Civil monetary penalties: the OIG fines that reach transportation providers
Overview
The Civil Monetary Penalties Law, 42 U.S.C. 1320a-7a, lets HHS OIG fine a provider without a court case for false claims, kickbacks, gifts that steer Medicare or Medicaid patients, and hiring excluded people. Since January 2026 the top fine is $25,595 per false item or service and $127,973 per kickback, plus up to three times the amount claimed and possible exclusion.
On this page
What the law punishes
The Civil Monetary Penalties Law gives HHS’s Office of Inspector General its own way to fine people who cheat federal health programs, Medicaid included. The conduct that matters to a ride company sits in subsection (a) of 42 U.S.C. 1320a-7a:
- False or inflated claims. Billing for a service not provided as claimed, a pattern of codes that pay more than the service given, or a pattern of services that were not medically necessary.
- Gifts to riders. Offering a Medicare or Medicaid beneficiary something of value likely to steer them to your company, subject to the law’s exceptions.
- Excluded people. Employing or contracting with someone you know or should know is excluded, one reason providers screen staff against the LEIE.
- Kickbacks. Any act the Anti-Kickback Statute prohibits.
- False enrollment papers. A false statement in an application to enroll with Medicare, Medicaid, or a Medicaid managed care plan.
- Kept overpayments. Knowing about an overpayment and not reporting and returning it under the 60-day rule.
The labels behind these cases are explained in fraud, waste, and abuse.
How much the fines are in 2026
The statute sets base amounts, and HHS raises them for inflation every year in 45 CFR 102.3. The latest adjustment took effect January 28, 2026, for penalties assessed from that date on violations since November 2, 2015. These are the maximums that apply to the conduct above:
| Violation | Counted per | Maximum fine |
|---|---|---|
| False claim | Item or service | $25,595 |
| Gift to steer a beneficiary | Item or service | $25,595 |
| Employing or contracting with an excluded person | Item or service | $25,595 |
| Overpayment not reported and returned | Item or service | $25,595 |
| Kickback | Act | $127,973 |
| False statement in an enrollment application | Statement | $127,973 |
On top of the fine, OIG can add an assessment of up to three times the amount claimed for each item or service, or for kickbacks up to three times the total payment involved. It can exclude the person from federal health programs in the same proceeding.
How an OIG case runs
A CMP case is administrative, not a lawsuit. OIG needs the Attorney General’s authorization to bring one and has six years from the claim or conduct (1320a-7a(c)(1)). It starts with a written notice of the proposed penalty (42 CFR 1003.1500), which may rest on a statistical sample of your claims (42 CFR 1003.1580). You then have 60 days from receiving the notice to request a hearing before an HHS administrative law judge (42 CFR 1005.2).
The amount depends on factors in 42 CFR 1003.140: the nature of the violation, how much the company knew, its history, and whether it took timely corrective action, which includes disclosing through OIG’s Self-Disclosure Protocol.
Transportation companies that have paid
OIG posts its settlements online. These three involve transportation companies:
- Ultra Radio Dispatch Service, Bronx, New York (October 9, 2024). $61,000 to resolve allegations that it paid cash for referrals of Medicaid beneficiaries for transportation.
- Friendly Medical Transportation, North Carolina (December 12, 2017). $54,812.25 after self-disclosing that it employed someone it knew or should have known was excluded.
- Elite Medical Transport, El Paso, Texas (August 7, 2025). $144,669.97 after self-disclosing ambulance claims that carried forged and otherwise invalid signatures.
How a CMP differs from other cases
The same conduct can lead to more than one kind of case:
- CMP. OIG decides it, an administrative law judge hears any appeal, and the fines count per item or service.
- False Claims Act. A civil suit in federal court, brought by the Justice Department or a whistleblower, with triple damages and a penalty per claim.
- Criminal case. Prosecutors must prove the crime, such as a knowing and willful kickback, and a conviction can bring prison time.
The Elite case turned on signatures. In HealthRide, the rider signs on the driver’s screen at the trip, and the signature stays with that ride’s record in the driver app.
Frequently asked questions
- Does OIG have to prove the company meant to cheat?
- No. Many of the law's provisions apply when a person knows or should know the claim or arrangement is improper, and "should know" means deliberate ignorance or reckless disregard of the truth, with no proof of specific intent to defraud (42 U.S.C. 1320a-7a(i)(7)). An owner who never checks the billing can still be liable for what goes out.
- How far back can OIG go?
- Six years. OIG may not start a case later than six years after the claim was presented, the payment request was made, or the conduct took place, and it needs the Attorney General's authorization to start one at all (42 U.S.C. 1320a-7a(c)(1)).
- Does self-disclosing lower the penalty?
- It is the main mitigating factor the rules name. Under 42 CFR 1003.140, timely corrective action counts in a provider's favor, and it must include disclosing the conduct through OIG's Self-Disclosure Protocol and cooperating with the review. Two of the three transportation settlements on this page followed a self-disclosure.
