification requirements. These
amounts represent the upper range per
day.
Minimum.................................. 2024 8,140 8,351
Maximum.................................. 2024 26,685 27,378
42 CFR CMS........... Penalty per day of a Skilled Nursing 2024 ........... 0
488.438(a)(1)(ii). Facility that fails to meet
certification requirements. These
amounts represent the lower range per
day.
Minimum.................................. 2024 133 136
Maximum.................................. 2024 8,003 8,211
42 CFR 488.438(a)(2).. CMS........... Penalty per instance of a Skilled Nursing 2024 ........... 0
Facility that fails to meet
certification requirements.
Minimum.................................. 2024 2,670 2,739
Maximum.................................. 2024 26,685 27,378
42 CFR 488.447........ CMS........... Penalty imposed for failure to comply 2024 ........... ...........
with infection control weekly reporting
requirements at 42 CFR 483.80(g)(1) and
(2).
First occurrence......................... 2024 1,196 1,227
Incremental increases for each subsequent 2024 598 614
occurrence.
1395i-6(c)(5)(B)(i)....... 42 CFR 488.1245....... CMS........... Penalty for noncompliance by hospice 2024 11,124 11,413
program with requirements specified in
section 1395x(dd) of 42 U.S.C..
42 CFR CMS........... Adjustment to penalties. Maximum penalty 2024 11,124 11,413
488.1245(b)(2)(iii). assessment for each day a hospice is not
in substantial compliance with one or
more conditions of participation.
42 CFR 488.1245(b)(3). CMS........... Penalty imposed for hospice condition- 2024 ........... ...........
level deficiency that is immediate
jeopardy. These amounts represent the
upper range of penalty.
Minimum.................................. 2024 9,455 9,701
Maximum.................................. 2024 11,124 11,413
42 CFR CMS........... Penalty imposed for hospice condition- 2024 11,124 11,413
488.1245(b)(3)(i). level deficiency that is immediate
jeopardy. These amounts represent the
upper range of penalty.
42 CFR CMS........... Penalty imposed for hospice condition- 2024 10,011 10,271
488.1245(b)(3)(ii). level deficiency that is immediate
jeopardy. These amounts represent the
upper range of penalty.
42 CFR CMS........... Penalty imposed for hospice condition- 2024 9,455 9,701
488.1245(b)(3)(iii). level deficiency that is immediate
jeopardy. These amounts represent the
upper range of penalty.
42 CFR 488.1245(b)(4). CMS........... Penalty imposed for hospice repeat or 2024 ........... ...........
condition-level deficiency or both that
does not constitute immediate jeopardy
but is directly related to poor quality
patient care outcomes. These amounts
represent the middle range of penalty.
Minimum.................................. 2024 1,668 1,711
Maximum.................................. 2024 9,455 9,701
42 CFR 488.1245(b)(5). CMS........... Penalty imposed for hospice repeat or 2024 ........... ...........
condition-level deficiency or both that
does not constitute immediate jeopardy
and are related predominantly to
structure or process-oriented conditions
rather than directly related to patient
outcomes. These amounts represent the
lower range of penalty.
Minimum.................................. 2024 556 570
Maximum.................................. 2024 4,450 4,566
42 CFR 488.1245(b)(6). CMS........... Penalty range imposed for per instance of 2024 ........... ...........
hospice noncompliance.
Minimum.................................. 2024 1,112 1,141
Maximum.................................. 2024 11,124 11,413
42 CFR CMS........... Penalty for each per instance of hospice 2024 11,124 11,413
488.1245(d)(1)(ii). noncompliance, maximum per day per
hospice program.
2024 ........... ...........
1395l(h)(5)(D)............ 42 CFR CMS........... Penalty for knowingly, willfully, and 2024 19,435 19,940
402.105(d)(2)(i). 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)).
1395l(i)(6)............... ...................... CMS........... Penalty for knowingly and willfully 2024 5,121 5,254
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.
1395l(q)(2)(B)(i)......... 42 CFR 402.105(a)..... CMS........... Penalty for knowingly and willfully 2024 4,899 5,026
failing to provide information about a
referring physician when seeking payment
on an unassigned basis.

