Source: https://www.ecfr.gov/cgi-bin/text-idx?mc=true&node=pt20.2.498&rgn=div5
Timestamp: 2019-12-06 04:30:09
Document Index: 462645910

Matched Legal Cases: ['art 498', 'ART 498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§3720', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498', '§498']

Title 20 → Chapter III → Part 498
PART 498—CIVIL MONETARY PENALTIES, ASSESSMENTS AND RECOMMENDED EXCLUSIONS
§498.100 Basis and purpose.
§498.101 Definitions.
§498.102 Basis for civil monetary penalties and assessments.
§498.103 Amount of penalty.
§498.104 Amount of assessment.
§498.105 [Reserved]
§498.106 Determinations regarding the amount or scope of penalties and assessments.
§498.107 [Reserved]
§498.108 Penalty and assessment not exclusive.
§498.109 Notice of proposed determination.
§498.110 Failure to request a hearing.
§498.114 Collateral estoppel.
§§498.115-498.125 [Reserved]
§498.126 Settlement.
§498.127 Judicial review.
§498.128 Collection of penalty and assessment.
§498.129 Notice to other agencies.
§498.132 Limitations.
§498.201 Definitions.
§498.202 Hearing before an administrative law judge.
§498.203 Rights of parties.
§498.204 Authority of the administrative law judge.
§498.205 Ex parte contacts.
§498.206 Prehearing conferences.
§498.207 Discovery.
§498.208 Exchange of witness lists, witness statements and exhibits.
§498.209 Subpoenas for attendance at hearing.
§498.210 Fees.
§498.211 Form, filing and service of papers.
§498.212 Computation of time.
§498.213 Motions.
§498.214 Sanctions.
§498.215 The hearing and burden of proof.
§498.216 Witnesses.
§498.217 Evidence.
§498.218 The record.
§498.219 Post-hearing briefs.
§498.220 Initial decision.
§498.221 Appeal to DAB.
§498.222 Final decision of the Commissioner.
§498.223 Stay of initial decision.
§498.224 Harmless error.
Authority: Secs. 702(a)(5), 1129, and 1140 of the Social Security Act (42 U.S.C. 902(a)(5), 1320a-8, and 1320b-10).
Source: 60 FR 58226, Nov. 27, 1995, unless otherwise noted.
Assessment means the amount described in §498.104, and includes the plural of that term.
Penalty means the amount described in §498.103 and includes the plural of that term.
(a) Under §498.102(a), the Office of the Inspector General may impose a penalty of not more than $5,000 for each false statement or representation, omission, or receipt of payment or benefit while withholding disclosure of a material fact.
(b) Under §498.102(b), the Office of the Inspector General may impose a penalty of not more than $5,000 against a representative payee for each time the representative payee receives a payment under title II, title VIII, or title XVI of the Social Security Act for the use and benefit of another individual, and who converts such payment, or any part thereof, to a use that such representative payee knew or should have known was other than for the use and benefit of such other individual.
(c) Under §498.102(c), the Office of the Inspector General may impose a penalty of not more than $5,000 for each violation resulting from the misuse of Social Security Administration program words, letters, symbols, or emblems relating to printed media and a penalty of not more than $25,000 for each violation in the case that such misuse related to a broadcast or telecast.
(d) Under §498.102(d), the Office of the Inspector General may impose a penalty of not more than $5,000 for each violation resulting from insufficient notice relating to printed media regarding products or services provided free of charge by the Social Security Administration and a penalty of not more than $25,000 for each violation in the case that such insufficient notice relates to a broadcast or telecast.
(1) In the case of a mailed solicitation, advertisement, or other communication, each separate piece of mail which contains one or more program words, letters, symbols, or emblems or insufficient notice related to a determination under §498.102(c) or (d); and
(2) In the case of a broadcast or telecast, each airing of a single commercial or solicitation related to a determination under §498.102(c) or (d).
(g)(1) The amount of the penalties described in paragraphs (a) through (d) of this section are the maximum penalties which may be assessed under these paragraphs for violations made after June 16, 2006, but before August 1, 2016.
(2)(i) After August 1, 2016 penalties are adjusted in accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990 (Pub. L. 101-410), as amended by the Debt Collection Improvement Act of 1996 (Pub. L. 104-134), as further amended by the Bipartisan Budget Act of 2015, Section 701: Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 (Section 701 of Pub. L. 114-74).
