Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69531 

pilot to evaluate the use of this 

increased delegated authority by ALP 

CDCs and to identify opportunities for 

further modification. 

For further guidance on ALP Express 

authority, see the Economic Aid Act and 

the ALP Express Pilot Program Guide. 

2. Application Terms and Conditions 

and Forms 

CDCs must use the application forms 

required for current 504 loan processing 

and execute an SBA Terms and 

Conditions document for each ALP 

Express Pilot Loan, as set forth in SOP 

50 10 7. For further guidance on the 

SBA Terms and Conditions and the 

required forms, see SOP 50 10 7 and the 

ALP Express Pilot Program Guide. 

Reporting Requirements 

CDCs must document on SBA Form 

1244 (by checking the ALP Express box 

on page 12) whether the ALP CDC is 

using its ALP Express authority when 

submitting an application for an ALP 

Express Pilot Loan. This will allow SBA 

to track ALP CDCs’ use of this increased 

delegated authority. CDCs must also 

continue to comply with the reporting 

requirements in 13 CFR 120.830. 

Lender Oversight 

ALP CDC oversight procedures shall 

follow the requirements set forth in 13 

CFR part 120—Subpart I and SOPs 50 

53 (Lender Supervision and 

Enforcement) and 51 00 (On-Site Lender 

Reviews and Examinations). The SOPs 

can be found at: https://archive.sba.gov/ 

tools/resourcelibrary/sops/index.html. 

ALP CDCs will be monitored both for 

performance and other risk 

characteristics as well as for compliance 

with the requirements of the ALP 

Express Pilot Program. The ALP CDC 

must maintain compliance with the 

requirement that it only makes ALP 

Express Pilot Loans in an amount of 

$500,000 or less, along with all other 

Loan Program Requirements. ALP CDCs 

also will be subject to 13 CFR 120.1400 

through 120.1600 and the provisions of 

SOP 50 53 concerning supervision and 

enforcement. 

Evaluation Criteria for ALP Express 

Pilot 

SBA is reviewing the following data 

related to ALP CDCs and their use of 

ALP Express authority and will use the 

same evaluation criteria for the ALP 

Express Pilot: 

(1.) Did the number and/or percentage 

of 504 loans in the portfolio under 

$500,000 increase as a result of the 

availability of ALP Express authority? 

(2.) How do the default rates of ALP 

Express loans compare with similarly 

sized loans not processed and serviced 

using this authority? 

(3.) Did ALP Express loan approvals 

and servicing turn times improve, 

resulting in enhanced customer service? 

For data collections to evaluate the 

effectiveness of this pilot, SBA will use 

ETran, SBA’s electronic system for loan 

submission and servicing. 

Authority: 13 CFR 120.3. 

Isabella Casillas Guzman, 

Administrator. 

[FR Doc. 2023–22171 Filed 10–5–23; 8:45 am] 

BILLING CODE 8026–09–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

45 CFR Part 102 

RIN 0991–AC34 

Annual Civil Monetary Penalties 

Inflation Adjustment 

AGENCY: Office of the Assistant 

Secretary for Financial Resources, 

Department of Health and Human 

Services. 

ACTION: Final rule. 

SUMMARY: The Department of Health and 

Human Services (HHS) is updating its 

regulations to reflect required annual 

inflation-related increases to the civil 

monetary penalty (CMP) amounts in its 

regulations, under the Federal Civil 

Penalties Inflation Adjustment Act 

Improvements Act of 2015 and adds 

references to new penalty authorities. 

DATES: 

Effective date: This final rule is 

effective October 6, 2023. 

Applicability date: The adjusted civil 

monetary penalty amounts apply to 

penalties assessed on or after the date of 

publication to the Federal Register, if 

the violation occurred on or after 

November 2, 2015. 

FOR FURTHER INFORMATION CONTACT: 

Katrina Brisbon, Deputy Assistant 

Secretary, Office of Acquisitions, Office 

of the Assistant Secretary for Financial 

Resources, Room 536–H, Hubert 

Humphrey Building, 200 Independence 

Avenue SW, Washington DC 20201; 

(202)260–6677. 

SUPPLEMENTARY INFORMATION: 

I. Background 

The Federal Civil Penalties Inflation 

Adjustment Act Improvements Act of 

2015 (section 701 of Pub. L. 114–74) 

(the ‘‘2015 Act’’) amended the Federal 

Civil Penalties Inflation Adjustment Act 

of 1990 (Pub. L. 101–410, 104 Stat. 890 

(1990)), which is intended to improve 

the effectiveness of CMPs and to 

maintain the deterrent effect of such 

penalties, requires agencies to adjust the 

CMPs for inflation annually. 

HHS lists the CMP authorities and the 

amounts administered by all of its 

agencies in tabular form in 45 CFR 

102.3, which was issued in an interim 

final rule published in the September 6, 

2016, Federal Register (81 FR 61538). 

Annual adjustments were subsequently 

published on February 3, 2017 (82 FR 

9175), October 11, 2018 (83 FR 51369), 

November 5, 2019 (84 FR 59549), 

January 17, 2020 (85 FR 2869), 

November 15, 2021 (86 FR 62928), and 

March 17, 2022 (87 FR 15100). 

II. Calculation of Annual Inflation 

Adjustment and Other Updates 

The annual inflation adjustment for 

each applicable CMP is determined 

using the percent increase in the 

Consumer Price Index for all Urban 

Consumers (CPI–U) for the month of 

October of the year in which the amount 

of each CMP was most recently 

established or modified. In the 

December 15, 2022, Office of 

Management and Budget (OMB) 

Memorandum for the Heads of 

Executive Agencies and Departments, 

M–23–05, ‘‘Implementation of Penalty 

Inflation Adjustments for 2023, 

Pursuant to the Federal Civil Penalties 

Inflation Adjustment Act Improvements 

Act of 2015,’’ OMB published the 

multiplier for the required annual 

adjustment. The cost-of-living 

adjustment multiplier for 2023, based 

on the CPI–U for the month of October 

2022, not seasonally adjusted, is 

1.07745. The multiplier is applied to 

each applicable penalty amount that 

was updated and published for fiscal 

year (FY) 2022 and is rounded to the 

nearest dollar. 

In addition to the inflation 

adjustments for 2023, this final rule 

updates the table in 45 CFR 102.3 to add 

references to new, applicable CMP 

authorities that were established or 

implemented since the publication of 

the March 17, 2022, update and that are 

being updated in this rule. 

First, in the final rule, ‘‘Medicare and 

Medicaid Program: Hospital Outpatient 

Prospective Payment and Ambulatory 

Surgical Center Payment Systems and 

Quality Reporting Programs; Price 

Transparency of Hospital Standard 

Charges; Radiation Oncology Model’’ 

final rule with comment period (86 FR 

63548, November 16, 2021), the Centers 

for Medicare & Medicaid Services (CMS) 

finalized a new provision, effective 

January 1, 2022, at 45 CFR 180.90(c)(ii) 

to increase the CMP amounts associated 

with a hospital’s noncompliance with 


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price transparency disclosure and 

display requirements at 45 CFR 180.40, 

180.50, and 180.60. 

Second, in the final rule, ‘‘Medicare 

and Medicaid Programs; CY 2022 Home 

Health Prospective Payment System 

Rate Update; Home Health Value-Based 

Purchasing Model Requirements and 

Model Expansion; Home Health and 

Other Quality Reporting Program 

Requirements; Home Infusion Therapy 

Services Requirements; Survey and 

Enforcement Requirements for Hospice 

Programs; Medicare Provider 

Enrollment Requirements; and COVID– 

19 Reporting Requirements for LongTerm Care Facilities’’ final rule (86 FR 

62240, November 9, 2021), CMS 

finalized a new provision, effective 

January 1, 2022, establishing 

enforcement remedies for noncompliant 

hospice programs, including a CMP 

remedy at 42 CFR 488.1245. This final 

rule implemented Division CC, section 

407 of the Consolidated Appropriations 

Act, 2021 which added a new section 

1822 of the Social Security Act for 

hospice program survey and 

enforcement requirements, specifically 

authorizing the Secretary to establish 

CMPs in an amount not to exceed 

$10,000 for each day of noncompliance 

by a hospice program (see 42 U.S.C. 

1395i–6(c)(5)(B)(i)). 

The table has been modified to reflect 

these new regulatory and statutory 

amounts. 

III. Statutory and Executive Order 

Reviews and Waiver of Proposed 

Rulemaking 

The 2015 Act requires Federal 

agencies to publish annual penalty 

inflation adjustments notwithstanding 

section 553 of the Administrative 

Procedure Act (APA). Section 4(a) of the 

2015 Act directs Federal agencies to 

publish annual adjustments no later 

than January 15th of each year 

thereafter. In accordance with section 

553 of the APA, most rules are subject 

to notice and comment and are effective 

no earlier than 30 days after publication 

in the Federal Register. However, 

section 4(b)(2) of the 2015 Act provides 

that each agency shall make the annual 

inflation adjustments ‘‘notwithstanding 

section 553’’ of the APA. According to 

OMB’s Memorandum M–23–05, the 

phrase ‘‘notwithstanding section 553’’ 

in section 4(b)(2) of the 2015 Act means 

that ‘‘the public procedure the APA 

generally requires—notice, an 

opportunity for comment, and a delay in 

effective date—is not required for 

agencies to issue regulations 

implementing the annual adjustment.’’ 