[[Page 3676]]

1395m(a)(11)(A)........... 42 CFR 402.1(c)(4), CMS........... Penalty for any durable medical equipment 2024 19,435 19,940
402.105(d)(2)(ii). 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)).
1395m(a)(18)(B)........... 42 CFR 402.1(c)(5), CMS........... Penalty for any nonparticipating durable 2024 19,435 19,940
402.105(d)(2)(iii). 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)).
1395m(b)(5)(C)............ 42 CFR 402.1(c)(6), CMS........... Penalty for any nonparticipating 2024 19,435 19,940
402.105(d)(2)(iv). 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)).
1395m(h)(3)............... 42 CFR 402.1(c)(8), CMS........... Penalty for any supplier of prosthetic 2024 19,435 19,940
402.105(d)(2)(vi). 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)).
1395m(j)(2)(A)(iii)....... ...................... CMS........... Penalty for any supplier of durable 2024 2,058 2,111
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.
1395m(j)(4)............... 42 CFR 402.1(c)(10), CMS........... Penalty for any supplier of durable 2024 19,435 19,940
402.105(d)(2)(vii). 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)).
1395m-1(a)................ 42 CFR. 414.504(e).... CMS........... Penalty for an applicable entity that has 2024 12,958 13,295
failed to report or made a
misrepresentation or omission in
reporting applicable information with
respect to a clinical diagnostic
laboratory test.
42 CFR 402.1(c)(31), CMS........... Penalty for any person or entity who 2024 19,435 19,940
402.105(d)(3). knowingly and willfully bills or
collects for any outpatient therapy
services or comprehensive outpatient
rehabilitation services on other than an
assignment-related basis. (Penalties are
assessed in the same manner as 42 U.S.C.
1395m(k)(6) and 1395u(j)(2)(B), which is
assessed according to 1320a-7a(a)).
1395m(l)(6)............... 42 CFR 402.1(c)(32), CMS........... Penalty for any supplier of ambulance 2024 19,435 19,940
402.105(d)(4). 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)).
1395u(b)(18)(B)........... 42 CFR 402.1(c)(11), CMS........... Penalty for any practitioner specified in 2024 19,435 19,940
402.105(d)(2)(viii). 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)).
1395u(j)(2)(B)............ 42 CFR 402.1(c)....... CMS........... Penalty for any physician who charges 2024 19,435 19,940
more than 125% for a non-participating
referral. (Penalties are assessed in the
same manner as 42 U.S.C. 1320a-7a(a)).

[[Page 3677]]

