42 U.S.C. § 1320a-7b : US Code - Section 1320A-7B: Criminal penalties for acts involving Federal health care programs

    (a) Making or causing to be made false statements or
      representations
      Whoever - 
        (1) knowingly and willfully makes or causes to be made any
      false statement or representation of a material fact in any
      application for any benefit or payment under a Federal health
      care program (as defined in subsection (f) of this section),
        (2) at any time knowingly and willfully makes or causes to be
      made any false statement or representation of a material fact for
      use in determining rights to such benefit or payment,
        (3) having knowledge of the occurrence of any event affecting
      (A) his initial or continued right to any such benefit or
      payment, or (B) the initial or continued right to any such
      benefit or payment of any other individual in whose behalf he has
      applied for or is receiving such benefit or payment, conceals or
      fails to disclose such event with an intent fraudulently to
      secure such benefit or payment either in a greater amount or
      quantity than is due or when no such benefit or payment is
      authorized,
        (4) having made application to receive any such benefit or
      payment for the use and benefit of another and having received
      it, knowingly and willfully converts such benefit or payment or
      any part thereof to a use other than for the use and benefit of
      such other person,
        (5) presents or causes to be presented a claim for a
      physician's service for which payment may be made under a Federal
      health care program and knows that the individual who furnished
      the service was not licensed as a physician, or
        (6) for a fee knowingly and willfully counsels or assists an
      individual to dispose of assets (including by any transfer in
      trust) in order for the individual to become eligible for medical
      assistance under a State plan under subchapter XIX of this
      chapter, if disposing of the assets results in the imposition of
      a period of ineligibility for such assistance under section
      1396p(c) of this title,

    shall (i) in the case of such a statement, representation,
    concealment, failure, or conversion by any person in connection
    with the furnishing (by that person) of items or services for which
    payment is or may be made under the program, be guilty of a felony
    and upon conviction thereof fined not more than $25,000 or
    imprisoned for not more than five years or both, or (ii) in the
    case of such a statement, representation, concealment, failure,
    conversion, or provision of counsel or assistance by any other
    person, be guilty of a misdemeanor and upon conviction thereof
    fined not more than $10,000 or imprisoned for not more than one
    year, or both. In addition, in any case where an individual who is
    otherwise eligible for assistance under a Federal health care
    program is convicted of an offense under the preceding provisions
    of this subsection, the administrator of such program may at its
    option (notwithstanding any other provision of such program) limit,
    restrict, or suspend the eligibility of that individual for such
    period (not exceeding one year) as it deems appropriate; but the
    imposition of a limitation, restriction, or suspension with respect
    to the eligibility of any individual under this sentence shall not
    affect the eligibility of any other person for assistance under the
    plan, regardless of the relationship between that individual and
    such other person.
    (b) Illegal remunerations
      (1) Whoever knowingly and willfully solicits or receives any
    remuneration (including any kickback, bribe, or rebate) directly or
    indirectly, overtly or covertly, in cash or in kind - 
        (A) in return for referring an individual to a person for the
      furnishing or arranging for the furnishing of any item or service
      for which payment may be made in whole or in part under a Federal
      health care program, or
        (B) in return for purchasing, leasing, ordering, or arranging
      for or recommending purchasing, leasing, or ordering any good,
      facility, service, or item for which payment may be made in whole
      or in part under a Federal health care program,

    shall be guilty of a felony and upon conviction thereof, shall be
    fined not more than $25,000 or imprisoned for not more than five
    years, or both.
      (2) Whoever knowingly and willfully offers or pays any
    remuneration (including any kickback, bribe, or rebate) directly or
    indirectly, overtly or covertly, in cash or in kind to any person
    to induce such person - 
        (A) to refer an individual to a person for the furnishing or
      arranging for the furnishing of any item or service for which
      payment may be made in whole or in part under a Federal health
      care program, or
        (B) to purchase, lease, order, or arrange for or recommend
      purchasing, leasing, or ordering any good, facility, service, or
      item for which payment may be made in whole or in part under a
      Federal health care program,

    shall be guilty of a felony and upon conviction thereof, shall be
    fined not more than $25,000 or imprisoned for not more than five
    years, or both.
      (3) Paragraphs (1) and (2) shall not apply to - 
        (A) a discount or other reduction in price obtained by a
      provider of services or other entity under a Federal health care
      program if the reduction in price is properly disclosed and
      appropriately reflected in the costs claimed or charges made by
      the provider or entity under a Federal health care program;
        (B) any amount paid by an employer to an employee (who has a
      bona fide employment relationship with such employer) for
      employment in the provision of covered items or services;
        (C) any amount paid by a vendor of goods or services to a
      person authorized to act as a purchasing agent for a group of
      individuals or entities who are furnishing services reimbursed
      under a Federal health care program if - 
          (i) the person has a written contract, with each such
        individual or entity, which specifies the amount to be paid the
        person, which amount may be a fixed amount or a fixed
        percentage of the value of the purchases made by each such
        individual or entity under the contract, and
          (ii) in the case of an entity that is a provider of services
        (as defined in section 1395x(u) of this title), the person
        discloses (in such form and manner as the Secretary requires)
        to the entity and, upon request, to the Secretary the amount
        received from each such vendor with respect to purchases made
        by or on behalf of the entity;

        (D) a waiver of any coinsurance under part B of subchapter
      XVIII of this chapter by a Federally qualified health care center
      with respect to an individual who qualifies for subsidized
      services under a provision of the Public Health Service Act [42
      U.S.C. 201 et seq.];
        (E) any payment practice specified by the Secretary in
      regulations promulgated pursuant to section 14(a) of the Medicare
      and Medicaid Patient and Program Protection Act of 1987 or in
      regulations under section 1395w-104(e)(6) (!1) of this title;

