FY 2017 HHS Agency Financial Report
Topics in this Section: Other Financial Information | Reduce the Footprint | Summary of Financial Statement Audit and Management Assurances | Civil Monetary Penalty Adjustment for Inflation | Grants Oversight & New Efficiency Act Report | Payment Integrity Report (Section 1-10 | 11 | 12-13) | FY 2017 Top Management and Performance Challenges Identified by the Office of Inspector General
SUMMARY OF FINANCIAL STATEMENT AUDIT AND MANAGEMENT ASSURANCES
As described in the “Management’s Discussion and Analysis” section, management annually presents an assurance statement on the effectiveness of internal control. The following two tables present summary information related to the material weakness identified during the audit, as well as conformance with FMFIA and compliance with FFMIA.
Table 1: Summary of Financial Statement Audit
| Audit Opinion | Unmodified for Four Financial Statements Disclaimed Opinion on Statement of Social Insurance and Statement of Changes in Social Insurance Amounts |
||||
|---|---|---|---|---|---|
| Restatement | No | ||||
| Material Weaknesses | Beginning Balance | New | Resolved | Consolidated | Ending Balance |
| Financial Information Systems | 1 | − | − | − | 1 |
| Total Material Weaknesses | 1 | − | − | − | 1 |
Definition of Terms – Tables 1 and 2
(Reference: OMB Circular A-136, Financial Reporting Requirements, August 15, 2017, page 107)
Beginning Balance: The beginning balance will agree with the ending balance of material weaknesses from the prior year.
New: The total number of material weaknesses that have been identified during the current year.
Resolved: The total number of material weaknesses that have dropped below the level of materiality in the current year.
Consolidated: The combining of two or more findings.
Reassessed: The removal of any finding not attributable to corrective actions (e.g., management has re-evaluated and determined a finding does not meet the criteria for materiality or is redefined as more correctly classified under another heading (e.g., Section 2 to a Section 4 and vice versa).
Ending Balance: The agency’s year-end balance of material weaknesses.
Table 2: Summary of Management Assurances
| Effectiveness of Internal Control over Financial Reporting (FMFIA #2) | ||||||
|---|---|---|---|---|---|---|
| Statement of Assurance | Modified | |||||
| Material Weaknesses | Beginning Balance | New | Resolved | Consolidated | Reassessed | Ending Balance |
| No Material Weaknesses Noted | ||||||
| Total Material Weaknesses | 0 | - | - | - | - | 0 |
| Effectiveness of Internal Control over Operations (FMFIA #2) | ||||||
|---|---|---|---|---|---|---|
| Statement of Assurance | Modified | |||||
| Material Weaknesses | Beginning Balance | New | Resolved | Consolidated | Reassessed | Ending Balance |
| Information System Controls and Security | 1 | - | 1[1] | - | - | 0 |
| Error Rate Measurement | 1 | - | - | - | - | 1 |
| Medicare Appeals Process | 1 | - | - | - | - | 1 |
| Total Material Weaknesses | 3 | - | 1 | - | - | 2 |
[1] Beginning in FY 2015, HHS implemented a comprehensive strategy to strengthen the HHS Financial Systems Controls Environment and address the IT material weakness. Since then, significant progress has been made in resolving audit findings, reducing risk across the operating environment, and maturing the security and controls posture of HHS’s financial systems. As part of the strategy, HHS established a Management Assessment Framework that defines the conditions and criteria to evaluate the severity of control deficiencies found in Information System Controls and Security in HHS’s financial systems. Evaluation criteria include four key components: (1) Leadership Commitment and Sustained Governance; (2) Reduced Risk through Corrective Actions; (3) Demonstrated Measurable Remediation Progress; and (4) Mature Controls Environment. While control deficiencies still exist across several HHS FISCAM systems, our evaluation based on the HHS Management Assessment Framework demonstrates that these deficiencies, in aggregate, no longer rise to the level of a “material weakness” under OMB Circular A-123, as of September 30, 2017.
Compliance with Federal Financial Management System Requirements (FMFIA #4)
| Statement of Assurance |
Federal Systems comply to financial management system requirements |
|||||
|---|---|---|---|---|---|---|
| Non-Compliance | Beginning Balance | New | Resolved | Consolidated | Reassessed | Ending Balance |
| Information System Controls and Security | 0 | - | - | - | - | 0 |
| Total Non-Compliance | 0 | - | - | - | - | 0 |
| Compliance with Section 803(a) of the Federal Financial Management Improvement Act (FFMIA) | ||
|---|---|---|
| Agency | Auditor | |
| 1. Federal Financial Management System Requirements | No lack of compliance noted | Lack of compliance noted |
| 2. Applicable Federal Accounting Standards | No lack of compliance noted | No lack of compliance noted |
| 3. USSGL at Transaction Level | No lack of compliance noted | No lack of compliance noted |
CIVIL MONETARY PENALTY ADJUSTMENT FOR INFLATION
On November 2, 2015, the President signed into law the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 (the 2015 Act) (Sec. 701 of Public Law 114-74), which further amended the Federal Civil Penalties Inflation Adjustment Act of 1990 (Public Law 104-410), to improve the effectiveness of civil monetary penalties and to maintain their deterrent effect. Agencies must report the most recent inflationary adjustments to civil monetary penalties in order to ensure penalty adjustments are both timely and accurate.