1395u(k).................. 42 CFR 402.1(c)(12), CMS........... Penalty for any physician who knowingly 2024 19,435 19,940
402.105(d)(2)(ix) and willfully presents or causes to be
1834A(a)(9) and 42 presented a claim for bill for an
CFR 414.504(e). 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)).
1395u(l)(3)............... 42 CFR 402.1(c)(13), CMS........... Penalty for any nonparticipating 2024 19,435 19,940
402.105(d)(2)(x). 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)).
1395u(m)(3)............... 42 CFR 402.1(c)(14), CMS........... Penalty for any nonparticipating 2024 19,435 19,940
402.105(d)(2)(xi). 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)).
1395u(n)(3)............... 42 CFR 402.1(c)(15), CMS........... Penalty for any physician who knowingly, 2024 19,435 19,940
402.105(d)(2)(xii). 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)).
1395u(o)(3)(B)............ 42 CFR 414.707(b)..... CMS........... Penalty for any practitioner specified in 2024 19,435 19,940
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)).
1395u(p)(3)(A)............ ...................... CMS........... Penalty for any physician or practitioner 2024 5,121 5,254
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.
1395w-3a(d)(4)(A)......... 42 CFR 414.806........ CMS........... Penalty for a pharmaceutical 2024 16,630 17,062
manufacturer's misrepresentation of
average sales price of a drug, or
biologic.
1395w-4(g)(1)(B).......... 42 CFR 402.1(c)(17), CMS........... Penalty for any nonparticipating 2024 19,435 19,940
402.105(d)(2)(xiii). 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)).
1395w-4(g)(3)(B).......... 42 CFR 402.1(c)(18), CMS........... Penalty for any person that knowingly and 2024 19,435 19,940
402.105(d)(2)(xiv). 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)).
1395w-27(g)(3)(A); 42 CFR 422.760(b); 42 CMS........... Penalty for each termination 2024 47,596 48,833
1857(g)(3); 1860D- CFR 423.760(b). determination the Secretary makes that
12(b)(3)(E). 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.
1395w-27(g)(3)(B); ...................... CMS........... Penalty for each week beginning after the 2024 19,040 19,535
1857(g)(3); 1860D- initiation of civil money penalty
12(b)(3)(E). 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.
1395w-27(g)(3)(D); ...................... CMS........... Penalty for a Medicare Advantage 2024 176,807 181,400
1857(g)(3): 1860D- organization's or Part D sponsor's early
12(b)(3)(E). termination of its contract.
1395y(b)(3)(C)............ 42 CFR 411.103(b)..... CMS........... Penalty for an employer or other entity 2024 11,524 11,823
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.
1395y(b)(5)(C)(ii)........ 42 CFR 402.1(c)(20), CMS........... Penalty for any non-governmental employer 2024 1,877 1,926
42 CFR 402.105(b)(2). 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.

[[Page 3678]]

1395y(b)(6)(B)............ 42 CFR 402.1(c)(20), CMS........... Penalty for any entity that knowingly, 2024 4,117 4,224
402.105(a). 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.