Consistent with the language of the 

2015 Act and OMB’s implementation 

guidance, the inflation adjustments set 

out in this rule are not subject to notice 

and an opportunity for public comment 

and will be effective immediately upon 

publication. Additionally, HHS finds 

that notice and comment procedures 

would be impracticable and 

unnecessary under the APA for making 

the statutorily required inflation 

updates to newly established penalty 

amounts. 

Pursuant to OMB Memorandum M– 

23–05, HHS has determined that the 

annual inflation adjustment to the civil 

monetary penalties in its regulations 

does not trigger any requirements under 

procedural statutes and Executive 

Orders that govern rulemaking 

procedures. 

IV. Effective and Applicability Dates 

This rule is effective on the date 

specified in the DATES section of this 

final rule. The adjusted civil monetary 

penalty amounts apply to penalties 

assessed on or after the date specified in 

the DATES section of this final rule, if the 

violation occurred on or after November 

2, 2015. If the violation occurred before 

November 2, 2015, or a penalty was 

assessed before September 6, 2016, the 

pre-adjustment civil penalty amounts in 

effect before September 6, 2016, will 

apply. 

List of Subjects in 45 CFR Part 102 

Administrative practice and 

procedure, Penalties. 

For reasons discussed in the 

preamble, the Department of Health and 

Human Services amends subtitle A, title 

45 of the Code of Federal Regulations as 

follows: 

PART 102—ADJUSTMENT OF CIVIL 

MONETARY PENALTIES FOR 

INFLATION 

■ 1. The authority citation for part 102 

continues to read as follows: 

Authority: Pub. L. 101–410, Sec. 701 of 

Pub. L. 114–74, 31 U.S.C. 3801–3812. 

■ 2. Amend § 102.3 by revising table 1 

to read as follows: 

§ 102.3 Penalty adjustment and table. 

* * * * * 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

21 U.S.C.: 

333(b)(2)(A) ................................... ......................................... FDA Penalty for violations related to drug 

samples resulting in a conviction of 

any representative of manufacturer 

or distributor in any 10-year period.

2022 115,054 123,965 

333(b)(2)(B) ................................... ......................................... FDA 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.

2022 2,301,065 2,479,282 

333(b)(3) ........................................ ......................................... FDA Penalty for failure to make a report required by 21 U.S.C. 353(d)(3)(E) relating to drug samples.2022 230,107 247,929 

333(f)(1)(A) .................................... ......................................... FDA Penalty for any person who violates a 

requirement related to devices for 

each such violation.

2022 31,076 33,483 

FDA Penalty for aggregate of all violations 

related to devices in a single proceeding.

2022 2,071,819 2,232,281 


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TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

333(f)(2)(A) .................................... ......................................... FDA 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.

2022 87,362 94,128 

FDA Penalty in the case of any other person (other than an individual) for 

such introduction or delivery of adulterated food.

2022 436,809 470,640 

FDA Penalty for aggregate of all such violations related to adulterated food adjudicated in a single proceeding.2022 873,618 941,280 

333(f)(3)(A) .................................... ......................................... FDA Penalty for all violations adjudicated in 

a single proceeding for any person 

who violates 21 U.S.C. 331(jj) 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).

2022 13,237 14,262 

333(f)(3)(B) .................................... ......................................... FDA Penalty for each day any above violation is not corrected after a 30-day 

period following notification until the 

violation is corrected.

2022 13,237 14,262 

333(f)(4)(A)(i) ................................. ......................................... FDA 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).

2022 330,948 356,580 

FDA Penalty for aggregate of all such 

above violations in a single proceeding.

2022 1,323,791 1,426,319 

333(f)(4)(A)(ii) ................................ ......................................... FDA 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.

2022 330,948 356,580 

FDA 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.

2022 1,323,791 1,426,319 

FDA Penalty for aggregate of all such 

above violations adjudicated in a 

single proceeding.

2022 13,237,910 14,263,186 

333(f)(9)(A) .................................... ......................................... FDA Penalty for any person who violates a 

requirement which relates to tobacco products for each such violation.

2022 19,192 20,678 

FDA Penalty for aggregate of all such violations of tobacco product requirement adjudicated in a single proceeding.2022 1,279,448 1,378,541 

333(f)(9)(B)(i)(I) ............................. ......................................... FDA Penalty per violation related to violations of tobacco requirements.2022 319,863 344,636 

FDA Penalty for aggregate of all such violations of tobacco product requirements adjudicated in a single proceeding.2022 1,279,448 1,378,541 

333(f)(9)(B)(i)(II) ............................ ......................................... FDA 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.

2022 319,863 344,636 


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TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

FDA 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.

2022 1,279,448 1,378,541 

FDA Penalty for aggregate of all such violations related to tobacco product requirements adjudicated in a single 

proceeding.

2022 12,794,487 13,785,420 

333(f)(9)(B)(ii)(I) ............................. ......................................... FDA 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.

2022 319,863 344,636 

FDA Penalty for aggregate of for all such 

above violations adjudicated in a 

single proceeding.

2022 1,279,448 1,378,541 

333(f)(9)(B)(ii)(II) ............................ ......................................... FDA 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.

2022 319,863 344,636 

FDA Penalty for post-notice violation of 

modified risk tobacco product postmarket 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.

2022 1,279,448 1,378,541 

Penalty for aggregate above tobacco 

product requirement violations adjudicated in a single proceeding.

2022 12,794,487 13,785,420 

333(g)(1) ........................................ ......................................... FDA 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.

2022 330,948 356,580 

Penalty for each subsequent above 

violation in any 3-year period.

2022 661,896 713,160 

333 note ........................................ ......................................... FDA Penalty to be applied for violations of 

21 U.S.C. 387f(d)(5) or of 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.

2022 320 345 

FDA Penalty in the case of a third violation 

of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 

24-month period.

2022 638 687 

FDA Penalty in the case of a fourth violation of 21 U.S.C. 387f(d)(5) or of the 

tobacco product regulations within a 

24-month period.

2022 2,559 2,757 

FDA Penalty in the case of a fifth violation 

of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 

36-month period.

2022 6,397 6,892 


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TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

FDA Penalty in the case of a sixth or subsequent violation of 21 U.S.C. 

387f(d)(5) or of the tobacco product 

regulations within a 48-month period 

as determined on a case-by-case 

basis.

2022 12,794 13,785 

FDA Penalty to be applied for violations of 

21 U.S.C. 387f(d)(5) or of 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.

2022 320 345 

FDA Penalty in the case of a second violation of 21 U.S.C. 387f(d)(5) or of the 

tobacco product regulations within a 

12-month period.

2022 638 687 

FDA Penalty in the case of a third violation 

of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 

24-month period.

2022 1,280 1,379 

FDA Penalty in the case of a fourth violation of 21 U.S.C. 387f(d)(5) or of the 

tobacco product regulations within a 

24-month period.

2022 2,559 2,757 

FDA Penalty in the case of a fifth violation 

of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 

36-month period.

2022 6,397 6,892 

FDA Penalty in the case of a sixth or subsequent violation of 21 U.S.C. 

387f(d)(5) or of the tobacco product 

regulations within a 48-month period 

as determined on a case-by-case 

basis.

2022 12,794 13,785 

335b(a) .......................................... ......................................... FDA 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.

2022 487,638 525,406 

FDA Penalty in the case of any other person (other than an individual) per 

above violation.

2022 1,950,548 2,101,618 

360pp(b)(1) .................................... ......................................... FDA Penalty for any person who violates

any such requirements for electronic 

products, with each unlawful act or 

omission constituting a separate violation.

2022 3,198 3,446 

FDA Penalty imposed for any related series 

of violations of requirements relating 

to electronic products.

2022 1,090,241 1,174,680 

42 U.S.C. .............................................. ......................................... .............................................................. 2022 0 ....................

262(d) ............................................ ......................................... FDA Penalty per day for violation of order 

of recall of biological product presenting imminent or substantial hazard.

2022 250,759 270,180 

263b(h)(3) ...................................... ......................................... FDA Penalty for failure to obtain a mammography certificate as required.2022 19,507 21,018 

300aa–28(b)(1) .............................. ......................................... FDA Penalty per occurrence for any vaccine manufacturer that intentionally 

destroys, alters, falsifies, or conceals any record or report required.

2022 250,759 270,180 

256b(d)(1)(B)(vi) ............................ ......................................... HRSA Penalty for each instance of overcharging a 340B covered entity.2022 6,323 6,813 


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TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

299c–3(d) ...................................... ......................................... AHRQ Penalty for using or disclosing identifiable information obtained in the 

course of activities undertaken pursuant to Title IX of the Public Health 

Service Act, for a purpose other 

than that for which the information 

was supplied, without consent to do 

so.

2022 16,443 17,717 

653(l)(2) ......................................... 45 CFR 303.21(f) ............ ACF Penalty for Misuse of Information in 

the National Directory of New Hires.

2022 1,687 1,818 

262a(i)(1) ....................................... 42 CFR 1003.910 ........... OIG Penalty for each individual who violates safety and security procedures 

related to handling dangerous biological agents and toxins.

2022 381,393 410,932 

OIG Penalty for any other person who violates safety and security procedures 

related to handling dangerous biological agents and toxins.