The 2015 Act applies to eight Operating Divisions (OpDivs) and Staff Divisions (StaffDivs): ACF, AHRQ, HRSA, FDA, CMS, Office for Civil Rights, Office of the General Counsel, and Office of Inspector General. The table below illustrates HHS’s civil monetary penalties by OpDivs and StaffDivs. Supporting details can be found in Federal Register 82, No. 22 (February 3, 2017): 9174-9189.
[1] Beginning in FY 2015, HHS implemented a comprehensive strategy to strengthen the HHS Financial Systems Controls Environment and address the IT material weakness. Since then, significant progress has been made in resolving audit findings, reducing risk across the operating environment, and maturing the security and controls posture of HHS’s financial systems. As part of the strategy, HHS established a Management Assessment Framework that defines the conditions and criteria to evaluate the severity of control deficiencies found in Information System Controls and Security in HHS’s financial systems. Evaluation criteria include four key components: (1) Leadership Commitment and Sustained Governance; (2) Reduced Risk through Corrective Actions; (3) Demonstrated Measurable Remediation Progress; and (4) Mature Controls Environment. While control deficiencies still exist across several HHS FISCAM systems, our evaluation based on the HHS Management Assessment Framework demonstrates that these deficiencies, in aggregate, no longer rise to the level of a “material weakness” under OMB Circular A-123, as of September 30, 2017.
Administration for Children and Families
| Penalty | Statutory Authority | Date of Previous Adjustment | Date of Current Adjustment | Current Penalty Level ($ Amount) |
|---|---|---|---|---|
| Penalty for Misuse of Information in the National Directory of New Hires. | 42 U.S.C. 653(l)(2) | 2016 | 2017 | $ 1,474 |
Agency for Healthcare Research and Quality
| Penalty | Statutory Authority | Date of Previous Adjustment | Date of Current Adjustment | Current Penalty Level ($ Amount) |
|---|---|---|---|---|
| Penalty for an establishment or person supplying information obtained in the course of activities for any purpose other than the purpose for which it was supplied. | 42 U.S.C. 299c—(3)(d) | 2016 | 2017 | $ 14,371 |
Health Resources and Services Administration
| Penalty | Statutory Authority | Date of Previous Adjustment | Date of Current Adjustment | Current Penalty Level ($ Amount) |
|---|---|---|---|---|
| Penalty for each instance of overcharging a 340B covered entity. | 42 U.S.C. 256b(d)(1)(B)(vi) | 2016 | 2017 | $ 5,526 |
Office for Civil Rights
| Penalty | Statutory Authority | Date of Previous Adjustment | Date of Current Adjustment | Current Penalty Level ($ Amount) |
|---|---|---|---|---|
| Penalty for violation of confidentiality provision of the Patient Safety and Quality Improvement Act. | 42 U.S.C. 299b-22(f)(1) | 2016 | 2017 | $ 12,135 |
| Penalty for each pre-February 18, 2009 violation of the HIPAA administrative simplification provisions. | 42 U.S.C. 1320(d)-5(a) | 2016 | 2017 | 152 |
| Calendar Year Cap | 2016 | 2017 | 38,175 | |
| 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. | 2017 | |||
| Minimum | 2016 | 2017 | 112 | |
| Maximum | 2016 | 2017 | 55,910 | |
| Calendar Year Cap | 2016 | 2017 | 1,677,299 | |
| Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification provision in which it is established that the violation was due to reasonable cause and not to willful neglect. | 2017 | |||
| Minimum | 2016 | 2017 | 1,118 | |
| Maximum | 2016 | 2017 | 55,910 | |
| Calendar Year Cap | 2016 | 2017 | 1,677,299 | |
| Penalty for each February 18, 2009 or later violation of a HIPAA 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. | 2017 | |||
| Minimum | 2016 | 2017 | 11,182 | |
| Maximum | 2016 | 2017 | 55,910 | |
| Calendar Year Cap | 2016 | 2017 | 1,677,299 | |
| Penalty for each February 18, 2009 or later violation of a HIPAA 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. | 2017 | |||
| Minimum | 2016 | 2017 | 55,910 | |
| Maximum | 2016 | 2017 | 1,677,299 | |
| Calendar Year Cap | 2016 | 2017 | 1,677,299 |
Office of the General Counsel
| Penalty | Statutory Authority | Date of Previous Adjustment | Date of Current Adjustment | Current Penalty Level ($ Amount) |
|---|---|---|---|---|
| Penalty for the first time an individual makes an expenditure prohibited by regulations regarding lobbying disclosure, absent aggravating circumstances. | 31 U.S.C. 1352 | 2016 | 2017 | $ 19,246 |
| Penalty for second and subsequent offenses by individuals who make an expenditure prohibited by regulations regarding lobbying disclosure. | 2017 | |||
| Minimum | 2016 | 2017 | 19,246 | |
| Maximum | 2016 | 2017 | 192,459 | |