1395y(b)(7)(B)(i)......... 42 CFR 402.1(c)(21), CMS........... Penalty for any entity serving as 2024 1,474 1,512
402.105(a). 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.
1395y(b)(8)(E)............ ...................... CMS........... Penalty for any non-group health plan 2024 1,474 1,512
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.
1395nn(g)(5).............. 42 CFR 411.361........ CMS........... Penalty for any person that fails to 2024 24,496 25,132
report information required by HHS under
Section 1877(f) concerning ownership,
investment, and compensation
arrangements.
1395pp(h)................. 42 CFR 402.1(c)(23), CMS........... Penalty for any durable medical equipment 2024 19,435 19,940
402.105(d)(2)(xv). 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)).
1395ss(a)(2).............. 402.102(f)(1)......... CMS........... Penalty for any person that issues a 2024 66,711 68,444
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.
1395ss(d)(3)(A)(vi)(II)... 42 CFR 402.1(c)(25), CMS........... Penalty for someone other than issuer 2024 34,568 35,466
402.105(e),402.105(f) that sells or issues a Medicare
(2). supplemental policy to beneficiary
without a disclosure statement.
CMS........... Penalty for an issuer that sells or 2024 57,617 59,114
issues a Medicare supplemental policy
without disclosure statement.
1395ss(d)(3)(B)(iv)....... ...................... CMS........... Penalty for someone other than issuer 2024 34,568 35,466
that sells or issues a Medicare
supplemental policy without
acknowledgement form.
CMS........... Penalty for issuer that sells or issues a 2024 57,617 59,114
Medicare supplemental policy without an
acknowledgement form.
1395ss(p)(8).............. 42 CFR 402.1(c)(25), CMS........... Penalty for someone other than issuer 2024 34,568 35,466
402.105(e). that sells or issues Medicare
supplemental polices after a given date
that fail to conform to the NAIC or
Federal standards established by statute.
42 CFR 402.1(c)(25), CMS........... Penalty for an issuer that sells or 2024 57,617 59,114
405402.105(f)(2). issues Medicare supplemental polices
after a given date that fail to conform
to the NAIC or Federal standards
established by statute.
1395ss(p)(9)(C)........... 42 CFR 402.1(c)(26), CMS........... Penalty for someone other than issuer 2024 34,568 35,466
402.105(e), that sells a Medicare supplemental
402.105(f)(3), (4). 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.
42 CFR 402.105(f)(3), CMS........... Penalty for an issuer that sells a 2024 57,617 59,114
(4). 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.
1395ss(q)(5)(C)........... 42 CFR 402.105(f)(5).. CMS........... Penalty for any person that fails to 2024 57,617 59,114
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.
1395ss(r)(6)(A)........... 42 CFR 402.105(f)(6).. CMS........... Penalty for any person that fails to 2024 57,617 59,114
provide refunds or credits as required
by section 1882(r)(1)(B).
1395ss(s)(4).............. 42 CFR 402.1(c)(29), CMS........... Penalty for any issuer of a Medicare C2024 24,460 25,095
402.105(c). 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.

