US · guidance
CMS Pub. 100-08, ch. 4, § 4.15.4
Excluded Individuals
The following individuals are not eligible to receive a reward under the IRP:
• An individual who was, or is, an immediate family member of an
officer or employee of DHHS, its UPICs, SMRCs, MACs, or
subcontractors, the Social Security Administration (SSA), the OIG, a
SMA, the DOJ, the FBI, or any other federal, state, or local LE agency
at the time he/she came into possession, or divulged information
leading to a recovery of Medicare funds. Immediate family is as
defined in 42 CFR 411.12(b), which includes any of the following:
o Husband or wife;
o Natural or adoptive parent, child, or sibling;
o Stepparent, stepchild, stepbrother, or stepsister;
o Father-in-law, mother-in-law, son-in-law, daughter-in-law,
brother- in- law, or sister-in-law; and
o Grandparent or grandchild.
• Any other federal or state employee, UPIC, SMRCs, MAC, or
subcontractor, or DHHS grantee, if the information submitted came to
his/her knowledge during the course of his/her official duties;
• An individual who received a reward under another government
program for the same information furnished;
• An individual who illegally obtained the information he/she
submitted; and.
• An individual who participated in the sanctionable offense with
respect to which payment would be made.
History
(Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3fe94928aeb64b6b91ccfa1ed07bf10ad578c76a272e71aca111c2825f3fad1a
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