2022 762,790 821,868 

300jj–51 ......................................... ......................................... OIG Penalty per violation for committing information blocking.2022 1,162,924 1,252,992 

1320a–7a(a) .................................. 42 CFR 1003.210(a)(1) ... OIG Penalty for knowingly presenting or 

causing to be presented to an officer, employee, or agent of the 

United States a false claim.

2022 22,427 24,164 

OIG Penalty for knowingly presenting or 

causing to be presented a request 

for payment which violates the 

terms of an assignment, agreement, 

or PPS agreement.

2022 22,427 24,164 

42 CFR 1003.210(a)(2) ... OIG 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.

2022 33,641 36,246 

42 CFR 1003.210(a)(3) ... OIG Penalty for an excluded party retaining 

ownership or control interest in a 

participating entity.

2022 22,427 24,164 

42 CFR 1003.1010 ......... OIG Penalty for remuneration offered to induce program beneficiaries to use 

particular providers, practitioners, or 

suppliers.

2022 22,427 24,164 

42 CFR 1003.210(a)(4) ... OIG Penalty for employing or contracting 

with an excluded individual.

2022 22,427 24,164 

42 CFR 1003.310(a)(3) ... OIG 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.

2022 112,131 120,816 

42 CFR 1003.210(a)(1) ... OIG Penalty for ordering or prescribing 

medical or other item or service during a period in which the person 

was excluded.

2022 22,427 24,164 

42 CFR 1003.210(a)(6) ... OIG 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.

2022 112,131 120,816 

42 CFR 1003.210(a)(8) ... OIG Penalty for knowing of an overpayment and failing to report and return.2022 22,427 24,164 

42 CFR 1003.210(a)(7) ... OIG Penalty for making or using a false 

record or statement that is material 

to a false or fraudulent claim.

2022 63,231 68,128 

42 CFR 1003.210(a)(9) ... OIG Penalty for failure to grant timely access to HHS OIG for audits, investigations, evaluations, and other 

statutory functions of HHS OIG.

2022 33,641 36,246 

1320a–7a(b) .................................. ......................................... OIG 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.

2022 5,606 6,040 


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TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

OIG 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.

2022 5,606 6,040 

42 CFR 1003.210(a)(10) OIG Penalty for a physician who executes 

a document that falsely certifies 

home health needs for Medicare 

beneficiaries.

2022 11,213 12,081 

1320a–7a(o) .................................. ......................................... OIG Penalty for knowingly presenting or 

causing to be presented a false or 

fraudulent specified claim under a 

grant, contract, or other agreement 

for which the Secretary provides 

funding.

2022 10,937 11,784 

OIG Penalty for knowingly making, using, 

or causing to be made or used any 

false statement, omission, or misrepresentation of a material fact in 

any application, proposal, bid, 

progress report, or other document 

required to directly or indirectly receive or retain funds provided pursuant to grant, contract, or other 

agreement.

2022 54,686 58,921 

OIG Penalty for Knowingly making, using, 

or causing to be made or used, a 

false record or statement material to 

a false or fraudulent specified claim 

under grant, contract, or other 

agreement.

2022 54,686 58,921 

OIG Penalty for knowingly making, using, 

or causing to be made or used, a 

false record or statement material to 

an obligation to pay or transmit 

funds or property with respect to 

grant, contract, or other agreement, 

or knowingly conceals or improperly 

avoids or decreases any such obligation.

2022 53,772 each 

false record 

or 

statement, 

10,754 per 

day 

61,458 each 

false record 

or 

statement, 

12,308 per 

day 

OIG Penalty for failure to grant timely access, upon reasonable request, to 

the I.G. for purposes of audits, investigations, evaluations, or other 

statutory functions of I.G. in matters 

involving grants, contracts, or other 

agreements.

2022 16,406 17,677 

1320a–7e(b)(6)(A) ......................... 42 CFR 1003.810 ........... OIG Penalty for failure to report any final 

adverse action taken against a 

health care provider, supplier, or 

practitioner.

2022 42,788 46,102 

1320b–10(b)(1) .............................. 42 CFR 1003.610(a) ....... OIG 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.

2022 11,506 12,397 

1320b–10(b)(2) .............................. 42 CFR 1003.610(a) ....... OIG 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.

2022 57,527 61,982 

1395i–3(b)(3)(B)(ii)(1) .................... 42 CFR 1003.210(a)(11) OIG Penalty for certification of a false 

statement in assessment of functional capacity of a Skilled Nursing 

Facility resident assessment.

2022 2,400 2,586 

1395i–3(b)(3)(B)(ii)(2) .................... 42 CFR 1003.210(a)(11) OIG Penalty for causing another to certify 

or make a false statement in assessment of functional capacity of a 

Skilled Nursing Facility resident assessment.

2022 11,995 12,924 


lotter on DSK11XQN23PROD with RULES1
69538 Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

1395i–3(g)(2)(A) ............................ 42 CFR 1003.1310 ......... OIG 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.

2022 4,799 5,171 

1395w–27(g)(2)(A) ........................ 42 CFR 1003.410 ........... OIG Penalty for a Medicare Advantage organization that substantially fails to 

provide medically necessary, required items and services.

2022 43,678 47,061 

OIG Penalty for a Medicare Advantage organization that charges excessive 

premiums.

2022 42,788 46,102 

OIG Penalty for a Medicare Advantage organization that improperly expels or 

refuses to reenroll a beneficiary.

2022 42,788 46,102 

OIG Penalty for a Medicare Advantage organization that engages in practice 

that would reasonably be expected 

to have the effect of denying or discouraging enrollment.

2022 171,156 184,412 

OIG 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.

2022 25,673 27,661 

OIG Penalty for a Medicare Advantage organization misrepresenting or falsifying information to Secretary.2022 171,156 184,412 

OIG Penalty for a Medicare Advantage organization misrepresenting or falsifying information to individual or 

other entity.

2022 42,788 46,102 

OIG Penalty for Medicare Advantage organization interfering with provider’s 

advice to enrollee and non-MCO affiliated providers that balance bill 

enrollees.

2022 42,788 46,102 

OIG Penalty for a Medicare Advantage organization that employs or contracts 

with excluded individual or entity.

2022 42,788 46,102 

OIG Penalty for a Medicare Advantage organization enrolling an individual in 

without prior written consent.

2022 42,788 46,102 

OIG Penalty for a Medicare Advantage organization transferring an enrollee 

to another plan without consent or 

solely for the purpose of earning a 

commission.

2022 42,788 46,102 

OIG Penalty for a Medicare Advantage organization failing to comply with 

marketing restrictions or applicable 

implementing regulations or guidance.

2022 42,788 46,102 

OIG Penalty for a Medicare Advantage organization employing or contracting 

with an individual or entity who violates 1395w–27(g)(1)(A)–(J).

2022 42,788 46,102 

1395w–141(i)(3) ............................ ......................................... OIG Penalty for a prescription drug card 

sponsor that falsifies or misrepresents marketing materials, overcharges program enrollees, or misuse transitional assistance funds.

2022 14,950 16,108 

1395cc(g) ....................................... 42 CFR 1003.210(a)(5) ... OIG Penalty for improper billing by Hospitals, Critical Access Hospitals, or 

Skilled Nursing Facilities.

2022 5,816 6,266 

1395dd(d)(1) .................................. 42 CFR 1003.510 ........... OIG Penalty for a hospital with 100 beds or 

more or responsible physician 

dumping patients needing emergency medical care.

2022 119,942 129,232 

Penalty for a hospital with less than 

100 beds dumping patients needing 

emergency medical care.

2022 59,973 64,618 

1395mm(i)(6)(B)(i) ......................... 42 CFR 1003.410 ........... OIG Penalty for a HMO or competitive 

medical plan if such plan substantially fails to provide medically necessary, required items or services.

2022 59,973 64,618 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69539 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

OIG Penalty for HMOs/competitive medical 

plans that charge premiums in excess of permitted amounts.

2022 59,973 64,618 

OIG Penalty for a HMO or competitive 

medical plan that expels or refuses 

to reenroll an individual per prescribed conditions.

2022 59,973 64,618 

OIG Penalty for a HMO or competitive 

medical plan that implements practices to discourage enrollment of individuals needing services in future.

2022 239,885 258,464 

OIG 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.

2022 34,517 37,190 

OIG Penalty for a HMO or competitive 

medical plan that misrepresents or 

falsifies information to the Secretary.

2022 239,885 258,464 

OIG Penalty for a HMO or competitive 

medical plan that misrepresents or 

falsifies information to an individual 

or any other entity.

2022 59,973 64,618 

OIG Penalty for failure by HMO or competitive medical plan to assure prompt 

payment of Medicare risk sharing 

contracts or incentive plan provisions.

2022 59,973 64,618 

OIG Penalty for HMO that employs or contracts with excluded individual or entity.2022 55,052 59,316 

1395nn(g)(3) .................................. 42 CFR 1003.310 ........... OIG Penalty for submitting or causing to be 

submitted claims in violation of the 

Stark Law’s restrictions on physician 

self-referrals.

2022 27,750 29,899 

1395nn(g)(4) .................................. 42 CFR 1003.310 ........... OIG Penalty for circumvention schemes in 

violation of the Stark Law’s restrictions on physician self-referrals.