[[Page 3679]]

1395ss(t)(2).............. 42 CFR 402.1(c)(30), CMS........... Penalty for any issuer of a Medicare 2024 57,617 59,114
402.105(f)(7). supplemental policy that fails to
fulfill listed responsibilities.
1395ss(v)(4)(A)........... ...................... CMS........... Penalty someone other than issuer who 2024 24,946 25,594
sells, issues, or renews a medigap Rx
policy to an individual who is a Part D
enrollee.
CMS........... Penalty for an issuer who sells, issues, 2024 41,577 42,657
or renews a Medigap Rx policy who is a
Part D enrollee.
1395bbb(c)(1)............. 42 CFR 488.725(c)..... CMS........... Penalty for any individual who notifies 2024 5,339 5,478
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.
1395bbb(f)(2)(A)(i)....... 42 CFR CMS........... Maximum daily penalty amount for each day 2024 25,597 26,262
488.845(b)(2)(iii) 42 a home health agency is not in
CFR 488.845(b)(3)- compliance with statutory requirements.
(6); and 42 CFR
488.845(d)(1)(ii).
42 CFR 488.845(b)(3).. CMS........... Penalty per day for home health agency's 2024 ........... 0
noncompliance (Upper Range).
Minimum.................................. 2024 21,757 22,322
Maximum.................................. 2024 25,597 26,262
42 CFR CMS........... Penalty for a home health agency's 2024 25,597 26,262
488.845(b)(3)(i). deficiency or deficiencies that cause
immediate jeopardy and result in actual
harm.
42 CFR CMS........... Penalty for a home health agency's 2024 23,036 23,634
488.845(b)(3)(ii). deficiency or deficiencies that cause
immediate jeopardy and result in
potential for harm.
42 CFR CMS........... Penalty for an isolated incident of 2024 21,757 22,322
488.845(b)(3)(iii). noncompliance in violation of
established HHA policy.
42 CFR 488.845(b)(4).. CMS........... Penalty for a repeat and/or condition- 2024 ........... 0
level deficiency that does not
constitute immediate jeopardy, but is
directly related to poor quality patient
care outcomes (Lower Range).
Minimum.................................. 2024 3,841 3,941
Maximum.................................. 2024 21,757 22,322
42 CFR 488.845(b)(5).. CMS........... Penalty for a repeat and/or condition- 2024 ........... 0
level deficiency that does not
constitute immediate jeopardy and that
is related predominately to structure or
process-oriented conditions (Lower
Range).
Minimum.................................. 2024 1,280 1,313
Maximum.................................. 2024 2,559 2,625
42 CFR 488.845(b)(6).. CMS........... Penalty imposed for instance of 2024 ........... 0
noncompliance that may be assessed for
one or more singular events of condition-
level noncompliance that are identified
and where the noncompliance was
corrected during the onsite survey.
Penalty for each day of noncompliance 2024 2,559 2,625
(Minimum).
Penalty for each day of noncompliance 2024 25,597 26,262
(Maximum).
42 CFR CMS........... Penalty for each day of noncompliance 2024 25,597 26,262
488.845(d)(1)(ii). (Maximum).
1395eee(e)(6)(B); 1396u- 42 CFR 460.46......... CMS........... Penalty for PACE organization that 2024 47,596 48,833
4(e)(6)(B). 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.
CMS........... For each individual not enrolled as a 2024 ........... ...........
result of the PACE organization's
discrimination in enrollment or
disenrollment or practice that would
deny or discourage enrollment.
Minimum.................................. 2024 17,933 18,399
Maximum.................................. 2024 119,555 122,661
CMS........... Penalty for a PACE organization that 2024 47,596 48,833
charges excessive premiums.
CMS........... Penalty for a PACE organization 2024 190,389 195,335
misrepresenting or falsifying
information to CMS or the State.
CMS........... Penalty for any other violation specified 2024 47,596 48,833
in 42 CFR 460.40.
1396r(h)(3)(C)(ii)(I)..... 42 CFR CMS........... Penalty per day for a nursing facility's 2024 ........... 0
488.408(d)(1)(iii). failure to meet a Category 2
Certification.
Minimum.................................. 2024 133 136
Maximum.................................. 2024 8,003 8,211
42 CFR CMS........... Penalty per instance for a nursing 2024 ........... ...........
488.408(d)(1)(iv). facility's failure to meet Category 2
certification.
Minimum.................................. 2024 2,670 2,739
Maximum.................................. 2024 26,685 27,378
42 CFR CMS........... Penalty per day for a nursing facility's 2024 ........... ...........
488.408(e)(1)(iii). failure to meet Category 3 certification.
Minimum.................................. 2024 8,140 8,351
Maximum.................................. 2024 26,685 27,378
42 CFR CMS........... Penalty per instance for a nursing 2024 ........... 0
488.408(e)(1)(iv). facility's failure to meet Category 3
certification.
Minimum.................................. 2024 2,670 2,739
Maximum.................................. 2024 26,685 27,378

