US Code
Part A— General Provisions
§ 1320a–8a. Administrative procedure for imposing penalties for false or misleading statements

(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

US Code

Title 42— THE PUBLIC HEALTH AND WELFARE

CHAPTER 7— SOCIAL SECURITY

SUBCHAPTER XI— GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION

Part A— General Provisions

§ 1301. Definitions

§ 1301–1. Omitted

§ 1301a. Omitted

§ 1302. Rules and regulations; impact analyses of Medicare and Medicaid rules and regulations on small rural hospitals

§ 1303. Separability

§ 1304. Reservation of right to amend or repeal

§ 1305. Short title of chapter

§ 1306. Disclosure of information in possession of Social Security Administration or Department of Health and Human Services

§ 1306a. Public access to State disbursement records

§ 1306b. State data exchanges

§ 1306c. Restriction on access to the Death Master File

§ 1307. Penalty for fraud

§ 1308. Additional grants to Puerto Rico, Virgin Islands, Guam, and American Samoa; limitation on total payments

§ 1309. Amounts disregarded not to be taken into account in determining eligibility of other individuals

§ 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

§ 1314b. National Advisory Committee on the Sex Trafficking of Children and Youth in the United States

§ 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

§ 1317. Appointment of the Administrator and Chief Actuary of the Centers for Medicare & Medicaid Services

§ 1318. Alternative Federal payment with respect to public assistance expenditures

§ 1319. Federal participation in payments for repairs to home owned by recipient of aid or assistance

§ 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–1a. Transferred

§ 1320a–2. Effect of failure to carry out State plan

§ 1320a–2a. Reviews of child and family services programs, and of foster care and adoption assistance programs, for conformity with State plan requirements

§ 1320a–3. Disclosure of ownership and related information; procedure; definitions; scope of requirements

§ 1320a–3a. Disclosure requirements for other providers under part B of Medicare

§ 1320a–4. Issuance of subpenas by Comptroller General

§ 1320a–5. Disclosure by institutions, organizations, and agencies of owners, officers, etc., convicted of offenses related to programs; notification requirements; “managing employee” defined

§ 1320a–6. Adjustments in SSI benefits on account of retroactive benefits under subchapter II

§ 1320a–6a. Interagency coordination to improve program administration

§ 1320a–7. Exclusion of certain individuals and entities from participation in Medicare and State health care programs

§ 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–7l. Nationwide program for national and State background checks on direct patient access employees of long-term care facilities and providers

§ 1320a–7m. Use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program

§ 1320a–7n. Disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse

§ 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. Repealed. , ,

§ 1320b–1. Notification of Social Security claimant with respect to deferred vested benefits

§ 1320b–2. Period within which certain claims must be filed

§ 1320b–3. Applicants or recipients under public assistance programs not to be required to make election respecting certain veterans’ benefits

§ 1320b–4. Nonprofit hospital or critical access hospital philanthropy

§ 1320b–5. Authority to waive requirements during national emergencies

§ 1320b–6. Exclusion of representatives and health care providers convicted of violations from participation in social security programs

§ 1320b–7. Income and eligibility verification system

§ 1320b–8. Hospital protocols for organ procurement and standards for organ procurement agencies

§ 1320b–9. Improved access to, and delivery of, health care for Indians under subchapters XIX and XXI

§ 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–14. Outreach efforts to increase awareness of the availability of medicare cost-sharing and subsidies for low-income individuals under subchapter XVIII

§ 1320b–15. Protection of social security and medicare trust funds

§ 1320b–16. Public disclosure of certain information on hospital financial interest and referral patterns

§ 1320b–17. Cross-program recovery of overpayments from benefits

§ 1320b–18. Repealed. , ,

§ 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–22. Grants to develop and establish State infrastructures to support working individuals with disabilities

§ 1320b–23. Pharmacy benefit managers transparency requirements

§ 1320b–24. Consultation with Tribal Technical Advisory Group

§ 1320b–25. Reporting to law enforcement of crimes occurring in federally funded long-term care facilities

§ 1320b–26. Funding for providers relating to COVID–19