Healthcare providers will be subject to up to a $10,000 fine per false claim rather than the previous maximum of $2,000 under new civil fraud regulations issued late last week by HHS' inspector general's office.
The regulations, published in the April 26 Federal Register, outline the agency's legal authorities under the existing civil monetary penalties rule.
The new regulations expand the inspector general's ability to punish fraudulent healthcare providers, attempt to equalize standards and legal provisions, and offer new exemptions to the civil monetary penalty rule.
For example, the new regulations extend the agency's authority beyond Medicare and Medicaid to other federal health insurance programs, including military health program Tricare (formerly CHAMPUS) and the programs at Veterans Affairs and the U.S. Public Health Service. They also close a loophole that allowed individuals excluded from Medicare or Medicaid to maintain interests in healthcare organizations billing those programs.
The 20-page set of regulations also codify some elements of the 1996 Health Insurance Portability and Accountability Act, such as increasing civil monetary penalties to $10,000 per false claim from $2,000.
The final regulations, which were proposed on March 25, 1998, took effect on April 26.