(ii) The maximum penalties which may be assessed under this section is the larger of:
(A) The amount for the previous calendar year; or
(B) An amount adjusted for inflation, calculated by multiplying the amount for the previous calendar year by the percentage by which the Consumer Price Index for all urban consumers for the month of October preceding the current calendar year exceeds the Consumer Price Index for all urban consumers for the month of October of the calendar year two years prior to the current calendar year, adding that amount to the amount for the previous calendar year, and rounding the total to the nearest dollar.
(iii) Notice of the maximum penalty which may be assessed under this section for calendar years after 2016 will be published in the Federal Register on an annual basis on or before January 15 of each calendar year.
[71 FR 28580, May 17, 2006, as amended at 81 FR 41440, June 27, 2016]
A person subject to a penalty determined under §498.102(a) may be subject, in addition, to an assessment of not more than twice the amount of benefits or payments paid under title II, title VIII or title XVI of the Social Security Act as a result of the statement, representation, omission, or withheld disclosure of a material fact which was the basis for the penalty. A representative payee subject to a penalty determined under §498.102(b) may be subject, in addition, to an assessment of not more than twice the amount of benefits or payments received by the representative payee for the use and benefit of another individual and converted to a use other than for the use and benefit of such other individual. An assessment is in lieu of damages sustained by the United States because of such statement, representation, omission, withheld disclosure of a material fact, or conversion, as referred to in §498.102(a) and (b).
[71 FR 28581, May 17, 2006]
(a) In determining the amount or scope of any penalty and assessment, as applicable, in accordance with §498.103(a) and (b) and 498.104, the Office of the Inspector General will take into account:
(1) The nature of the statements, representations, or actions referred to in §498.102(a) and (b) and the circumstances under which they occurred;
(b) In determining the amount of any penalty in accordance with §498.103(c) and (d), the Office of the Inspector General will take into account—
(c) In cases brought under section 1140 of the Social Security Act, the use of a disclaimer of affiliation with the United States Government, the Social Security Administration or its programs will not be considered as a mitigating factor in determining the amount of a penalty in accordance with §498.106.
Penalties and assessments, as applicable, imposed under this part are in addition to any other penalties prescribed by law.
(2) A description of the false statements, representations, other actions (as described in §498.102(a) and (b)), and incidents, as applicable, with respect to which the penalty and assessment, as applicable, are proposed;
(4) Any circumstances described in §498.106 that were considered when determining the amount of the proposed penalty and assessment, as applicable; and
If the respondent does not request a hearing within the time prescribed by §498.109(a), the Office of the Inspector General may seek the proposed penalty and assessment, as applicable, or any less severe penalty and assessment. The Office of the Inspector General shall notify the respondent by certified mail, return receipt requested, of any penalty and assessment, as applicable, that has been imposed and of the means by which the respondent may satisfy the amount owed.
In a proceeding under section 1129 of the Social Security Act that—
(a) Is against a person who has been convicted (whether upon a verdict after trial or upon a plea of guilty or nolo contendere) of a Federal or State crime; and
(b) Involves the same transactions as in the criminal action, the person is estopped from denying the essential elements of the criminal offense.
(1) Violations referred to in §498.102(c) or (d) occurred; or
(2) A tax refund to which a person is entitled to after notice to the Secretary of the Treasury under 31 U.S.C. §3720A;
As provided in section 1129 of the Social Security Act, when a determination to impose a penalty and assessment, as applicable, with respect to a physician or medical provider becomes final, the Office of the Inspector General will notify the Secretary of the final determination and the reasons therefore.
[61 FR 18081, Apr. 24, 1996]
The Office of the Inspector General may initiate a proceeding in accordance with §498.109(a) to determine whether to impose a penalty and assessment, as applicable—
(a) In cases brought under section 1129 of the Social Security Act, after receiving authorization from the Attorney General pursuant to procedures agreed upon by the Inspector General and the Attorney General; and
(b) Within 6 years from the date on which the violation was committed.
ALJ refers to an Administrative Law Judge of the Departmental Appeals Board.
Civil monetary penalty cases refer to all proceedings arising under any of the statutory bases for which the Inspector General, Social Security Administration has been delegated authority to impose civil monetary penalties.
DAB refers to the Departmental Appeals Board of the U.S. Department of Health and Human Services.
[61 FR 65468, Dec. 13, 1996]
(a) A party sanctioned under any criteria specified in §§498.100 through 498.132 may request a hearing before an ALJ.
(b) In civil monetary penalty cases, the parties to a hearing will consist of the respondent and the Inspector General.
(c) The request for a hearing must be:
(1) In writing and signed by the respondent or by the respondent's attorney; and
(2) Filed within 60 days after the notice, provided in accordance with §498.109, is received by the respondent or upon a showing of good cause, the time permitted by an ALJ.
