(a) In generalAny person who—(1) makes, or causes to be made, a statement or representation of a material fact, for use in determining any initial or continuing right to or the amount of monthly insurance benefits under subchapter II or benefits or payments under subchapter XVI that the person knows or should know is false or misleading,
(2) makes such a statement or representation for such use with knowing disregard for the truth, or
(3) omits from a statement or representation for such use, or otherwise withholds disclosure of, a fact which the person knows or should know is material to the determination of any initial or continuing right to or the amount of monthly insurance benefits under subchapter II or benefits or payments under subchapter XVI, if the person knows, or should know, that the statement or representation with such omission is false or misleading or that the withholding of such disclosure is misleading,
shall be subject to, in addition to any other penalties that may be prescribed by law, a penalty described in subsection (b) to be imposed by the Commissioner of Social Security.
(b) PenaltyThe penalty described in this subsection is—(1) nonpayment of benefits under subchapter II that would otherwise be payable to the person; and
(2) ineligibility for cash benefits under subchapter XVI,
for each month that begins during the applicable period described in subsection (c).
(c) Duration of penaltyThe duration of the applicable period, with respect to a determination by the Commissioner under subsection (a) that a person has engaged in conduct described in subsection (a), shall be—(1) six consecutive months, in the case of the first such determination with respect to the person;
(2) twelve consecutive months, in the case of the second such determination with respect to the person; and
(3) twenty-four consecutive months, in the case of the third or subsequent such determination with respect to the person.
(d) Effect on other assistanceA person subject to a period of nonpayment of benefits under subchapter II or ineligibility for subchapter XVI benefits by reason of this section nevertheless shall be considered to be eligible for and receiving such benefits, to the extent that the person would be receiving or eligible for such benefits but for the imposition of the penalty, for purposes of—(1) determination of the eligibility of the person for benefits under subchapters XVIII and XIX; and
(2) determination of the eligibility or amount of benefits payable under subchapter II or XVI to another person.
(e) DefinitionIn this section, the term “benefits under subchapter VIII or XVI” includes State supplementary payments made by the Commissioner pursuant to an agreement under section 1010a or 1382e(a) of this title or section 212(b) of Public Law 93–66, as the case may be.
(f) ConsultationsThe Commissioner of Social Security shall consult with the Inspector General of the Social Security Administration regarding initiating actions under this section.
Structure US Code
Title 42— THE PUBLIC HEALTH AND WELFARE
SUBCHAPTER XI— GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION
§ 1304. Reservation of right to amend or repeal
§ 1305. Short title of chapter
§ 1306a. Public access to State disbursement records
§ 1306c. Restriction on access to the Death Master File
§ 1310. Cooperative research or demonstration projects
§ 1311. Public assistance payments to legal representatives
§ 1312. Medical care guides and reports for public assistance and medical assistance
§ 1313. Assistance for United States citizens returned from foreign countries
§ 1314. Public advisory groups
§ 1314a. Measurement and reporting of welfare receipt
§ 1315. Demonstration projects
§ 1315a. Center for Medicare and Medicaid Innovation
§ 1315b. Providing Federal coverage and payment coordination for dual eligible beneficiaries
§ 1316. Administrative and judicial review of public assistance determinations
§ 1318. Alternative Federal payment with respect to public assistance expenditures
§ 1320. Approval of certain projects
§ 1320a. Uniform reporting systems for health services facilities and organizations
§ 1320a–1. Limitation on use of Federal funds for capital expenditures
§ 1320a–2. Effect of failure to carry out State plan
§ 1320a–3a. Disclosure requirements for other providers under part B of Medicare
§ 1320a–4. Issuance of subpenas by Comptroller General
§ 1320a–6. Adjustments in SSI benefits on account of retroactive benefits under subchapter II
§ 1320a–6a. Interagency coordination to improve program administration
§ 1320a–7a. Civil monetary penalties
§ 1320a–7b. Criminal penalties for acts involving Federal health care programs
§ 1320a–7c. Fraud and abuse control program
§ 1320a–7d. Guidance regarding application of health care fraud and abuse sanctions
§ 1320a–7e. Health care fraud and abuse data collection program
§ 1320a–7f. Coordination of medicare and medicaid surety bond provisions
§ 1320a–7g. Funds to reduce medicaid fraud and abuse
§ 1320a–7h. Transparency reports and reporting of physician ownership or investment interests
§ 1320a–7i. Reporting of information relating to drug samples
§ 1320a–7j. Accountability requirements for facilities
§ 1320a–7k. Medicare and Medicaid program integrity provisions
§ 1320a–8. Civil monetary penalties and assessments for subchapters II, VIII and XVI
§ 1320a–8a. Administrative procedure for imposing penalties for false or misleading statements
§ 1320a–8b. Attempts to interfere with administration of this chapter
§ 1320a–9. Demonstration projects
§ 1320a–10. Effect of failure to carry out State plan
§ 1320b–1. Notification of Social Security claimant with respect to deferred vested benefits
§ 1320b–2. Period within which certain claims must be filed
§ 1320b–4. Nonprofit hospital or critical access hospital philanthropy
§ 1320b–5. Authority to waive requirements during national emergencies
§ 1320b–7. Income and eligibility verification system
§ 1320b–8. Hospital protocols for organ procurement and standards for organ procurement agencies
§ 1320b–9a. Child health quality measures
§ 1320b–9b. Adult health quality measures
§ 1320b–10. Prohibitions relating to references to Social Security or Medicare
§ 1320b–11. Blood donor locator service
§ 1320b–12. Research on outcomes of health care services and procedures
§ 1320b–13. Social security account statements
§ 1320b–15. Protection of social security and medicare trust funds
§ 1320b–17. Cross-program recovery of overpayments from benefits
§ 1320b–19. The Ticket to Work and Self-Sufficiency Program
§ 1320b–20. Work incentives outreach program
§ 1320b–21. State grants for work incentives assistance to disabled beneficiaries
§ 1320b–23. Pharmacy benefit managers transparency requirements
§ 1320b–24. Consultation with Tribal Technical Advisory Group