42 CFR § 1003.410 - Amount of penalties and assessments for Contracting Organization.

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§ 1003.410 Amount of penalties and assessments for Contracting Organization.

(a)Penalties.3 (1) The OIG may impose a penalty of up to $25,000 for each individual violation under § 1001.400, except as provided in this section.

3 The penalty amounts in this section are adjusted for inflation annually. Adjusted amounts are published at 45 CFR part 102.

(2) The OIG may impose a penalty of up to $100,000 for each individual violation under § 1003.400(a)(3), (a)(5), or (e).

(b)Additional penalties. In addition to the penalties described in paragraph (a) of this section, the OIG may impose -

(1) An additional penalty equal to double the amount of excess premium charged by the contracting organization for each individual violation of § 1003.400(a)(2). The excess premium amount will be deducted from the penalty and returned to the enrollee.

(2) An additional $15,000 4penalty for each individual expelled or not enrolled in violation of § 1003.400(a)(3) or (e).

4 This penalty amount is adjusted for inflation annually. Adjusted amounts are published at 45 CFR part 102.

(c)Assessments. The OIG may impose an assessment against a contracting organization with a contract under section 1857 or 1860D-12 of the Act (Medicare Advantage or Part D) of not more than the amount claimed in violation of § 1003.400(a)(4) or (a)(5) on the basis of the misrepresentation or falsified information involved.

(d) The OIG may impose a penalty or, when applicable, an assessment, against a contracting organization with a contract under section 1857 or 1860D-12 of the Act (Medicare Advantage or Part D) if any of its employees, agents, or contracting providers or suppliers engages in any of the conduct described in § 1003.400(a) through (d).