| Penalty for the first time an individual fails to file or amend a lobbying disclosure form, absent aggravating circumstances. | 2016 | 2017 | 19,246 | |
| Penalty for second and subsequent offenses by individuals who fail to file or amend a lobbying disclosure form, absent aggravating circumstances. | 2017 | |||
| Minimum | 2016 | 2017 | 19,246 | |
| Maximum | 2016 | 2017 | 192,459 | |
| Penalty for failure to provide certification regarding lobbying in the award documents for all sub-awards of all tiers. | 2017 | |||
| Minimum | 2016 | 2017 | 19,246 | |
| Maximum | 2016 | 2017 | 192,459 | |
| Penalty for failure to provide statement regarding lobbying for loan guarantee and loan insurance transactions. | 2017 | |||
| Minimum | 2016 | 2017 | 19,246 | |
| Maximum | 2016 | 2017 | 192,459 | |
| Penalty against any individual who - with knowledge or reason to know - makes, presents or submits a false, fictitious or fraudulent claim to the Department | 31 U.S.C. 3801-3812 | 2016 | 2017 | 10,056 |
| Penalty against any individual who - with knowledge or reason to know - makes, presents or submits a false, fictitious or fraudulent claim to the Department | 2016 | 2017 | 10,056 |
Office of Inspector General
| Penalty | Statutory Authority | Date of Previous Adjustment | Date of Current Adjustment | Current Penalty Level ($ Amount) |
|---|---|---|---|---|
| Penalty for each individual who violates safety and security procedures related to handling dangerous biological agents and toxins. | 42 U.S.C. 262a(i)(1) | 2016 | 2017 | $ 333,327 |
| Penalty for any other person who violates safety and security procedures related to handling dangerous biological agents and toxins. | 2016 | 2017 | 666,656 | |
| Penalty per violation for committing information blocking. | 42 U.S.C. 300jj-51 | 2016 | 2017 | 1,016,360 |
| Penalty for knowingly presenting or causing to be presented to an officer, employee, or agent of the United States a false claim. | 42 U.S.C. 1320a-7a(a) | 2016 | 2017 | 15,270 |
| Penalty for knowingly presenting or causing to be presented a request for payment which violates the terms of an assignment, agreement, or PPS agreement. | 2016 | 2017 | 15,270 | |
| Penalty for knowingly giving or causing to be presented to a participating provider or supplier false or misleading information that could reasonably be expected to influence a discharge decision. | 2016 | 2017 | 22,906 | |
| Penalty for an excluded party retaining ownership or control interest in a participating entity. | 2016 | 2017 | 15,270 | |
| Penalty for remuneration offered to induce program beneficiaries to use particular providers, practitioners, or suppliers. | 2016 | 2017 | 15,270 | |
| Penalty for employing or contracting with an excluded individual. | 2016 | 2017 | 14,959 | |
| Penalty for knowing and willful 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. | 2016 | 2017 | 74,792 | |
| Penalty for ordering or prescribing medical or other item or service during a period in which the person was excluded. | 2016 | 2017 | 11,052 | |
| Penalty for knowingly making or causing 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. | 2016 | 2017 | 55,262 | |
| Penalty for knowing of an overpayment and failing to report and return. | 2016 | 2017 | 11,052 | |
| Penalty for making or using a false record or statement that is material to a false or fraudulent claim | 2016 | 2017 | 55,262 | |
| Penalty for failure to grant timely access to HHS OIG for audits, investigations, evaluations, and other statutory functions of HHS OIG. | 2016 | 2017 | 16,579 | |
| 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. | 42 U.S.C. 1320a-7a(b) | 2016 | 2017 | 4,384 |
| Penalty for physicians who knowingly 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. | 2016 | 2017 | 4,384 | |
| Penalty for a physician who executes a document that falsely certifies home health needs for Medicare beneficiaries. | 2016 | 2017 | 7,635 | |
| Penalty for failure to report any final adverse action taken against a health care provider, supplier, or practitioner. | 42 U.S.C. 1320a-7e(b)(6)(A) | 2016 | 2017 | 37,396 |
| 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. | 42 U.S.C. 1320b-10(b)(1) | 2016 | 2017 | 10,055 |
| 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. | 42 U.S.C. 1320b-10(b)(2) | 2016 | 2017 | 50,276 |
| Penalty for certification of a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment. | 42 U.S.C. 1395i-3(b)(3)(B)(ii)(1) | 2016 | 2017 | 2,097 |
| Penalty for causing another to certify or make a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment. | 42 U.S.C. 1395i-3(b)(3)(B)(ii)(2) | 2016 | 2017 | 10,483 |
| 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. | 42 U.S.C. 1395i-3(g)(2)(A) | 2016 | 2017 | 4,194 |
