Basis for Imposing Intermediate Sanctions and Civil Monetary Penalties

For the violations listed below, CMS may impose one or more sanctions on any MA organization with a contract. The MA organization may also be subject to other remedies authorized under law if the MA organization:

  • Employs or contracts with an individual or entity who is excluded from participation in Medicare under section 1128 or 1128A of the Act (or with an entity that employs or contracts with such an excluded individual or entity) for the provision of any of the following:
    • Health care
    • Utilization review
    • Medical social work
    • Administrative services