Regulations last checked for updates: Nov 24, 2024
Title 45 - Public Welfare last revised: Nov 19, 2024
§ 1174.4 - Who investigates program fraud.
The Inspector General, or his or her designee, is the investigating official responsible for investigating allegations that a person has made a false claim or statement. In this regard, the Inspector General has authority under the PFCRA and the Inspector General Act of 1978, 5 U.S.C. App. 3, as amended, to issue administrative subpoenas for the production of records and documents.
§ 1174.5 - Review of suspected program fraud by the reviewing official.
(a) If the investigating official concludes that the results of his or her investigation warrant an action under this part, the investigating official shall submit to the reviewing official a report containing the investigation's findings and conclusions.
(b) If the reviewing official determines that the report provides adequate evidence that a person made a false, fictitious or fraudulent claim or statement, the reviewing official shall transmit to the Attorney General written notice of the reviewing official's intention to refer the matter for adjudication, with a request for approval of such referral. This notice will include the reviewing official's statement concerning:
(1) The reasons for the referral;
(2) The claims or statements that form the basis for liability;
(3) The evidence that supports liability;
(4) An estimate of the amount of money or the value of property, services, or other benefits requested or demanded in the false claim or statement;
(5) Any exculpatory or mitigating circumstances that may relate to the claims or statements that are known by the reviewing official or the investigating official; and
(6) A statement that there is a reasonable prospect of collecting an appropriate amount of penalties and assessments.
(c) If, at any time, the Attorney General (or designee) requests in writing that the authority stay this administrative process, the authority head must stay the process immediately. The authority head may resume the process only upon receipt of the Attorney General's written authorization.
§ 1174.6 - Prerequisites for issuing a complaint.
The authority may issue a complaint only if:
(a) The Attorney General (or designee) approves the reviewing official's referral of the allegations for adjudication; and
(b) In a case of submission of false claims, if the amount of money or the value of property or services that a false claim (or a group of related claims submitted at the same time) demanded or requested does not exceed $150,000.
§ 1174.7 - Contents of a complaint.
(a) The complaint will state that the authority seeks to impose civil penalties, assessments, or both, against the defendant and will include:
(1) The allegations of liability against the defendant and the statutory basis for liability, identification of the claims or statements involved, and the reasons liability allegedly arises from such claims or statements;
(2) The maximum amount of penalties and assessments for which the defendant may be held liable;
(3) A statement that the defendant may request a hearing by filing an answer and may be represented by a representative;
(4) Instructions for filing such an answer; and
(5) A warning that failure to file an answer within thirty days of service of the complaint will result in an imposition of the maximum amount of penalties and assessments.
(b) The reviewing official must serve the complaint on the defendant and, if the defendant requests a hearing, provide a copy to the ALJ assigned to the case.
§ 1174.8 - Service of a complaint.
(a) The reviewing official must serve the complaint on an individual defendant directly, on a partnership through a general partner, and on a corporation or an unincorporated association through an executive officer or a director, except that the reviewing official may also make service on any person authorized by appointment or by law to receive process for the defendant.
(b) The reviewing official may serve the complaint either by:
(1) Registered or certified mail; or
(2) Personal delivery by anyone eighteen years of age or older.
(c) The date of service is the date of personal delivery or, in the case of service by registered or certified mail, the date of postmark.
(d) When the reviewing official serves the complaint, he or she should also serve the defendant with a copy of this part and 31 U.S.C. 3801-3812.
source: 86 FR 44628, Aug. 13, 2021, unless otherwise noted.
cite as: 45 CFR 1174.7