Form Cms-8550 - Medicare Enrollment Application (Page 8 of 10) in pdf

SECTION 7: PENALTIES FOR FALSIFYING INFORMATION ON THIS APPLICATION

This section explains the penalties for deliberately furnishing false information in this application to gain or

maintain enrollment in the Medicare program.

1. 18 U.S.C. section 1001 authorizes criminal penalties against an individual who, in any matter within the

jurisdiction of any department or agency of the United States, knowingly and willfully falsifies, conceals

or covers up by any trick, scheme or device a material fact, or makes any false, fictitious, or fraudulent

statements or representations, or makes any false writing or document knowing the same to contain any

false, fictitious or fraudulent statement or entry. Individual offenders are subject to fines of up to $250,000

and imprisonment for up to five years. Offenders that are organizations are subject to fines of up to

$500,000 (18 U.S.C. section 3571). Section 3571(d) also authorizes fines of up to twice the gross gain derived

by the offender if it is greater than the amount specifically authorized by the sentencing statute.

2. Section 1128B(a)(1) of the Social Security Act authorizes criminal penalties against any individual who,

“knowingly and willfully,” makes or causes to be made any false statement or representation of a material

fact in any application for any benefit or payment under a federal health care program. The offender is

subject to fines of up to $25,000 and/or imprisonment for up to five years.

3. The Civil False Claims Act, 31 U.S.C. section 3729, imposes civil liability, in part, on any person who:

a) knowingly presents, or causes to be presented, to an officer or any employee of the United States

Government a false or fraudulent claim for payment or approval;

b) knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or

fraudulent claim paid or approved by the Government;

c) conspires to defraud the Government by getting a false or fraudulent claim allowed or paid.

The Act imposes a civil penalty of $5,000 to $10,000 per violation, plus three times the amount of damages

sustained by the Government

4. Section 1128A(a)(1) of the Social Security Act imposes civil liability, in part, on any person (including an

organization, agency or other entity) that knowingly presents or causes to be presented to an officer,

employee, or agent of the United States, or of any department or agency thereof, or of any State

agency…a claim…that the Secretary determines is for a medical or other item or service that the person

knows or should know:

a) was not provided as claimed; and/or

b) the claim is false or fraudulent.

5. This provision authorizes a civil monetary penalty of up to $10,000 for each item or service, an assessment

of up to three times the amount claimed, and exclusion from participation in the Medicare program and

State health care programs.

6. 18 U.S.C. 1035 authorizes criminal penalties against individuals in any matter involving a health care

benefit program who knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device

a material fact; or makes any materially false, fictitious, or fraudulent statements or representations,

or makes or uses any materially false fictitious, or fraudulent statement or entry, in connection with

the delivery of or payment for health care benefits, items or services. The individual shall be fined or

imprisoned up to 5 years or both.

7. 18 U.S.C. 1347 authorizes criminal penalties against individuals who knowing and willfully execute, or

attempt, to executive a scheme or artifice to defraud any health care benefit program, or to obtain, by

means of false or fraudulent pretenses, representations, or promises, any of the money or property owned

by or under the control of any, health care benefit program in connection with the delivery of or payment

for health care benefits, items, or services. Individuals shall be fined or imprisoned up to 10 years or both.

If the violation results in serious bodily injury, an individual will be fined or imprisoned up to 20 years, or

both. If the violation results in death, the individual shall be fined or imprisoned for any term of years or

for life, or both.

8. The government may assert common law claims such as “common law fraud,” “money paid by mistake,”

and “unjust enrichment.”

Remedies include compensatory and punitive damages, restitution, and recovery of the amount of the

unjust profit.

CMS-855O (01/17)

Form Cms-8550 - Medicare Enrollment Application Page 8

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