2022 185,009 199,338 

1395ss(d)(1) .................................. 42 CFR 1003.1110 ......... OIG Penalty for a material misrepresentation regarding Medigap compliance 

policies.

2022 11,506 12,397 

1395ss(d)(2) .................................. 42 CFR 1003.1110 ......... OIG Penalty for selling Medigap policy 

under false pretense.

2022 11,506 12,397 

1395ss(d)(3)(A)(ii) ......................... 42 CFR 1003.1110 ......... OIG Penalty for an issuer that sells health 

insurance policy that duplicates benefits.

2022 51,796 55,808 

OIG Penalty for someone other than issuer 

that sells health insurance that duplicates benefits.

2022 31,076 33,483 

1395ss(d)(4)(A) ............................. 42 CFR 1003.1110 ......... OIG Penalty for using mail to sell a non-approved Medigap insurance policy.2022 11,506 12,397 

1396b(m)(5)(B)(i) ........................... 42 CFR 1003.410 ........... OIG Penalty for a Medicaid MCO that substantially fails to provide medically 

necessary, required items or services.

2022 57,527 61,982 

OIG Penalty for a Medicaid MCO that 

charges excessive premiums.

2022 57,527 61,982 

OIG Penalty for a Medicaid MCO that improperly expels or refuses to reenroll a beneficiary.2022 230,107 247,929 

OIG 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.

2022 34,517 37,190 

OIG Penalty for a Medicaid MCO misrepresenting or falsifying information to 

the Secretary.

2022 230,107 247,929 

OIG Penalty for a Medicaid MCO misrepresenting or falsifying information to 

an individual or another entity.

2022 57,527 61,982 

OIG Penalty for a Medicaid MCO that fails 

to comply with contract requirements with respect to physician incentive plans.

2022 51,796 55,808 


lotter on DSK11XQN23PROD with RULES1
69540 Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

1396r(b)(3)(B)(ii)(I) ........................ 42 CFR 1003.210(a)(11) OIG Penalty for willfully and knowingly certifying a material and false statement in a Skilled Nursing Facility 

resident assessment.

2022 2,400 2,586 

1396r(b)(3)(B)(ii)(II) ....................... 42 CFR 1003.210(a)(11) OIG Penalty for willfully and knowingly 

causing another individual to certify 

a material and false statement in a 

Skilled Nursing Facility resident assessment.

2022 11,995 12,924 

1396r(g)(2)(A)(i) ............................. 42 CFR 1003.1310 ......... OIG 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.

2022 4,799 5,171 

1396r–8(b)(3)(B) ............................ 42 CFR 1003.1210 ......... OIG Penalty for the knowing provision of 

false information or refusing to provide information about charges or 

prices of a covered outpatient drug.

2022 207,183 223,229 

1396r–8(b)(3)(C)(i) ........................ 42 CFR 1003.1210 ......... OIG Penalty per day for failure to timely 

provide information by drug manufacturer with rebate agreement.

2022 20,719 22,324 

1396r–8(b)(3)(C)(ii) ........................ 42 CFR 1003.1210 ......... OIG Penalty for knowing provision of false 

information by drug manufacturer 

with rebate agreement.

2022 207,183 223,229 

1396t(i)(3)(A) ................................. 42 CFR 1003.1310 ......... OIG Penalty for notifying home and community-based providers or settings 

of survey.

2022 4,144 4,465 

11131(c) ........................................ 42 CFR 1003.810 ........... OIG Penalty for failing to report a medical 

malpractice claim to National Practitioner Data Bank.

2022 25,076 27,018 

11137(b)(2) .................................... 42 CFR 1003.810 ........... OIG Penalty for breaching confidentiality of 

information reported to National 

Practitioner Data Bank.

2022 25,076 27,018 

299b–22(f)(1) ................................. 42 CFR 3.404 ................. OCR Penalty for violation of confidentiality 

provision of the Patient Safety and 

Quality Improvement Act.

2022 13,885 14,960 

45 CFR 160.404(b)(1)(i), 

(ii).

OCR Penalty for each pre-February 18, 

2009 violation of the HIPAA administrative simplification provisions.

2022 174 187 

Calendar Year Cap .............................. 2022 43,678 47,061 

1320(d)–5(a) .................................. 45 CFR 

160.404(b)(2)(i)(A), (B).

OCR 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: 

2022 .................... ....................

Minimum ....................................... 2022 127 137 

Maximum ...................................... 2022 63,973 68,928 

Calendar Year Cap .............................. 2022 1,919,173 2,067,813 

45 CFR 

160.404(b)(2)(ii)(A), (B).

OCR 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: 

2022 .................... ....................

Minimum ....................................... 2022 1,280 1,379 

Maximum ...................................... 2022 63,973 68,928 

Calendar Year Cap .............................. 2022 1,919,173 2,067,813 

45 CFR 

160.404(b)(2)(iii)(A), 

(B).

OCR 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: 

2022 .................... ....................

Minimum ....................................... 2022 12,794 13,785 

Maximum ...................................... 2022 63,973 68,928 

Calendar Year Cap .............................. 2022 1,919,173 2,067,813 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69541 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

45 CFR 

160.404(b)(2)(iv)(A), 

(B).

OCR 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: 

2022 .................... ....................

Minimum ....................................... 2022 63,973 68,928 

Maximum ...................................... 2022 1,919,173 2,067,813 

Calendar Year Cap .............................. 2022 1,919,173 2,067,813 

42 U.S.C. 300gg–18, 42 U.S.C. 

1302.

45 CFR 180.90 ............... CMS Penalty for a hospital’s non-compliance with making public standard 

charges for hospital items and services.

2022 300 323 

Per Day (Maximum) ............................. 2022 5,500 5,926 

45 CFR 180.90(c)(2)(i) .... CMS Per day penalty for a hospital’s noncompliance with making public 

standard charges for hospital items 

and services.

2022 304 328 

45 CFR 

180.90(c)(2)(ii)(A).

CMS Per day penalty for hospitals with 

equal to or less than 30 beds.

2022 300 323 

45 CFR 

180.90(c)(2)(ii)(B).

CMS Per day, per bed penalty for hospitals 

having at least 31 and up to and including 550 beds.

2022 10 11 

45 CFR 

180.90(c)(2)(ii)(C).

CMS Per day penalty for hospitals having 

greater than 550 beds.

2022 5,500 5,926 

CARES Act, Public Law 116–136, section 3202(b)(2).45 CFR 182.70 ............... CMS Penalty for a provider’s non-compliance with price transparency requirements regarding diagnostic 

tests for COVID–19.

2022 .................... ....................

Per Day (Maximum) ............................. 2022 300 323 

263a(h)(2)(B) & 1395w– 

2(b)(2)(A)(ii).

42 CFR 493.1834(d)(2)(i). CMS Penalty for a clinical laboratory’s failure to meet participation and certification requirements and poses immediate jeopardy: 2022 .................... ....................

Minimum ....................................... 2022 7,018 7,562 

Maximum ...................................... 2022 23,011 24,793 

42 CFR 493.1834(d)(2)(ii) CMS Penalty for a clinical laboratory’s failure to meet participation and certification requirements and the failure 

does not pose immediate jeopardy: 

2022 .................... ....................

Minimum ....................................... 2022 116 125 

Maximum ...................................... 2022 6,902 7,437 

42 CFR 

493.1834(d)(2)(iii).

CMS Penalty for a clinical laboratory’s failure to meet SARS–CoV–2 test reporting requirements: 2022 .................... ....................

First day of noncompliance ................. 2022 .................... ....................

Each additional day of noncompliance 2022 .................... ....................

300gg–15(f) ................................... 45 CFR 147.200(e) ......... CMS Failure to provide the Summary of 

Benefits and Coverage.

2022 1,264 1,362 

300gg–18 ....................................... 45 CFR 158.606 ............. CMS Penalty for violations of regulations related to the medical loss ratio reporting and rebating.2022 126 136 

45 CFR 180.90 ............... CMS Price against hospital identified by 

CMS as noncompliant according to 

§ 182.50 with respect to price transparency requirements regarding diagnostic tests for COVID–19.

2022 .................... ....................

42 U.S.C. 300gg–118 note, 

300gg–134.

......................................... CMS Penalties for failure to comply with No 

Surprises Act requirements on providers, facilities, providers of air ambulance services.

2022 10,622 11,445 

1320a–7h(b)(1) .............................. 42 CFR 402.105(d)(5), 42 

CFR 403.912(a) & (c).

CMS Penalty for manufacturer or group purchasing organization failing to report 

information required under 42 

U.S.C. 1320a–7h(a), relating to physician ownership or investment interests: 

2022 .................... ....................

Minimum ....................................... 2022 1,264 1,362 

Maximum ...................................... 2022 12,646 13,625 

Calendar Year Cap .............................. 2022 189,692 204,384 


lotter on DSK11XQN23PROD with RULES1
69542 Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

1320a–7h(b)(2) .............................. 42 CFR 402.105(h), 42 

CFR 403.912(b) & (c).

CMS Penalty for manufacturer or group purchasing organization knowingly failing to report information required 

under 42 U.S.C. 1320a–7h(a), relating to physician ownership or investment interests: 

2022 .................... ....................