[[Page 3680]]

42 CFR CMS........... Penalty per instance for a nursing 2024 ........... 0
488.408(e)(2)(ii). facility's failure to meet Category 3
certification, which results in
immediate jeopardy.
Minimum.................................. 2024 2,670 2,739
Maximum.................................. 2024 26,685 27,378
42 CFR CMS........... Penalty per day for nursing facility's 2024 ........... 0
488.438(a)(1)(i). failure to meet certification (Upper
Range).
Minimum.................................. 2024 8,140 8,351
Maximum.................................. 2024 26,685 27,378
42 CFR CMS........... Penalty per day for nursing facility's 2024 ........... 0
488.438(a)(1)(ii). failure to meet certification (Lower
Range).
Minimum.................................. 2024 133 136
Maximum.................................. 2024 8,003 8,211
42 CFR 488.438(a)(2).. CMS........... Penalty per instance for nursing 2024 ........... 0
facility's failure to meet certification.
Minimum.................................. 2024 2,670 2,739
Maximum.................................. 2024 26,685 27,378
42 CFR 488.447........ CMS........... Penalty imposed for failure to comply 2024 ........... ...........
with infection control weekly reporting
requirements at 42 CFR 483.80(g)(1) and
(2).
First occurrence (Minimum)............... 2024 1,196 1,227
Incremental increases for each subsequent 2024 598 614
occurrence.
1396r(f)(2)(B)(iii)(I)(c). 42 CFR CMS........... Grounds to prohibit approval of Nurse 2024 13,343 13,690
483.151(b)(2)(iv) and Aide Training Program--if assessed a
(b)(3)(iii). penalty in 1819(h)(2)(B)(i) or
1919(h)(2)(A)(ii) of ``not less than
$5,000'' [Not CMP authority, but a
specific CMP amount (CMP at this level)
that is the triggering condition for
disapproval].
1396r(h)(3)(C)(ii)(I)..... 42 CFR 483.151(c)(2).. CMS........... Grounds to waive disapproval of nurse 2024 13,343 13,690
aide training program--reference to
disapproval based on imposition of CMP
``not less than $5,000'' [Not CMP
authority but CMP imposition at this
level determines eligibility to seek
waiver of disapproval of nurse aide
training program].
1396t(j)(2)(C)............ ...................... CMS........... Penalty for each day of noncompliance for 2024 ........... 0
a home or community care provider that
no longer meets the minimum requirements
for home and community care.
Minimum.................................. 2024 2 2
Maximum.................................. 2024 23,048 23,647
1396u-2(e)(2)(A)(i)....... 42 CFR 438.704........ CMS........... Penalty for a Medicaid managed care 2024 47,596 48,833
organization that fails substantially to
provide medically necessary items and
services.
CMS........... Penalty for Medicaid managed care 2024 47,596 48,833
organization that imposes premiums or
charges on enrollees in excess of the
premiums or charges permitted.
CMS........... Penalty for a Medicaid managed care 2024 47,596 48,833
organization that misrepresents or
falsifies information to another
individual or entity.
CMS........... Penalty for a Medicaid managed care 2024 47,596 48,833
organization that fails to comply with
the applicable statutory requirements
for such organizations..
1396u-2(e)(2)(A)(ii)...... 42 CFR 438.704........ CMS........... Penalty for a Medicaid managed care 2024 190,389 195,335
organization that misrepresents or
falsifies information to the HHS
Secretary.
CMS........... Penalty for Medicaid managed care 2024 190,389 195,335
organization that acts to discriminate
among enrollees on the basis of their
health status.
1396u-2(e)(2)(A)(iv)...... 42 CFR 438.704........ CMS........... Penalty for each individual that does not 2024 28,557 29,299
enroll as a result of a Medicaid managed
care organization that acts to
discriminate among enrollees on the
basis of their health status.
1396u(h)(2)............... 42 CFR Part 441, CMS........... Penalty for a provider not meeting one of 2024 26,685 27,378
Subpart I. the requirements relating to the
protection of the health, safety, and
welfare of individuals receiving
community supported living arrangements
services.
1396w-2(c)(1)............. 42 U.S.C. 300gg- CMS........... Penalty for each day, for each individual 2024 14,232 14,602
22(b)(2)(C)(i) 45 CFR affected by the failure of a health
150.315. insurance issuer or non-Federal
governmental group health plan to comply
with federal market reform provisions in
part A or D of title XXVII of the PHS
Act[verbar]2022[verbar]174[verbar]177.

[[Page 3681]]

