US · guidance
CMS Pub. 100-08, ch. 4, § 4.17
Participation Agreement and Limiting Charge Violations
Section 2306 of the Deficit Reduction Act of 1984 established a physician/supplier
participation program. The Omnibus Budget Reconciliation Act of l989 established a
limitation on actual charges by non-participating physicians (see §1848(g) of the Act).
Participating physicians/suppliers who violate their participation agreements, and non-participating physicians who knowingly, willfully, and repeatedly increase their charges
to Medicare beneficiaries beyond the limits, are liable for action in the form of CMPs,
assessments, and exclusion from the Medicare program for up to 5 years, or both.
Criminal penalties also apply to serious violations of the participation agreement
provisions.
For further discussion of the participation agreement and limiting charge provisions, see
IOM Pub.100-04, chapter 1.
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
ada9da989d9e478290d5969f7f19d876d4fedde670556d1182771f66fd413fa1
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