Minimum ....................................... 2022 12,646 13,625 

Maximum ...................................... 2022 126,463 136,258 

Calendar Year Cap .............................. 2022 1,264,622 1,362,567 

CMS Penalty for an administrator of a facility that fails to comply with notice requirements for the closure of a facility.2022 126,463 136,258 

1320a–7j(h)(3)(A) .......................... 42 CFR 488.446(a)(1), 

(2), & (3).

CMS Minimum penalty for the first offense 

of an administrator who fails to provide notice of facility closure.

2022 632 681 

Minimum penalty for the second offense of an administrator who fails 

to provide notice of facility closure.

2022 1,898 2,045 

Minimum penalty for the third and subsequent offenses of an administrator 

who fails to provide notice of facility 

closure.

2022 3,793 4,087 

1320a–8(a)(1) ................................ ......................................... CMS 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.

2022 9,250 9,966 

Penalty for violation of 42 U.S.C. 

1320a–8(a)(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.

2022 8,723 9,399 

1320a–8(a)(3) ................................ ......................................... CMS Penalty for a representative payee 

(under 42 U.S.C. 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.

2022 7,244 7,805 

1320b–25(c)(1)(A) ......................... ......................................... CMS 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.

2022 252,925 272,514 

1320b–25(c)(2)(A) ......................... ......................................... CMS 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.

2022 379,386 408,769 

1320b–25(d)(2) .............................. ......................................... CMS 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.

2022 252,925 272,514 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69543 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

1395b–7(b)(2)(B) ........................... 42 CFR 402.105(g) ......... CMS 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.

2022 171 184 

1395i–3(h)(2)(B)(ii)(I) ..................... 42 CFR 488.408(d)(1)(iii) CMS Penalty per day for a Skilled Nursing 

Facility that has a Category 2 violation of certification requirements: 

2022 .................... ....................

Minimum ....................................... 2022 120 129 

Maximum ...................................... 2022 7,195 7,752 

42 CFR 488.408(d)(1)(iv) CMS Penalty per instance of Category 2 

noncompliance by a Skilled Nursing 

Facility: 

2022 .................... ....................

Minimum ....................................... 2022 2,400 2,586 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.408(e)(1)(iii) CMS Penalty per day for a Skilled Nursing 

Facility that has a Category 3 violation of certification requirements: 

2022 .................... ....................

Minimum ....................................... 2022 7,317 7,884 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.408(e)(1)(iv) CMS Penalty per instance of Category 3 

noncompliance by a Skilled Nursing 

Facility: 

2022 .................... ....................

Minimum ....................................... 2022 2,400 2,586 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.408(e)(2)(ii) CMS Penalty per day and per instance for a 

Skilled Nursing Facility that has Category 3 noncompliance with Immediate Jeopardy: 

2022 .................... ....................

Per Day (Minimum) .............................. 2022 7,317 7,884 

Per Day (Maximum) ............................. 2022 23,989 25,847 

Per Instance (Minimum) ...................... 2022 2,400 2,586 

Per Instance (Maximum) ..................... 2022 23,989 25,847 

42 CFR 488.438(a)(1)(i) CMS Penalty per day of a Skilled Nursing 

Facility that fails to meet certification 

requirements. These amounts represent the upper range per day: 

2022 .................... ....................

Minimum ....................................... 2022 7,317 7,884 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.438(a)(1)(ii) CMS Penalty per day of a Skilled Nursing 

Facility that fails to meet certification 

requirements. These amounts represent the lower range per day: 

2022 .................... ....................

Minimum ....................................... 2022 120 129 

Maximum ...................................... 2022 7,195 7,752 

42 CFR 488.438(a)(2) ..... CMS Penalty per instance of a Skilled Nursing Facility that fails to meet certification requirements: 2022 .................... ....................

Minimum ....................................... 2022 2,400 2,586 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.447 ............. CMS Penalty imposed for failure to comply 

with infection control weekly reporting requirements at 42 CFR 

483.80(g)(1) and (2).

2022 .................... ....................

First occurrence ................................... 2022 1,075 1,158 

Incremental increases for each subsequent occurrence.2022 537 579 

1395i–6(c)(5)(B)(i) ......................... 42 CFR 488.1245 ........... CMS Penalty for noncompliance by hospice 

program with requirements specified 

in section 1395x(dd) of 42 USC.

2022 10,000 10,775 

42 CFR 

488.1245(b)(2)(iii).

CMS Adjustment to penalties. Maximum 

penalty assessment for each day a 

hospice is not in substantial compliance with one or more conditions of 

participation.

2022 10,000 10,775 

42 CFR 488.1245(b)(3) ... CMS Penalty imposed for hospice conditionlevel deficiency that is immediate 

jeopardy. These amounts represent 

the upper range of penalty.

.................... .................... ....................

CMS Minimum ....................................... 2022 8,500 9,158 

Maximum ...................................... 2022 10,000 10,775 

42 CFR 488.1245(b)(3)(i) CMS Penalty imposed for hospice conditionlevel deficiency that is immediate 

jeopardy. These amounts represent 

the upper range of penalty.

2022 10,000 10,775 


lotter on DSK11XQN23PROD with RULES1
69544 Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

42 CFR 488.1245(b)(3)(ii) CMS Penalty imposed for hospice conditionlevel deficiency that is immediate 

jeopardy. These amounts represent 

the upper range of penalty.

2022 9,000 9,697 

42 CFR 

488.1245(b)(3)(iii).

CMS Penalty imposed for hospice conditionlevel deficiency that is immediate 

jeopardy. These amounts represent 

the upper range of penalty.

2022 8,500 9,158 

42 CFR 488.1245(b)(4) ... CMS Penalty imposed for hospice repeat or 

condition-level deficiency or both 

that does not constitute immediate 

jeopardy but is directly related to 

poor quality patient care outcomes. 

These amounts represent the middle range of penalty.

2022 .................... ....................

Minimum ....................................... 2022 1,500 1,616 

Maximum ...................................... 2022 8,500 9,158 

42 CFR 488.1245(b)(5) ... CMS Penalty imposed for hospice repeat or 

condition-level deficiency or both 

that does not constitute immediate 

jeopardy and are related predominantly to structure or process-oriented conditions rather than directly 

related to patient outcomes. These 

amounts represent the lower range 

of penalty.

2022 .................... ....................

Minimum ....................................... 2022 500 539 

Maximum ...................................... 2022 4,000 4,310 

42 CFR 488.1245(b)(6) ... CMS Penalty range imposed for per instance of hospice noncompliance.2022 .................... ....................

CMS Minimum ....................................... 2022 1,000 1,077 

Maximum ...................................... 2022 10,000 10,775 

42 CFR 488.1245(d)(1)(ii) CMS Penalty for each per instance of hospice noncompliance, maximum per 

day per hospice program.

2022 10,000 10,775 

1395l(h)(5)(D) ................................ 42 CFR 402.105(d)(2)(i) CMS 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 U.S.C. 1395u(j)(2)(B), 

which is assessed according to 

1320a–7a(a)).

2022 17,472 18,825 

1395l(i)(6) ...................................... ......................................... CMS 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.

2022 4,603 4,960 

1395l(q)(2)(B)(i) ............................. 42 CFR 402.105(a) ......... CMS Penalty for knowingly and willfully failing to provide information about a 

referring physician when seeking 

payment on an unassigned basis.

2022 4,404 4,745 

1395m(a)(11)(A) ............................ 42 CFR 402.1(c)(4), 

402.105(d)(2)(ii).

CMS 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 

U.S.C. 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).

2022 17,472 18,825 

1395m(a)(18)(B) ............................ 42 CFR 402.1(c)(5), 

402.105(d)(2)(iii).

CMS 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 U.S.C. 

1395u(j)(2)(B), which is assessed 

according to 1320a–7a(a)).

2022 17,472 18,825 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69545 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

1395m(b)(5)(C) .............................. 42 CFR 402.1(c)(6), 

402.105(d)(2)(iv).

CMS 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 U.S.C. 1395u(j)(2)(B), which 

is assessed according to 1320a– 

7a(a)).

2022 17,472 18,825 

1395m(h)(3) ................................... 42 CFR 402.1(c)(8), 

402.105(d)(2)(vi).

CMS 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 U.S.C. 

1395m(a)(11)(A), that is in the same 

manner as 1395u(j)(2)(B), which is 

assessed according to 1320a–7a(a)).

2022 17,472 18,825 

1395m(j)(2)(A)(iii) .......................... ......................................... CMS 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.

2022 1,850 1,993 

1395m(j)(4) .................................... 42 CFR 402.1(c)(10), 

402.105(d)(2)(vii).

CMS 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 U.S.C. 1395m(j)(4) 

and 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).

2022 17,472 18,825 

1395m–1(a) ................................... 42 CFR 414.504(e) ......... CMS Penalty for an applicable entity that 

has failed to report or made a misrepresentation or omission in reporting applicable information with respect to a clinical diagnostic laboratory test.

2022 11,649 12,551 

42 CFR 402.1(c)(31), 

402.105(d)(3).

CMS 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 U.S.C. 

1395m(k)(6) and 1395u(j)(2)(B), 

which is assessed according to 

1320a–7a(a)).

2022 17,472 18,825 

1395m(l)(6) .................................... 42 CFR 402.1(c)(32), 

402.105(d)(4).

CMS 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 U.S.C. 