(d) The request for a hearing shall contain a statement as to the:
(1) Specific issues or findings of fact and conclusions of law in the notice letter with which the respondent disagrees; and
(2) Basis for the respondent's contention that the specific issues or findings and conclusions were incorrect.
(e) For purposes of this section, the date of receipt of the notice letter will be presumed to be five days after the date of such notice, unless there is a reasonable showing to the contrary.
(f) The ALJ shall dismiss a hearing request where:
(1) The respondent's hearing request is not filed in a timely manner and the respondent fails to demonstrate good cause for such failure;
(2) The respondent withdraws or abandons respondent's request for a hearing; or
(3) The respondent's hearing request fails to raise any issue which may properly be addressed in a hearing under this part.
(10) Receive, exclude, or limit evidence;
(11) Take official notice of facts;
(13) Conduct any conference or argument in person, or by telephone upon agreement of the parties.
(c) The ALJ does not have the authority to:
(1) Find invalid or refuse to follow Federal statutes or regulations, or delegations of authority from the Commissioner;
(4) Enjoin any act of the Commissioner or the Inspector General; or
(5) Review the exercise of discretion by the Office of the Inspector General to seek to impose a civil monetary penalty or assessment under §§498.100 through 498.132.
(b) The ALJ may use prehearing conferences to address the following:
(3) Stipulations and admissions of fact as to the contents and authenticity of documents and deadlines for challenges, if any, to the authenticity of documents;
(5) Whether a party chooses to waive appearance at a hearing and to submit only documentary evidence (subject to the objection of other parties) and written argument;
(7) The time and place for the hearing and dates for the exchange of witness lists and of proposed exhibits;
(9) Such other matters as may tend to encourage the fair, just, and expeditious disposition of the proceedings; and
(10) Potential settlement of the case.
(c) The ALJ shall issue an order containing the matters agreed upon by the parties or ordered by the ALJ at a prehearing conference.
(d)(1) A party who has been served with a request for production of documents may file a motion for a protective order. The motion for protective order shall describe the document or class of documents to be protected, specify which of the grounds in §498.207(d)(2) are being asserted, and explain how those grounds apply.
(3) Copies of proposed hearing exhibits, including copies of any written statements that the party intends to offer in lieu of live testimony in accordance with §498.216.
(c) Unless a party objects by the deadline set by the ALJ's prehearing order pursuant to §498.206 (b)(3) and (c), documents exchanged in accordance with paragraph (a) of this section will be deemed authentic for the purpose of admissibility at the hearing.
(a) A party wishing to procure the appearance and testimony of any individual, whose appearance and testimony are relevant and material to the presentation of a party's case at a hearing, may make a motion requesting the ALJ to issue a subpoena.
(b) A subpoena requiring the attendance of an individual may also require the individual (whether or not the individual is a party) to produce evidence at the hearing in accordance with §498.207.
(c) A party seeking a subpoena will file a written motion not less than 30 days before the date fixed for the hearing, unless otherwise allowed by the ALJ for good cause shown. Such request will:
(2) Designate the witness(es); and
(3) Describe the address and location with sufficient particularity to permit such witness(es) to be found.
(d) Within 20 days after the written motion requesting issuance of a subpoena is served, any party may file an opposition or other response.
(e) If the motion requesting issuance of a subpoena is granted, the party seeking the subpoena will serve the subpoena by delivery to the individual named, or by certified mail addressed to such individual at his or her last dwelling place or principal place of business.
(f) The subpoena will specify the time and place at which the witness is to appear and any evidence the witness is to produce.
(g) The individual to whom the subpoena is directed may file with the ALJ a motion to quash the subpoena within 10 days after service.
(h) When a subpoena is served by a respondent on a particular individual or particular office of the Office of the Inspector General, the OIG may comply by designating any of its representatives to appear and testify.
(i) In the case of contumacy by, or refusal to obey a subpoena duly served upon any person, the exclusive remedy is specified in section 205(e) of the Social Security Act (42 U.S.C. 405(e)).
The party requesting a subpoena will pay the cost of the fees and mileage of any witness subpoenaed in the amounts that would be payable to a witness in a proceeding in United States District Court. A check for witness fees and mileage will accompany the subpoena when served, except that when a subpoena is issued on behalf of the Inspector General, a check for witness fees and mileage need not accompany the subpoena.
(a) Form. (1) Unless the ALJ directs the parties to do otherwise, documents filed with the ALJ will include an original and two copies.
(2) Every document filed in the proceeding will contain a caption setting forth the title of the action, the case number, and a designation of the pleading or paper.