| Penalty for a Medicare Advantage organization that substantially fails to provide medically necessary, required items and services. | 42 U.S.C. 1395w-27(g)(2)(A) | 2016 | 2017 | 38,175 |
| Penalty for a Medicare Advantage organization that charges excessive premiums. | 2016 | 2017 | 37,396 | |
| Penalty for a Medicare Advantage organization that improperly expels or refuses to reenroll a beneficiary. | 2016 | 2017 | 37,396 | |
| Penalty for a Medicare Advantage organization that engages in practice that would reasonably be expected to have the effect of denying or discouraging enrollment. | 2016 | 2017 | 149,585 | |
| Penalty per individual who does not 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. | 2016 | 2017 | 22,438 | |
| Penalty for a Medicare Advantage organization misrepresenting or falsifying information to Secretary. | 2016 | 2017 | 149,585 | |
| Penalty for a Medicare Advantage organization misrepresenting or falsifying information to individual or other entity. | 2016 | 2017 | 37,396 | |
| Penalty for Medicare Advantage organization interfering with provider’s advice to enrollee and non-MCO affiliated providers that balance bill enrollees. | 2016 | 2017 | 37,396 | |
| Penalty for a Medicare Advantage organization that employs or contracts with excluded individual or entity. | 2016 | 2017 | 37,396 | |
| Penalty for a Medicare Advantage organization enrolling an individual in without prior written consent. | 2016 | 2017 | 37,396 | |
| Penalty for a Medicare Advantage organization transferring an enrollee to another plan without consent or solely for the purpose of earning a commission. | 2016 | 2017 | 37,396 | |
| Penalty for a Medicare Advantage organization failing to comply with marketing restrictions or applicable implementing regulations or guidance. | 2016 | 2017 | 37,396 | |
| Penalty for a Medicare Advantage organization employing or contracting with an individual or entity who violates 1395w-27(g)(1)(A)-(J). | 2016 | 2017 | 37,396 | |
| Penalty for a prescription drug card sponsor that falsifies or misrepresents marketing materials, overcharges program enrollees, or misuse transitional assistance funds. | 42 U.S.C. 1395w-141(i)(3) | 2016 | 2017 | 13,066 |
| Penalty for improper billing by Hospitals, Critical Access Hospitals, or Skilled Nursing Facilities. | 42 U.S.C. 1395cc(g) | 2016 | 2017 | 5,082 |
| Penalty for a hospital or responsible physician dumping patients needing emergency medical care, if the hospital has 100 beds or more. | 42 U.S.C. 1395dd(d)(1) | 2016 | 2017 | 104,826 |
| Penalty for a hospital or responsible physician dumping patients needing emergency care, if the hospital has less than 100 beds. | 2016 | 2017 | 52,414 | |
| Penalty for a HMO or competitive plan is such plan substantially fails to provide medically necessary, required items or services | 42 U.S.C. 1395mm(i)(6)(B)(i) | 2016 | 2017 | 52,414 |
| Penalty for HMOs/competitive medical plans that charge premiums in excess of permitted amounts | 2016 | 2017 | 52,414 | |
| Penalty for a HMO or competitive medical plan that expels or refuses to reenroll an individual per prescribed conditions | 2016 | 2017 | 52,414 | |
| Penalty for a HMO or competitive medical plan that implements practices to discourage enrollment of individuals needing services in future. | 2016 | 2017 | 209,653 | |
| Penalty per individual not enrolled in a plan as a result of a HMO or competitive medical plan that implements practices to discourage enrollment of individuals needing services in the future. | 2016 | 2017 | 30,166 | |
| Penalty for a HMO or competitive medical plan that misrepresents or falsifies information to the Secretary. | 2016 | 2017 | 209,653 | |
| Penalty for a HMO or competitive medical plan that misrepresents or falsifies information to an individual or any other entity. | 2016 | 2017 | 52,414 | |
| Penalty for failure by HMO or competitive medical plan to assure prompt payment of Medicare risk sharing contracts or incentive plan provisions. | 2016 | 2017 | 52,414 | |
| Penalty for HMO that employs or contracts with excluded individual or entity. | 2016 | 2017 | 48,114 | |
| Penalty for submitting or causing to be submitted claims in violation of the Stark Law’s restrictions on physician self-referrals. | 42 U.S.C. 1395nn(g)(3) | 2016 | 2017 | 24,253 |
| Penalty for circumventing Stark Law’s restrictions on physician self-referrals. | 42 U.S.C. 1395nn(g)(4) | 2016 | 2017 | 161,692 |
| Penalty for a material misrepresentation regarding Medigap compliance policies. | 42 U.S.C. 1395ss(d)(1) | 2016 | 2017 | 10,055 |
| Penalty for selling Medigap policy under false pretense. | 42 U.S.C. 1395ss(d)(2) | 2016 | 2017 | 10,055 |