1395u(b)(18)(B), which is assessed 

according to 1320a–7a(a)).

2022 17,472 18,825 


lotter on DSK11XQN23PROD with RULES1
69546 Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

1395u(b)(18)(B) ............................. 42 CFR 402.1(c)(11), 

402.105(d)(2)(viii).

CMS 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 U.S.C. 1395u(j)(2)(B), 

which is assessed according to 

1320a–7a(a)).

2022 17,472 18,825 

1395u(j)(2)(B) ................................ 42 CFR 402.1(c) ............. CMS Penalty for any physician who charges 

more than 125% for a non-participating referral. (Penalties are assessed in the same manner as 42 

U.S.C. 1320a–7a(a)).

2022 17,472 18,825 

1395u(k) ........................................ 42 CFR 402.1(c)(12), 

402.105(d)(2)(ix) 

1834A(a)(9) and 42 

CFR 414.504(e).

CMS 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 

U.S.C. 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).

2022 17,472 18,825 

1395u(l)(3) ..................................... 42 CFR 402.1(c)(13), 

402.105(d)(2)(x).

CMS 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 

U.S.C. 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).

2022 17,472 18,825 

1395u(m)(3) ................................... 42 CFR 402.1(c)(14), 

402.105(d)(2)(xi).

CMS 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 U.S.C. 1395u(j)(2)(B), which 

is assessed according to 1320a– 

7a(a)).

2022 17,472 18,825 

1395u(n)(3) .................................... 42 CFR 402.1(c)(15), 

402.105(d)(2)(xii).

CMS 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 

U.S.C. 1395u(j)(2)(B), which is assessed according to 1320a–7a(a)).

2022 17,472 18,825 

1395u(o)(3)(B) ............................... 42 CFR 414.707(b) ......... CMS 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 U.S.C. 1395u(b)(18)(B) and 

1395u(j)(2)(B), which is assessed 

according to 1320a–7a(a)).

2022 17,472 18,825 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69547 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

1395u(p)(3)(A) ............................... ......................................... CMS 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.

2022 4,603 4,960 

1395w–3a(d)(4)(A) ........................ 42 CFR 414.806 ............. CMS Penalty for a pharmaceutical manufacturer’s misrepresentation of average 

sales price of a drug, or biologic.

2022 14,950 16,108 

1395w–4(g)(1)(B) .......................... 42 CFR 402.1(c)(17), 

402.105(d)(2)(xiii).

CMS 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 statutorilydefined limiting charge or fails to 

make a timely refund or adjustment. 

(Penalties are assessed in the same 

manner as 42 U.S.C. 1395u(j)(2)(B), 

which is assessed according to 

1320a–7a(a)).

2022 17,472 18,825 

1395w–4(g)(3)(B) .......................... 42 CFR 402.1(c)(18), 

402.105(d)(2)(xiv).

CMS 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 U.S.C. 

1395u(j)(2)(B), which is assessed 

according to 1320a–7a(a)).

2022 17,472 18,825 

1395w–27(g)(3)(A); 1857(g)(3); 

1860D–12(b)(3)(E).

42 CFR 422.760(b); 42 

CFR 423.760(b).

CMS 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 

(or has the substantial likelihood of 

adversely affecting) an individual 

covered under the organization’s 

contract.

2022 42,788 46,102 

1395w–27(g)(3)(B); 1857(g)(3); 

1860D–12(b)(3)(E).

......................................... CMS 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.

2022 17,116 18,442 

1395w–27(g)(3)(D); 1857(g)(3): 

1860D–12(b)(3)(E).

......................................... CMS Penalty for a Medicare Advantage organization’s or Part D sponsor’s 

early termination of its contract.

2022 158,947 171,257 

1395y(b)(3)(C) ............................... 42 CFR 411.103(b) ......... CMS 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.

2022 10,360 11,162 

1395y(b)(5)(C)(ii) ........................... 42 CFR 402.1(c)(20), 42 

CFR 402.105(b)(2).

CMS 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.

2022 1,687 1,818 

1395y(b)(6)(B) ............................... 42 CFR 402.1(c)(21), 

402.105(a).

CMS 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.

2022 3,701 3,988 


lotter on DSK11XQN23PROD with RULES1
69548 Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

1395y(b)(7)(B)(i) ............................ ......................................... CMS 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.

2022 1,325 1,428 

1395y(b)(8)(E) ............................... ......................................... CMS 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.

2022 1,325 1,428 

1395nn(g)(5) .................................. 42 CFR 411.361 ............. CMS Penalty for any person that fails to report information required by HHS 

under Section 1877(f) concerning 

ownership, investment, and compensation arrangements.

2022 22,021 23,727 

1395pp(h) ...................................... 42 CFR 402.1(c)(23), 

402.105(d)(2)(xv).

CMS Penalty for any durable medical equipment supplier, 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 under certain conditions. 

(42 U.S.C. 1395(m)(18) sanctions 

apply here in the same manner, 

which is under 1395u(j)(2) and 

1320a–7a(a)).

2022 17,472 18,825 

1395ss(a)(2) .................................. 402.102(f)(1) ................... CMS Penalty for any person that issues a 

Medicare supplemental policy that 

has not been approved by the State 

regulatory program or does not 

meet Federal standards after a 

statutorily defined effective date.

2022 59,972 64,617 

1395ss(d)(3)(A)(vi)(II) .................... 42 CFR 402.1(c)(25), 

402.105(e), 

402.105(f)(2).

CMS Penalty for someone other than issuer 

that sells or issues a Medicare supplemental policy to beneficiary without a disclosure statement.

2022 31,076 33,483 

CMS Penalty for an issuer that sells or 

issues a Medicare supplemental 

policy without disclosure statement.

2022 51,796 55,808 

1395ss(d)(3)(B)(iv) ........................ ......................................... CMS Penalty for someone other than issuer 

that sells or issues a Medicare supplemental policy without acknowledgement form.

2022 31,076 33,483 

CMS Penalty for issuer that sells or issues a 

Medicare supplemental policy without an acknowledgement form.

2022 51,796 55,808 

1395ss(p)(8) .................................. 42 CFR 402.1(c)(25), 

402.105(e).

CMS Penalty for someone other than issuer 

that sells or issues Medicare supplemental polices after a given date 

that fail to conform to the NAIC or 

Federal standards established by 

statute.

2022 31,076 33,483 

42 CFR 402.1(c)(25), 

405402.105(f)(2).

CMS Penalty for an issuer that sells or 

issues Medicare supplemental polices after a given date that fail to 

conform to the NAIC or Federal 

standards established by statute.

2022 51,796 55,808 

1395ss(p)(9)(C) ............................. 42 CFR 402.1(c)(26), 

402.105(e), 

402.105(f)(3), (4).

CMS Penalty for someone other than issuer 

that sells a Medicare supplemental 

policy and fails to make available for 

sale the core group of basic benefits 

when selling other Medicare supplemental policies with additional benefits or fails to provide the individual, 

before selling the policy, an outline 

of coverage describing benefits.

2022 31,076 33,483 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69549 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

402.105(f)(3), (4) ............. CMS Penalty for an issuer that sells a Medicare supplemental policy and fails to 

make available for sale the core 

group of basic benefits when selling 

other Medicare supplemental policies with additional benefits or fails 

to provide the individual, before selling the policy, an outline of coverage describing benefits.

2022 51,796 55,808 

1395ss(q)(5)(C) ............................. 402.105(f)(5) ................... CMS Penalty for any person that fails to 

suspend the policy of a policyholder 

made eligible for medical assistance 

or automatically reinstates the policy 

of a policyholder who has lost eligibility for medical assistance, under 

certain circumstances.

2022 51,796 55,808 

1395ss(r)(6)(A) .............................. 402.105(f)(6) ................... CMS Penalty for any person that fails to 

provide refunds or credits as required by section 1882(r)(1)(B).

2022 51,796 55,808 

1395ss(s)(4) .................................. 42 CFR 402.1(c)(29), 

402.105(c).

CMS Penalty for any issuer of a Medicare 

supplemental policy that does not 

waive listed time periods if they 

were already satisfied under a proceeding Medicare supplemental policy, or denies a policy, or conditions 

the issuances or effectiveness of 

the policy, or discriminates in the 

pricing of the policy base on health 

status or other specified criteria.

2022 21,989 23,692 

1395ss(t)(2) ................................... 42 CFR 402.1(c)(30), 

402.105(f)(7).

CMS Penalty for any issuer of a Medicare 

supplemental policy that fails to fulfill listed responsibilities.

2022 51,796 55,808 

1395ss(v)(4)(A) .............................. ......................................... CMS Penalty someone other than issuer 

who sells, issues, or renews a 

medigap Rx policy to an individual 

who is a Part D enrollee.

2022 22,426 24,163 

CMS Penalty for an issuer who sells, 

issues, or renews a Medigap Rx 

policy who is a Part D enrollee.

2022 37,377 40,272 

1395bbb(c)(1) ................................ 42 CFR 488.725(c) ......... CMS Penalty for any individual who notifies 

or causes to be notified a home 

health agency of the time or date on 

which a survey of such agency is to 

be conducted.

2022 4,799 5,171 

1395bbb(f)(2)(A)(i) ......................... 42 CFR 488.845(b)(2)(iii), 

42 CFR 488.845(b)(3)– 

(6); and 42 CFR 

488.845(d)(1)(ii).