18041(c)(2)............... 45 CFR 156.805(c)..... CMS........... Failure to comply with ACA requirements 2024 193 198
related to risk adjustment, reinsurance,
risk corridors, Exchanges (including QHP
standards) and other ACA Subtitle D
standards; Penalty for violations of
rules or standards of behavior
associated with issuer compliance with
risk adjustment, reinsurance, risk
corridors, Exchanges (including QHP
standards) and other ACA Subtitle D
standards.
42 U.S.C. 300gg- 45 CFR 150.315........ CMS........... Penalty for each day, for each individual 2024 183 188
22(b)(2)(C)(i). affected by the failure of a health
insurance issuer or non-Federal
governmental group health plan to comply
with federal market reform provisions in
part A or D of title XXVII of the PHS
Act.
18081(h)(1)(A)(i)(II)..... 45 CFR 155.285........ CMS........... Penalty for providing false information 2024 35,169 36,083
on Exchange application.
18081(h)(1)(B)............ 45 CFR 155.285........ CMS........... Penalty for knowingly or willfully 2024 351,681 360,818
providing false information on Exchange
application.
18081(h)(2)............... 45 CFR 155.260........ CMS........... Penalty for knowingly or willfully 2024 ........... 0
disclosing protected information from
Exchange.
CMS........... Maximum.................................. 2024 35,169 36,083
CMS........... Minimum.................................. 2024 359 368
18041(c)(2)............... 45 CFR 155.206(i)..... CMS........... Penalties for violation of applicable 2024 43,128 44,248
Exchange standards by consumer
assistance entities in Federally-
facilitated Exchanges.
Maximum (Per Day)........................ 2024 119 122
31 U.S.C.................. 45 CFR 93.400(e)...... HHS........... 2024 359 368
Penalty for the first time an individual 2024 24,496 25,132
makes an expenditure prohibited by
regulations regarding lobbying
disclosure, absent aggravating
circumstances.
Penalty for second and subsequent 2024 ........... 0
offenses by individuals who make an
expenditure prohibited by regulations
regarding lobbying disclosure.
Minimum.................................. 2024 24,496 25,132
Maximum.................................. 2024 244,958 251,322
1352...................... ...................... HHS........... Penalty for the first time an individual 2024 24,496 25,132
fails to file or amend a lobbying
disclosure form, absent aggravating
circumstances.
Penalty for second and subsequent 2024 ........... 0
offenses by individuals who fail to file
or amend a lobbying disclosure form,
absent aggravating circumstances.
Minimum.................................. 2024 24,496 25,132
Maximum.................................. 2024 244,958 251,322
45 CFR Part 93, HHS........... Penalty for failure to provide 2024 ........... 0
Appendix A. certification regarding lobbying in the
award documents for all sub-awards of
all tiers.
Minimum.................................. 2024 24,496 25,132
Maximum.................................. 2024 244,958 251,322
HHS........... Penalty for failure to provide statement 2024 ........... 0
regarding lobbying for loan guarantee
and loan insurance transactions.
Minimum.................................. 2024 24,496 25,132
Maximum.................................. 2024 244,958 251,322
3801-3812................. 45 CFR 79.3(a)(1)(iv). HHS........... Penalty against any individual who--with 2024 12,800 13,133
knowledge or reason to know--makes,
presents or submits a false, fictitious
or fraudulent claim to the Department.
45 CFR 79.3(b)(1)(ii). HHS........... Penalty against any individual who--with 2024 12,800 13,133
knowledge or reason to know--makes,
presents or submits a false, fictitious
or fraudulent claim to the Department.
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Some HHS components have not promulgated regulations regarding their civil monetary penalty-specific statutory authorities.
\2\ The description is not intended to be a comprehensive explanation of the underlying violation; the statute and corresponding regulation, if
applicable, should be consulted.
\3\ Statutory or Inflation Act Adjustment.
\4\ OMB Memorandum M-16-06, Implementation of the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, published February 24,
2016, guided agencies on initial ``catch-up'' adjustment requirements, and M-17-11, Implementation of the 2017 annual adjustment pursuant to the
Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, published December 16, 2016; followed by M-18-03, M-19-04, M-20-05, M-21-
10, M-22-07, M-23-05, M-24-07, and M-25-02 guided agencies on annual adjustment requirements.
\5\ OMB Circular A-136, Financial Reporting Requirements, Section II.4.9, directs that agencies must make annual inflation adjustments to civil monetary
penalties and report on the adjustments in the Agency Financial Report (AFR) or Performance and Accountability Report (PAR).
\6\ Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, Sec. 701(b)(1)(A) (codified as amended at 28 U.S.C. 2461 note).
\7\ Annual inflation adjustments are based on the percent change between each published October's CPI-U. In this case, October 2024 CPI-U (315.664) /
October 2023 CPI-U (307.671) = 1.02598.

[[Page 3682]]

Robert F. Kennedy, Jr.,
Secretary, Department of Health and Human Services.
[FR Doc. 2026-01688 Filed 1-27-26; 8:45 am]
BILLING CODE 4150-24-P