Questions billers ask › What are the OIG civil money penalties for false Medicare claims?

What are the OIG civil money penalties for false Medicare claims?

Answered from the public Medicare sources on 2026-09-15. The quoted text is the source; the note beneath it is what our AI found. You decide what applies to your claim.

The rule, word for word

“(a) Penalties. (1) In cases under § 1003.700(a)(1), the OIG may impose a penalty of not more than $10,000 for each specified claim. (2) In cases under § 1003.700(a)(2), the OIG may impose a penalty of not more than $50,000 for each false statement, omission, or misrepresentation of a material fact. (3) In cases under § 1003.700(a)(3), the OIG may impose a penalty of not more than $50,000 for each false record or statement. (4) In cases under § 1003.700(a)(4), the OIG may impose a penalty of not more than $50,000 for each false record or statement or not more than $10,000 for each day that the person knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay. (5) In cases under § 1003.700(a)(5), the OIG may impose a penalty of not more than $15,000 for each day of the failure described in § 1003.700(a)(5). (b) Assessments. (1) In cases under § 1003.700(a)(1) and (3), such a person shall be subject to an assessment of not more than three times the amount claimed in the specified claim described in § 1003.700(a)(1) and (3) in lieu of damages sustained by the United States or a specified State agency because of such specified claim. (2) In cases under § 1003.700(a)(2) and (4), such a person shall be subject to an assessment of not more than three times the total amount of the funds described in § 1003.700(a)(2) and (4), respectively (or, in the case of [...]”

42 CFR § 1003.710, Subpart G -- CMPs, Assessments, and Exclusions for Fraud or False Claims or Similar Conduct Related to Grants, Contracts, and Other Agreements -- § 1003.710 Amount of penalties and assessments.
Published2026-04-06 Captured2026-04-06
sha256:8c3ae58a…b2f1d2b6 · Source

What our AI found in the sources

OIG civil money penalties for false claims depend on the type of violation. For specified false claims under § 1003.700(a)(1), the penalty is not more than $10,000 per claim. For false statements, omissions, or misrepresentations of material fact under § 1003.700(a)(2), the penalty is not more than $50,000 per false statement. For false records or statements under § 1003.700(a)(3), the penalty is not more than $50,000 per false record or statement. In addition to penalties, assessments of up to three times the amount claimed may apply.

Also cited

Federal Register, document 2023-13851, § 1003.710 (§ 1003.710 Amount of penalties and assessments.)
Published2023-07-03 Captured2023-07-03
sha256:72e9eb30…77f7e256 · Source

If this comes up on one of your claims

The quoted paragraph above is what you would put in the appeal or the audit file, with its citation and dates. Verbatim does not tell you how to bill; it shows you the rule as published so the decision is yours and the proof is in writing.

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