CMS Maximum daily penalty amount for 

each day a home health agency is 

not in compliance with statutory requirements.

2022 23,011 24,793 

42 CFR 488.845(b)(3) ..... CMS Penalty per day for home health agency’s noncompliance (Upper Range): 2022 .................... ....................

Minimum ....................................... 2022 19,559 21,074 

Maximum ...................................... 2022 23,011 24,793 

42 CFR 488.845(b)(3)(i) CMS Penalty for a home health agency’s 

deficiency or deficiencies that cause 

immediate jeopardy and result in actual harm.

2022 23,011 24,793 

42 CFR 488.845(b)(3)(ii) CMS Penalty for a home health agency’s 

deficiency or deficiencies that cause 

immediate jeopardy and result in 

potential for harm.

2022 20,709 22,313 

42 CFR 488.845(b)(3)(iii) CMS Penalty for an isolated incident of noncompliance in violation of established HHA policy.2022 19,559 21,074 

42 CFR 488.845(b)(4) ..... CMS Penalty for a repeat and/or conditionlevel deficiency that does not constitute immediate jeopardy, but is directly related to poor quality patient 

care outcomes (Lower Range): 

2022 .................... ....................

Minimum ....................................... 2022 3,453 3,720 

Maximum ...................................... 2022 19,559 21,074 

42 CFR 488.845(b)(5) ..... CMS Penalty for a repeat and/or conditionlevel deficiency that does not constitute immediate jeopardy and that 

is related predominately to structure 

or process-oriented conditions 

(Lower Range): 

2022 .................... ....................

Minimum ....................................... 2022 1,151 1,240 


lotter on DSK11XQN23PROD with RULES1
69550 Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

Maximum ...................................... 2022 2,301 2,479 

42 CFR 488.845(b)(6) ..... CMS Penalty imposed for instance of noncompliance that may be assessed 

for one or more singular events of 

condition-level noncompliance that 

are identified and where the noncompliance was corrected during 

the onsite survey: 

2022 .................... ....................

Penalty for each day of noncompliance (Minimum).2022 2,301 2,479 

Penalty for each day of noncompliance (Maximum).2022 23,011 24,793 

42 CFR 488.845(d)(1)(ii) CMS Penalty for each day of noncompliance (Maximum).2022 23,011 24,793 

1395eee(e)(6)(B); 1396u– 

4(e)(6)(B).

42 CFR 460.46 ............... CMS Penalty for PACE organization that 

discriminates in enrollment or 

disenrollment, or engages in any 

practice that would reasonably be 

expected to have the effect of denying or discouraging enrollment, on 

the basis of health status or the 

need for services: 

2022 42,788 46,102 

CMS For each individual not enrolled as a 

result of the PACE organization’s 

discrimination in enrollment or 

disenrollment or practice that would 

deny or discourage enrollment.

2022 .................... ....................

Minimum ....................................... 2022 16,121 17,370 

Maximum ...................................... 2022 107,478 115,802 

CMS Penalty for a PACE organization that 

charges excessive premiums.

2022 42,788 46,102 

CMS Penalty for a PACE organization misrepresenting or falsifying information 

to CMS or the State.

2022 171,156 184,412 

CMS Penalty for any other violation specified in 42 C.F.R. 460.40.2022 42,788 46,102 

1396r(h)(3)(C)(ii)(I) ........................ 42 CFR 488.408(d)(1)(iii) CMS Penalty per day for a nursing facility’s 

failure to meet a Category 2 Certification: 

2022 .................... ....................

Minimum ....................................... 2022 120 129 

Maximum ...................................... 2022 7,195 7,752 

42 CFR 488.408(d)(1)(iv) CMS Penalty per instance for a nursing facility’s failure to meet Category 2 

certification: 

2022 .................... ....................

Minimum ....................................... 2022 2,400 2,586 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.408(e)(1)(iii) CMS Penalty per day for a nursing facility’s 

failure to meet Category 3 certification: 

2022 .................... ....................

Minimum ....................................... 2022 7,317 7,884 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.408(e)(1)(iv) CMS Penalty per instance for a nursing facility’s failure to meet Category 3 

certification: 

2022 .................... ....................

Minimum ....................................... 2022 2,400 2,586 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.408(e)(2)(ii) CMS Penalty per instance for a nursing facility’s failure to meet Category 3 

certification, which results in immediate jeopardy: 

2022 .................... ....................

Minimum ....................................... 2022 2,400 2,586 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.438(a)(1)(i) CMS Penalty per day for nursing facility’s 

failure to meet certification (Upper 

Range): 

2022 .................... ....................

Minimum ....................................... 2022 7,317 7,884 

Maximum ...................................... 2022 23,989 25,847 

42 CFR 488.438(a)(1)(ii) CMS Penalty per day for nursing facility’s 

failure to meet certification (Lower 

Range): 

2022 .................... ....................

Minimum ....................................... 2022 120 129 

Maximum ...................................... 2022 7,195 7,752 

42 CFR 488.438(a)(2) ..... CMS Penalty per instance for nursing facility’s failure to meet certification: 2022 .................... ....................

Minimum ....................................... 2022 2,400 2,586 

Maximum ...................................... 2022 23,989 25,847 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69551 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

42 CFR 488.447 ............. CMS Penalty imposed for failure to comply 

with infection control weekly reporting requirements at 42 CFR 

483.80(g)(1) and (2).

2022 .................... ....................

First occurrence (Minimum) ................. 2022 1,075 1,158 

Incremental increases for each subsequent occurrence.2022 537 579 

1396r(f)(2)(B)(iii)(I)(c) .................... 42 CFR 483.151(b)(2)(iv) 

and (b)(3)(iii).

CMS Grounds to prohibit approval of Nurse 

Aide Training Program—if assessed 

a penalty in 1819(h)(2)(B)(i) or 

1919(h)(2)(A)(ii) of ‘‘not less than 

$5,000’’ [Not CMP authority, but a 

specific CMP amount (CMP at this 

level) that is the triggering condition 

for disapproval].

2022 11,995 12,924 

1396r(h)(3)(C)(ii)(I) ........................ 42 CFR 483.151(c)(2) ..... CMS Grounds to waive disapproval of nurse 

aide training program—reference to 

disapproval based on imposition of 

CMP ‘‘not less than $5,000’’ [Not 

CMP authority but CMP imposition 

at this level determines eligibility to 

seek waiver of disapproval of nurse 

aide training program].

2022 11,995 12,924 

1396t(j)(2)(C) ................................. ......................................... CMS Penalty for each day of noncompliance for a home or community care 

provider that no longer meets the 

minimum requirements for home 

and community care: 

2022 .................... ....................

Minimum ....................................... 2022 2 2 

Maximum ...................................... 2022 20,719 22,324 

1396u–2(e)(2)(A)(i) ........................ 42 CFR 438.704 ............. CMS Penalty for a Medicaid managed care 

organization that fails substantially 

to provide medically necessary 

items and services.

2022 42,788 46,102 

CMS Penalty for Medicaid managed care 

organization that imposes premiums 

or charges on enrollees in excess of 

the premiums or charges permitted.

2022 42,788 46,102 

CMS Penalty for a Medicaid managed care 

organization that misrepresents or 

falsifies information to another individual or entity.

2022 42,788 46,102 

CMS Penalty for a Medicaid managed care 

organization that fails to comply with 

the applicable statutory requirements for such organizations.

2022 42,788 46,102 

1396u–2(e)(2)(A)(ii) ....................... 42 CFR 438.704 ............. CMS Penalty for a Medicaid managed care 

organization that misrepresents or 

falsifies information to the HHS Secretary.

2022 171,156 184,412 

CMS Penalty for Medicaid managed care 

organization that acts to discriminate among enrollees on the basis 

of their health status.

2022 171,156 184,412 

1396u–2(e)(2)(A)(iv) ...................... 42 CFR 438.704 ............. CMS Penalty for each individual that does 

not enroll as a result of a Medicaid 

managed care organization that acts 

to discriminate among enrollees on 

the basis of their health status.

2022 25,673 27,661 

1396u(h)(2) .................................... 42 CFR Part 441, Subpart I.CMS Penalty for a provider not meeting one 

of the requirements relating to the 

protection of the health, safety, and 

welfare of individuals receiving community supported living arrangements services.

2022 23,989 25,847 

1396w–2(c)(1) ............................... 42 U.S.C. 300gg– 

22(b)(2)(C)(i) 45 CFR 

150.315.

CMS Penalty for each day, for each individual affected by the failure of a 

health insurance issuer or non-Federal governmental group health plan 

to comply with federal market reform 

provisions in part A or D of title 

XXVII of the PHS Act | 2022 | 174 | 

177.

2022 12,794 13,785 


lotter on DSK11XQN23PROD with RULES1
69552 Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

42 U.S.C. 300gg–22(b)(2)(C)(i) ..... 45 CFR 150.315 ............. CMS Penalty for each day, for each individual affected by the failure of a 

health insurance issuer or non-Federal governmental group health plan 

to comply with federal market reform 

provisions in part A or D of title 

XXVII of the PHS Act.

