[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR411.103]



[Page 398]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 411_EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

--Table of Contents

 

Subpart E_Limitations on Payment for Services Covered Under Group Health 

                        Plans: General Provisions

 

Sec. 411.103  Prohibition against financial and other incentives.



    (a) General rule. An employer or other entity (for example, an 

insurer) is prohibited from offering Medicare beneficiaries financial or 

other benefits as incentives not to enroll in, or to terminate 

enrollment in, a GHP that is, or would be, primary to Medicare. This 

prohibition precludes offering to Medicare beneficiaries an alternative 

to the employer primary plan (for example, coverage of prescription 

drugs) unless the beneficiary has primary coverage other than Medicare. 

An example would be primary coverage through his own or a spouse's 

employer.

    (b) Penalty for violation. (1) Any entity that violates the 

prohibition of paragraph (a) of this section is subject to a civil money 

penalty of up to $5,000 for each violation; and

    (2) The provisions of section 1128A of the Act (other than 

subsections (a) and (b)) apply to the civil money penalty of up to 

$5,000 in the same manner as the provisions apply to a penalty or 

proceeding under section 1128A(a).