        (F) any remuneration between an organization and an individual
      or entity providing items or services, or a combination thereof,
      pursuant to a written agreement between the organization and the
      individual or entity if the organization is an eligible
      organization under section 1395mm of this title or if the written
      agreement, through a risk-sharing arrangement, places the
      individual or entity at substantial financial risk for the cost
      or utilization of the items or services, or a combination
      thereof, which the individual or entity is obligated to provide;
        (G) the waiver or reduction by pharmacies (including pharmacies
      of the Indian Health Service, Indian tribes, tribal
      organizations, and urban Indian organizations) of any cost-
      sharing imposed under part D of subchapter XVIII of this
      chapter, if the conditions described in clauses (i) through (iii)
      of section 1320a-7a(i)(6)(A) of this title are met with respect
      to the waiver or reduction (except that, in the case of such a
      waiver or reduction on behalf of a subsidy eligible individual
      (as defined in section 1395w-114(a)(3) of this title), section
      1320a-7a(i)(6)(A) of this title shall be applied without regard
      to clauses (ii) and (iii) of that section);
        (H) any remuneration between a federally qualified health
      center (or an entity controlled by such a health center) and an
      MA organization pursuant to a written agreement described in
      section 1395w-23(a)(4) of this title;
        (I) any remuneration between a health center entity described
      under clause (i) or (ii) of section 1396d(l)(2)(B) of this title
      and any individual or entity providing goods, items, services,
      donations, loans, or a combination thereof, to such health center
      entity pursuant to a contract, lease, grant, loan, or other
      agreement, if such agreement contributes to the ability of the
      health center entity to maintain or increase the availability, or
      enhance the quality, of services provided to a medically
      underserved population served by the health center entity; and
        (J) a discount in the price of an applicable drug (as defined
      in paragraph (2) of section 1395w-114a(g) of this title) of a
      manufacturer that is furnished to an applicable beneficiary (as
      defined in paragraph (1) of such section) under the Medicare
      coverage gap discount program under section 1395w-114a of this
      title.
    (c) False statements or representations with respect to condition
      or operation of institutions
      Whoever knowingly and willfully makes or causes to be made, or
    induces or seeks to induce the making of, any false statement or
    representation of a material fact with respect to the conditions or
    operation of any institution, facility, or entity in order that
    such institution, facility, or entity may qualify (either upon
    initial certification or upon recertification) as a hospital,
    critical access hospital, skilled nursing facility, nursing
    facility, intermediate care facility for the mentally retarded,
    home health agency, or other entity (including an eligible
    organization under section 1395mm(b) of this title) for which
    certification is required under subchapter XVIII of this chapter or
    a State health care program (as defined in section 1320a-7(h) of
    this title), or with respect to information required to be provided
    under section 1320a-3a of this title, shall be guilty of a felony
    and upon conviction thereof shall be fined not more than $25,000 or
    imprisoned for not more than five years, or both.
    (d) Illegal patient admittance and retention practices
      Whoever knowingly and willfully - 
        (1) charges, for any service provided to a patient under a
      State plan approved under subchapter XIX of this chapter, money
      or other consideration at a rate in excess of the rates
      established by the State (or, in the case of services provided to
      an individual enrolled with a medicaid managed care organization
      under subchapter XIX of this chapter under a contract under
      section 1396b(m) of this title or under a contractual, referral,
      or other arrangement under such contract, at a rate in excess of
      the rate permitted under such contract), or
        (2) charges, solicits, accepts, or receives, in addition to any
      amount otherwise required to be paid under a State plan approved
      under subchapter XIX of this chapter, any gift, money, donation,
      or other consideration (other than a charitable, religious, or
      philanthropic contribution from an organization or from a person
      unrelated to the patient) - 
          (A) as a precondition of admitting a patient to a hospital,
        nursing facility, or intermediate care facility for the
        mentally retarded, or
          (B) as a requirement for the patient's continued stay in such
        a facility,

      when the cost of the services provided therein to the patient is
      paid for (in whole or in part) under the State plan,

    shall be guilty of a felony and upon conviction thereof shall be
    fined not more than $25,000 or imprisoned for not more than five
    years, or both.
    (e) Violation of assignment terms
      Whoever accepts assignments described in section
    1395u(b)(3)(B)(ii) of this title or agrees to be a participating
    physician or supplier under section 1395u(h)(1) of this title and
    knowingly, willfully, and repeatedly violates the term of such
    assignments or agreement, shall be guilty of a misdemeanor and upon
    conviction thereof shall be fined not more than $2,000 or
    imprisoned for not more than six months, or both.
    (f) "Federal health care program" defined
      For purposes of this section, the term "Federal health care
    program" means - 
        (1) any plan or program that provides health benefits, whether
      directly, through insurance, or otherwise, which is funded
      directly, in whole or in part, by the United States Government
      (other than the health insurance program under chapter 89 of
      title 5); or
        (2) any State health care program, as defined in section 1320a-
      7(h) of this title.
    (g) Liability under subchapter III of chapter 37 of title 31
      In addition to the penalties provided for in this section or
    section 1320a-7a of this title, a claim that includes items or
    services resulting from a violation of this section constitutes a
    false or fraudulent claim for purposes of subchapter III of chapter
    37 of title 31.
    (h) Actual knowledge or specific intent not required
      With respect to violations of this section, a person need not
    have actual knowledge of this section or specific intent to commit
    a violation of this section.