2022 174 177 

18041(c)(2) .................................... 45 CFR 156.805(c) ......... CMS Failure to comply with ACA requirements related to risk adjustment, reinsurance, risk corridors, Exchanges 

(including QHP standards) and 

other ACA Subtitle D standards; 

Penalty for violations of rules or 

standards of behavior associated 

with issuer compliance with risk adjustment, reinsurance, risk corridors, 

Exchanges (including QHP standards) and other ACA Subtitle D 

standards.

2022 174 187 

18081(h)(1)(A)(i)(II) ....................... 45 CFR 155.285 ............. CMS Penalty for providing false information 

on Exchange application.

2022 31,616 34,065 

18081(h)(1)(B) ............................... 45 CFR 155.285 ............. CMS Penalty for knowingly or willfully providing false information on Exchange application.2022 316,155 340,641 

18081(h)(2) .................................... 45 CFR 155.260 ............. CMS Penalty for knowingly or willfully disclosing protected information from 

Exchange.

2022 .................... ....................

CMS Minimum ....................................... 2022 31,616 34,065 

CMS Maximum ...................................... 2022 323 348 

18041(c)(2) .................................... 45 CFR 155.206(i) .......... CMS Penalties for violation of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges.2022 38,771 41,774 

Maximum (Per Day) ..................... 2022 107 115 

31 U.S.C. .............................................. 2022 323 348 

1352 ............................................... 45 CFR 93.400(e) ........... HHS Penalty for the first time an individual 

makes an expenditure prohibited by 

regulations regarding lobbying disclosure, absent aggravating circumstances.

2022 22,021 23,727 

Penalty for second and subsequent offenses by individuals who make an 

expenditure prohibited by regulations regarding lobbying disclosure: 

2022 .................... ....................

Minimum ....................................... 2022 22,021 23,727 

Maximum ...................................... 2022 220,213 237,268 

HHS Penalty for the first time an individual 

fails to file or amend a lobbying disclosure form, absent aggravating 

circumstances.

2022 22,021 23,727 

Penalty for second and subsequent offenses by individuals who fail to file 

or amend a lobbying disclosure 

form, absent aggravating circumstances: 

2022 .................... ....................

Minimum ....................................... 2022 22,021 23,727 

Maximum ...................................... 2022 220,213 237,268 

45 CFR Part 93, Appendix A.HHS Penalty for failure to provide certification regarding lobbying in the 

award documents for all sub-awards 

of all tiers: 

2022 .................... ....................

Minimum ....................................... 2022 22,021 23,727 

Maximum ...................................... 2022 220,213 237,268 

HHS Penalty for failure to provide statement 

regarding lobbying for loan guarantee and loan insurance transactions: 

2022 .................... ....................

Minimum ....................................... 2022 22,021 23,727 

Maximum ...................................... 2022 220,213 237,268 

3801–3812 ..................................... 45 CFR 79.3(a)(1)(iv) ...... HHS Penalty against any individual who— 

with knowledge or reason to know— 

makes, presents or submits a false, 

fictitious or fraudulent claim to the 

Department.

2022 11,507 12,398 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 88, No. 193 / Friday, October 6, 2023 / Rules and Regulations 69553 

TABLE 1 TO § 102.3—CIVIL MONETARY PENALTY AUTHORITIES ADMINISTERED BY HHS—Continued 

U.S.C. section(s) CFR 1 HHS 

agency Description 2

Date of last 

penalty 

figure or 

adjustment 3

2022 

Maximum 

adjusted 

penalty 

($) 

2023 

Maximum 

adjusted 

penalty 

($) 4

45 CFR 79.3(b)(1)(ii) ....... HHS Penalty against any individual who— 

with knowledge or reason to know— 

makes, presents or submits a false, 

fictitious or fraudulent claim to the 

Department.

2022 11,507 12,398 

1Some HHS components have not promulgated regulations regarding their civil monetary penalty-specific statutory authorities. 

2The description is not intended to be a comprehensive explanation of the underlying violation; the statute and corresponding regulation, if applicable, should be 

consulted. 3Statutory or Inflation Act Adjustment. 

4OMB Memorandum M–16–06, Implementation of the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, published February 24, 2016, 

guided agencies on initial ‘‘catch-up’’ adjustment requirements, and M–17–11, Implementation of the 2017 annual adjustment pursuant to the Federal Civil Penalties 

Inflation Adjustment Act Improvements Act of 2015, published December 16, 2016; followed by M–18–03, M–19–04, M–20–05, M–21–10, M–22–07, and M–23–05 

guided agencies on annual adjustment requirements 5OMB Circular A–136, Financial Reporting Requirements, Section II.4.9, directs that agencies must make annual inflation adjustments to civil monetary penalties 

and report on the adjustments in the Agency Financial Report (AFR) or Performance and Accountability Report (PAR). 6Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, § 701(b)(1)(A) (codified as amended at 28 U.S.C. 2461 note). 

7Annual inflation adjustments are based on the percent change between each published October’s CPI–U. In this case, October 2022 CPI–U (298.012) / October 

2021 CPI–U (276.589) = 1.07745. 

Dated: October 2, 2023. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2023–22264 Filed 10–5–23; 8:45 am] 

BILLING CODE 4150–24–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 622 

[Docket No. 230427–0115] 

RIN 0648–BL89 

Fisheries of the Caribbean, Gulf of 

Mexico, and South Atlantic; Reef Fish 

Resources of the Gulf of Mexico; 

Temporary Measures To Reduce 

Overfishing of Gag 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Temporary rule; interim 

measures extended. 

SUMMARY: NMFS issues this temporary 

rule to extend the expiration date of 

interim measures to reduce overfishing 

of gag in Federal waters of the Gulf of 

Mexico. This temporary rule extends the 

commercial and recreational harvest 

levels and the revised recreational 

fishing season for gag for an additional 

186 days. The purpose of this temporary 

rule extension is to reduce overfishing 

of gag while NMFS implements 

management measures to end 

overfishing of gag on a permanent basis. 

DATES: As of October 6, 2023, the 

expiration date for the final temporary 

rule published at 88 FR 27701 on May 

3, 2023, is extended from October 30, 

2023, through May 2, 2024, unless 

NMFS publishes a superseding 

document in the Federal Register. 

ADDRESSES: An electronic copy of the 

environmental assessment (EA) 

supporting these temporary measures 

may be obtained from the Southeast 

Regional Office website at https://

www.fisheries.noaa.gov/action/interimaction-reduce-overfishing-gag-gulfmexico. The EA includes a regulatory 

impact review and a Regulatory 

Flexibility Act (RFA) analysis. 

FOR FURTHER INFORMATION CONTACT: Dan 

Luers, NMFS Southeast Regional Office, 

telephone: 727–824–5305, or email: 

daniel.luers@noaa.gov. 

SUPPLEMENTARY INFORMATION: The reef 

fish fishery in the Gulf of Mexico (Gulf) 

is managed under the Fishery 

Management Plan for the Reef Fish 

Resources of the Gulf (FMP) and 

includes gag and other federally 

managed reef fish species. The FMP was 

prepared by the Gulf of Mexico Fishery 

Management Council (Council) and is 

implemented by NMFS through 

regulations at 50 CFR part 622 under 

authority of the Magnuson-Stevens 

Fishery Conservation and Management 

Act (Magnuson-Stevens Act). 

All weights described in this 

temporary rule are in gutted weight. 

On May 3, 2023, NMFS published the 

final temporary rule for interim 

measures to reduce overfishing of gag in 

Gulf Federal waters (88 FR 27701). The 

final temporary rule reduced the total 

annual catch limit (ACL) for gag to 

661,901 lb (300,233 kg). In addition, the 

final temporary rule specified the 

commercial and recreational ACLs, 

commercial quota, and recreational 

annual catch target (ACT) using the 

existing sector allocations of the total 

ACL of 39 percent commercial and 61 

percent recreational. Therefore, during 

the effectiveness of the final temporary 

rule and this temporary rule extension, 

the commercial ACL and commercial 

quota are 258,000 lb (117,027 kg) and 

199,000 lb (90,265 kg), respectively. The 

recreational ACL and ACT are 403,759 

lb (183,142 kg) and 362,374 lb (164,370 

kg), respectively. 

In addition to the reduced catch limits 

for gag, the final temporary rule changed 

the gag recreational fishing season for 

the 2023 fishing year. This temporary 

rule extension continues the same 

recreational fishing season of September 

1 through November 9, 2023, unless 

NMFS projects that recreational 

landings of gag will reach the 

recreational ACL sooner than November 

9, 2023, and will close the recreational 

sector as required by the accountability 

measures specified in 50 CFR 

622.41(r)(2). 

This temporary rule extension 

continues the measures in the final 

temporary rule unchanged for an 

additional 186 days, unless this 

temporary rule extension is superseded 

by subsequent rulemaking. The purpose 

of these interim measures is to reduce 

the overfishing of gag in Gulf Federal 

waters while NMFS implements longterm management measures to end 

overfishing and rebuild the Gulf gag 

stock. 

Amendment 56 was approved by the 

Council at the June 2023 meeting and 

includes management measures to end 

overfishing of gag on a long-term basis. 

NMFS is currently reviewing 

Amendment 56 and developing the 

proposed rule for Amendment 56 and, 

if approved, expects to implement a 

final rule before the expiration of the 

interim measures in this temporary rule 

extension in the 2024 fishing year. 


lotter on DSK11XQN23PROD with RULES1