| Penalty for an issuer that sells health insurance policy that duplicates benefits. | 42 U.S.C. 1395ss(d)(3)(A)(ii) | 2016 | 2017 | 45,268 |
| Penalty for someone other than issuer that sells health insurance that duplicates benefits. | 2016 | 2017 | 27,160 | |
| Penalty for using mail to sell a non-approved Medigap insurance policy. | 42 U.S.C. 1395ss(d)(4)(A) | 2016 | 2017 | 10,055 |
| Penalty for a Medicaid MCO that substantially fails to provide medically necessary, required items or services. | 42 U.S.C. 1396b(m)(5)(B)(i) | 2016 | 2017 | 50,276 |
| Penalty for a Medicaid MCO that charges excessive premiums. | 42 U.S.C. 1396b(m)(5)(B)(i) | 2016 | 2017 | 50,276 |
| Penalty for a Medicaid MCO that improperly expels or refuses to reenroll a beneficiary. | 2016 | 2017 | 201,106 | |
| Penalty per individual who does not enroll as a result of a Medicaid MCO’s practice that would reasonably be expected to have the effect of denying or discouraging enrollment. | 2016 | 2017 | 30,166 | |
| Penalty for a Medicaid MCO misrepresenting or falsifying information to the Secretary. | 2016 | 2017 | 201,106 | |
| Penalty for a Medicaid MCO misrepresenting or falsifying information to an individual or another entity. | 2016 | 2017 | 50,276 | |
| Penalty for a Medicaid MCO that fails to comply with contract requirements with respect to physician incentive plans. | 2016 | 2017 | 45,268 | |
| Penalty for willfully and knowingly certifying a material and false statement in a Skilled Nursing Facility resident assessment. | 42 U.S.C. 1396r(b)(3)(B)(ii)(I) | 2016 | 2017 | 2,097 |
| Penalty for willfully and knowingly causing another individual to certify a material and false statement in a Skilled Nursing Facility resident assessment. | 42 U.S.C. 1396r(b)(3)(B)(ii)(II) | 2016 | 2017 | 10,483 |
| Penalty for notifying or causing to be notified a Skilled Nursing Facility of the time or date on which a survey is to be conducted. | 42 U.S.C. 1396r(g)(2)(A)(i) | 2016 | 2017 | 4,194 |
| Penalty for the knowing provision of false information or refusing to provide information about charges or prices of a covered outpatient drug. | 42 U.S.C. 1396r-8(b)(3)(B) | 2016 | 2017 | 181,071 |
| Penalty per day for failure to timely provide information by drug manufacturer with rebate agreement. | 42 U.S.C. 1396r-8(b)(3)(C)(i) | 2016 | 2017 | 18,107 |
| Penalty for knowing provision of false information by drug manufacturer with rebate agreement. | 42 U.S.C. 1396r-8(b)(3)(C)(ii) | 2016 | 2017 | 181,071 |
| Penalty for notifying home and community-based providers or settings of survey. | 42 U.S.C. 1396t(i)(3)(A) | 2016 | 2017 | 3,621 |
| Penalty for failing to report a medical malpractice claim to National Practitioner Data Bank. | 42 U.S.C. 11131(c) | 2016 | 2017 | 21,916 |
| Penalty for breaching confidentiality of information reported to National Practitioner Data Bank. | 42 U.S.C. 11137(b)(2) | 2016 | 2017 | 21,916 |
Food and Drug Administration
| Penalty | Statutory Authority | Date of Previous Adjustment | Date of Current Adjustment | Current Penalty Level ($ Amount) |
|---|---|---|---|---|
| Penalty for violations related to drug samples resulting in a conviction of any representative of manufacturer or distributor in any 10-year period. | 21 U.S.C. 333(b)(2)(A) | 2016 | 2017 | $ 100,554 |
| Penalty for violation related to drug samples resulting in a conviction of any representative of manufacturer or distributor after the second conviction in any 10-yr period. | 21 U.S.C. 333(b)(2)(B) | 2016 | 2017 | 2,011,061 |
| Penalty for failure to make a report required by 21 U.S.C. 353(d)(3)(E) relating to drug samples. | 21 U.S.C 333(b)(3) | 2016 | 2017 | 201,106 |
| Penalty for any person who violates a requirement related to devices for each such violation. | 21 U.S.C 333(f)(1)(A) | 2016 | 2017 | 27,160 |
| Penalty for aggregate of all violations related to devices in a single proceeding. | 2016 | 2017 | 1,810,706 | |
| Penalty for any individual who introduces 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. | 21 U.S.C 333(f)(2)(A) | 2016 | 2017 | 76,352 |
| Penalty in the case of any other person other than an individual) for such introduction or delivery of adulterated food. | 2016 | 2017 | 381,758 | |
| Penalty for aggregate of all such violations related to adulterated food adjudicated in a single proceeding. | 2016 | 2017 | 763,515 | |
| Penalty for all violations adjudicated in a single proceeding for any person who fails to submit certification required by 42 U.S.C. 282(j)(5)(B) or knowingly submitting a false certification. | 21 U.S.C 333(f)(3)(A) | 2016 | 2017 | 11,569 |