(3) Every document will be signed by, and will contain the address and telephone number of the party or the person on whose behalf the document was filed, or his or her representative.
(4) Documents are considered filed when they are mailed.
(b) Service. A party filing a document with the ALJ will, at the time of filing, serve a copy of such document on every other party. Service upon any party of any document will be made by delivering a copy, or placing a copy of the document in the United States mail, postage prepaid and addressed, or with a private delivery service, to the party's last known address. When a party is represented by an attorney, service will be made upon such attorney. Proof of service should accompany any document filed with the ALJ.
(c) Where a document has been served or issued by placing it in the mail, an additional 5 days will be added to the time permitted for any response. This paragraph does not apply to requests for hearing under §498.202.
(a) An application to the ALJ for an order or ruling will be by motion. Motions will:
(1) State the relief sought, the authority relied upon and the facts alleged; and
(2) Be filed with the ALJ and served on all other parties.
(b) Except for motions made during a prehearing conference or at a hearing, all motions will be in writing.
(d) The ALJ may not grant or deny a written motion before the time for filing responses has expired, except upon consent of the parties or following a hearing on the motion.
(f) There is no right to appeal to the DAB any interlocutory ruling by the ALJ.
(b) In civil monetary penalty cases under §§498.100 through 498.132:
(e)(1) A hearing under this part is not limited to specific items and information set forth in the notice letter to the respondent. Subject to the 15-day requirement under §498.208, additional items or information may be introduced by either party during its case-in-chief, unless such information or items are inadmissible under §498.217.
(2) After both parties have presented their cases, evidence may be admitted on rebuttal as to those issues presented in the case-in-chief, even if not previously exchanged in accordance with §498.208.
(b) At the discretion of the ALJ, testimony (other than expert testimony) may be admitted in the form of a written statement. Any such written statement must be provided to all other parties along with the last known address of such witness, in a manner that allows sufficient time for other parties to subpoena such witness for cross-examination at the hearing. Prior written statements of witnesses proposed to testify at the hearing will be exchanged as provided in §498.208.
(c) The ALJ will exercise reasonable control over the mode and order of witness direct and cross examination and evidence presentation so as to:
(2) Avoid repetition or needless waste of time; and
(d) The ALJ may order witnesses excluded so that they cannot hear the testimony of other witnesses. This does not authorize exclusion of:
(3) An individual whose presence is shown by a party to be essential to the presentation of its case, including an individual engaged in assisting the attorney for the Inspector General.
(2) Such evidence is admissible regardless of whether the crimes, wrongs or acts occurred during the statute of limitations period applicable to the acts which constitute the basis for liability in the case, and regardless of whether they were referenced in the IG's notice sent in accordance with §498.109.
(a) The hearing shall be recorded and transcribed. Transcripts may be obtained following the hearing from the ALJ.
(b) The transcript of testimony, exhibits and other evidence admitted at the hearing, and all papers and requests filed in the proceeding constitute the record for the decision by the ALJ.
(c) The record may be inspected and copied (upon payment of a reasonable fee) by any person, unless otherwise ordered by the ALJ for good cause.
(a) Any party may file a post-hearing brief.
(b) The ALJ may require the parties to file post-hearing briefs and may permit the parties to file reply briefs.
(c) The ALJ will fix the time for filing briefs, which is not to exceed 60 days from the date the parties receive the transcript of the hearing or, if applicable, the stipulated record.
(d) The parties' briefs may be accompanied by proposed findings of fact and conclusions of law.
(d) Unless an appeal or request for extension pursuant to §498.221(a) is filed with the DAB, the initial decision of the ALJ becomes final and binding on the parties 30 days after the ALJ serves the parties with a copy of the decision. If service is by mail, the date of service will be deemed to be five days from the date of mailing.
(a) The filing of a respondent's request for review by the DAB will automatically stay the effective date of the ALJ's decision.
(b)(1) After issuance of the final decision, pending judicial review, the respondent may file a request for stay of the effective date of any penalty or assessment with the ALJ. The request must be accompanied by a copy of the notice of appeal filed with the Federal court. The filing of such a request will automatically act to stay the effective date of the penalty or assessment until such time as the ALJ rules upon the request.
No error in either the admission or the exclusion of evidence, and no error or defect in any ruling or order or in any act done or omitted by the ALJ or by any of the parties is ground for vacating, modifying or otherwise disturbing an otherwise appropriate ruling or order or act, unless refusal to take such action appears to the ALJ or the DAB to be inconsistent with substantial justice. The ALJ and the DAB at every stage of the proceeding will disregard any error or defect in the proceeding that does not affect the substantial rights of the parties.