| Penalty for all violations adjudicated in a single proceeding for any person who violates 21 U.S.C. 331(jj)(1) 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). | 21 U.S.C 333(f)(3)(B) | 2016 | 2017 | 11,569 |
| Penalty for any responsible person that 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). | 21 U.S.C 333(f)(4)(A)(i) | 2016 | 2017 | 289,239 |
| Penalty for aggregate of all such above violations in a single proceeding. | 2016 | 2017 | 1,156,953 | |
| Penalty for REMS violation that continues 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. | 21 U.S.C 333(f)(4)(A)(ii) | 2016 | 2017 | 289,239 |
| Penalty for REMS violation that continues 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. | 2016 | 2017 | 1,156,953 | |
| Penalty for aggregate of all such above violations adjudicated in a single proceeding. | 2016 | 2017 | 11,569,531 | |
| Penalty for any person who violates a requirement which relates to tobacco products for each such violation | 21 U.S.C 333(f)(9)(A) | 2016 | 2017 | 16,773 |
| Penalty for aggregate of all such violations of tobacco product requirement adjudicated in a single proceeding. | 2016 | 2017 | 1,118,199 | |
| Penalty per violation related to violations of tobacco requirements. | 21 U.S.C 333(f)(9)(B)(i)(I) | 2016 | 2017 | 279,550 |
| Penalty for aggregate of all such violations of tobacco product requirements adjudicated in a single proceeding. | 2016 | 2017 | 1,118,199 | |
| Penalty in the case of a violation of 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. | 21 U.S.C 333(f)(9)(B)(i)(II) | 2016 | 2017 | 279,550 |
| Penalty for violation of tobacco product 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. | 2016 | 2017 | 1,118,199 | |
| Penalty for aggregate of all such violations related to tobacco product requirements adjudicated in a single proceeding. | 2016 | 2017 | 11,181,993 | |
| Penalty for any person who either does 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. | 21 U.S.C 333(f)(9)(B)(ii)(I) | 2016 | 2017 | 279,550 |
| Penalty for aggregate of for all such above violations adjudicated in a single proceeding. | 2016 | 2017 | 1,118,199 | |
| Penalty for violation of modified risk 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. | 21 U.S.C 333(f)(9)(B)(ii)(II) | 2016 | 2017 | 279,550 |
| Penalty for post-notice violation of 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. | 2016 | 2017 | 1,118,199 | |
| Penalty for aggregate above tobacco product requirement violations adjudicated in a single proceeding. | 2016 | 2017 | 11,181,993 | |
| Penalty for any person who disseminates 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. | 21 U.S.C 333(g)(1) | 2016 | 2017 | 289,239 |
| Penalty for each subsequent above violation in any 3–year period. | 2016 | 2017 | 578,477 | |
| Penalty to be applied for 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. | 21 U.S.C 333 note | 2016 | 2017 | 279 |
| Penalty in the case of a third tobacco product regulation violation within a 24–month period. | 2016 | 2017 | 559 | |
| Penalty in the case of a fourth tobacco product regulation violation within a 24–month period. | 2016 | 2017 | 2,236 | |
| Penalty in the case of a fifth tobacco product regulation violation within a 36–month period. | 2016 | 2017 | 5,591 | |
| Penalty in the case of a sixth or subsequent tobacco product regulation violation within a 48–month period as determined on a case-by-case basis. | 21 U.S.C 333 note | 2016 | 2017 | 11,182 |
| Penalty to be applied for 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. | 2016 | 2017 | 279 | |
| Penalty in the case of a second tobacco product regulation violation within a 12-month period. | 2016 | 2017 | 559 | |
| Penalty in the case of a third tobacco product regulation violation within a 24–month period. | 2016 | 2017 | 1,118 | |
| Penalty in the case of a fourth tobacco product regulation violation within a 24–month period. | 2016 | 2017 | 2,236 | |
| Penalty in the case of a fifth tobacco product regulation violation within a 36–month period. | 2016 | 2017 | 5,591 | |
| Penalty in the case of a sixth or subsequent tobacco product regulation violation within a 48–month period as determined on a case-by-case basis. | 2016 | 2017 | 11,182 | |
| Penalty for each violation for any 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. | 21 U.S.C 335b(a) | 2016 | 2017 | 426,180 |
| Penalty in the case of any other person (other than an individual) per above violation. | 2016 | 2017 | 1,704,720 | |
| Penalty for any person who violates any such requirements for electronic products, with each unlawful act or omission constituting a separate violation. | 21 U.S.C 360pp(b)(1) | 2016 | 2017 | 2,795 |
| Penalty imposed for any related series of violations of requirements relating to electronic products. | 2016 | 2017 | 952,838 | |
| Penalty per day for violation of order of recall of biological product presenting imminent or substantial hazard. | 42 U.S.C. 262(d) | 2016 | 2017 | 219,156 |
| Penalty for failure to obtain a mammography certificate as required. | 42 U.S.C.263b(h)(3) | 2016 | 2017 | 17,047 |
| Penalty per occurrence for any vaccine manufacturer that intentionally destroys, alters, falsifies, or conceals any record or report required. | 42 U.S.C. 300aa-28(b)(1) | 2016 | 2017 | 219,156 |
Centers for Medicare & Medicaid Services
| Penalty | Statutory Authority | Date of Previous Adjustment | Date of Current Adjustment | Current Penalty Level ($ Amount) |
|---|---|---|---|---|
| Penalty for a clinical laboratory’s failure to meet participation and certification requirements and poses immediate jeopardy. | 42 U.S.C. 263a(h)(2)(B) & 42 U.S.C. 1395w-2(b)(2)(A)(ii) | 2017 | ||
| Minimum | 2016 | 2017 | $ 6,134 | |
| Maximum | 2016 | 2017 | 20,111 | |
| Penalty for a clinical laboratory’s failure to meet participation and certification requirements and the failure does not pose immediate jeopardy. | 2017 | |||
| Minimum | 2016 | 2017 | 101 | |
| Maximum | 2016 | 2017 | 6,033 | |
| Failure to provide the Summary of Benefits and Coverage (SBC) | 42 U.S.C. 300gg-15(f) | 2016 | 2017 | 1,105 |
| Penalty for violations of regulations related to the medical loss ratio reporting and rebating. | 42 U.S.C. 300gg-18 | 2016 | 2017 | 111 |
| Penalty for manufacturer or group purchasing organization failing to report information required under 42 USC 1320a-7h(a), relating to physician ownership or investment interests | 42 U.S.C. 1320a-7h(b)(1) | 2017 | ||
| Minimum | 2016 | 2017 | 1,105 | |
| Maximum | 2016 | 2017 | 11,052 | |
| Calendar Year Cap | 2016 | 2017 | 165,786 | |
| Penalty for manufacturer or group purchasing organization knowingly failing to report information required under 42 USC 1320a-7h(a) , relating to physician ownership or investment interests | 42 U.S.C. 1320a-7h(b)(2) | 2017 | ||
| Minimum | 2016 | 2017 | 11,052 | |
| Maximum | 2016 | 2017 | 110,524 | |
| Calendar Year Cap | 2016 | 2017 | 1,105,241 | |
| Penalty for an administrator of a facility that fails to comply with notice requirements for the closure of a facility. | 42 U.S.C. 1320a-7j(h)(3)(A) | 2016 | 2017 | 110,524 |
| Minimum penalty for the first offense of an administrator who fails to provide notice of facility closure. | 2016 | 2017 | 553 | |
| Minimum penalty for the second offense of an administrator who fails to provide notice of facility closure. | 2016 | 2017 | 1,658 | |
| Minimum penalty for the third and subsequent offenses of an administrator who fails to provide notice of facility closure. | 2016 | 2017 | 3,315 | |
| 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. | 42 U.S.C. 1320a-8(a)(1) | 2016 | 2017 | 8,084 |
| Penalty for the violation of 42 USC 1320a-8a(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. | 2016 | 2017 | 7,623 | |
| Penalty for a representative payee (under 42 USC 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. | 42 U.S.C. 1320a-8(a)(3) | 2016 | 2017 | 6,331 |
| 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. | 42 U.S.C. 1320b-25(c)(1)(A) | 2016 | 2017 | 221,048 |
| 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. | 42 U.S.C. 1320b-25(c)(2)(A) | 2016 | 2017 | 331,572 |
| 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. | 42 U.S.C. 1320b-25(d)(2) | 2016 | 2017 | 221,048 |
| 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. | 42 U.S.C. 1395b-7(b)(2)(B) | 2016 | 2017 | 149 |
| Penalty per day for a Skilled Nursing Facility that has a Category 2 violation of certification requirements. | 42 U.S.C. 1395i-3(h)(2)(B)(ii)(I) | 2017 | ||
| Minimum | 2016 | 2017 | 105 | |
| Maximum | 2016 | 2017 | 6,289 | |
| Penalty per instance of Category 2 noncompliance by a Skilled Nursing Facility. | 42 U.S.C. 1395i-3(h)(2)(B)(ii)(I) | 2017 | ||
| Minimum | 2016 | 2017 | 2,097 | |
| Maximum | 2016 | 2017 | 20,965 | |
| Penalty per day for a Skilled Nursing Facility that has a Category 3 violation of certification requirements. | 2017 | |||
| Minimum | 2016 | 2017 | 6,394 | |
| Maximum | 2016 | 2017 | 20,965 | |
| Penalty per instance of Category 3 noncompliance by a Skilled Nursing Facility. | 2017 | |||
| Minimum | 2016 | 2017 | 2,097 | |
| Maximum | 2016 | 2017 | 20,965 | |
| Penalty per day and per instance for a Skilled Nursing Facility that has Category 3 noncompliance with Immediate Jeopardy | 2017 | |||
| Per Day (Minimum) | 2016 | 2017 | 6,394 | |
| Per Day (Maximum) | 2016 | 2017 | 20,965 | |
| Per Instance (Minimum) | 2016 | 2017 | 2,097 | |
| Per Instance (Maximum) | 2016 | 2017 | 20,965 | |
| Penalty per day of a Skilled Nursing Facility that fails to meet certification requirements. These amounts represent the upper range per day. | 2017 | |||
| Minimum | 2016 | 2017 | 6,394 | |
| Maximum | 2016 | 2017 | 20,965 | |
| Penalty per day of a Skilled Nursing Facility that fails to meet certification requirements. These amounts represent the lower range per day. | 2017 | |||
| Minimum | 2016 | 2017 | 105 | |
| Maximum | 2016 | 2017 | 6,289 | |
| Penalty per instance of a Skilled Nursing Facility that fails to meet certification requirements. | 2017 | |||
| Minimum | 2016 | 2017 | 2,097 | |
| Maximum | 2016 | 2017 | 20,965 | |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395l(h)(5)(D) | 2016 | 2017 | 15,270 |
| 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. | 42 U.S.C. 1395l(i)(6) | 2016 | 2017 | 4,022 |
| Penalty for knowingly and willfully failing to provide information about a referring physician when seeking payment on an unassigned basis. | 42 U.S.C. 1395l(q)(2)(B)(i) | 2016 | 2017 | 3,849 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395m(a)(11)(A) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395m(a)(18)(B) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395m(b)(5)(C) | 2016 | 2017 | 15,270 |
| 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 USC 1395m(a)(11)(A), that is in the same manner as 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395m(h)(3) | 2016 | 2017 | 15,270 |
| 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. | 42 U.S.C. 1395m(j)(2)(A)(iii) | 2016 | 2017 | 1,617 |
| 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 USC 1395m(j)(4) and 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395m(j)(4) | 2016 | 2017 | 15,270 |
| Penalty for any person or entity who 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 USC 1395m(k)(6) and 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395m(k)(6) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(b)(18)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395m(l)(6) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395u(b)(18)(B) | 2016 | 2017 | 15,270 |
| Penalty for any physician who charges more than 125% for a non-participating referral. (Penalties are assessed in the same manner as 42 USC 1320a-7a(a)). | 42 U.S.C. 1395u(j)(2)(B) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395u(k) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395u(l)(3) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395u(m)(3) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395u(n)(3) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(b)(18)(B) and 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395u(o)(3)(B) | 2016 | 2017 | 15,270 |
| 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. | 42 U.S.C. 1395u(p)(3)(A) | 2016 | 2017 | 4,022 |
| Penalty for a pharmaceutical manufacturer’s misrepresentation of average sales price of a drug, or biologic. | 42 U.S.C. 1395w-3a(d)(4)(A) | 2016 | 2017 | 13,066 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395w-4(g)(1)(B) | 2016 | 2017 | 15,270 |
| 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 USC 1395u(j)(2)(B), which is assessed according to 1320a-7a(a)). | 42 U.S.C. 1395w-4(g)(3)(B) | 2016 | 2017 | 15,270 |
| 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 an individual covered under the organization’s contract. | 42 U.S.C. 1395w-27(g)(3)(A); 42 U.S.C. 1857(g)(3) | 2016 | 2017 | 37,396 |
| 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. | 42 U.S.C. 1395w-27(g)(3)(B);42 U.S.C. 1857(g)(3) | 2016 | 2017 | 14,959 |
| Penalty for a Medicare Advantage organization’s or Part D sponsor's early termination of its contract. | 42 U.S.C. 1395w-27(g)(3)(D); 42 U.S.C. 1857(g)(3) | 2016 | 2017 | 138,925 |
| 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. | 42 U.S.C. 1395y(b)(3)(C) | 2016 | 2017 | 9,054 |
| 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. | 42 U.S.C. 1395y(b)(5)(C)(ii) | 2016 | 2017 | 1,474 |
| 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. | 42 U.S.C. 1395y(b)(6)(B) | 2016 | 2017 | 3,234 |
| 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. | 42 U.S.C. 1395y(b)(7)(B)(i) | 2016 | 2017 | 1,157 |
| 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. | 42 U.S.C. 1395y(b)(8)(E) | 2016 | 2017 | 1,157 |
Also see these sections of the Agency Financial Report:
- Section I: Management, Discussion and Analysis
- Section II: Financial Section
- Section III: Other Information - Subsection 1
- Section III: Other Information - Subsection 3
- Section III: Other Information - Subsection 4
- Section III: Other Information - Subsection 5
- Appendices
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