---
kind: "range"
citation: "20 C.F.R. §§ 498.100–498.132"
title: "20"
from: "498.100"
to: "498.132"
count: 18
url: "https://uscodex.org/cfr/20/498.100..498.132"
---

# §498.100. Basis and purpose.

- (a) **Basis.** This part implements sections 1129 and 1140 of the Social Security Act (42 U.S.C. [1320a-8](/usc/42/1320a-8.md) and [1320b-10](/usc/42/1320b-10.md)).
- (b) **Purpose.** This part provides for the imposition of civil monetary penalties and assessments, as applicable, against persons who—
  - (1) Make or cause to be made false statements or representations or omissions or otherwise withhold disclosure of a material fact for use in determining any right to or amount of benefits under title II or benefits or payments under title VIII or title XVI of the Social Security Act;
  - (2) Convert any payment, or any part of a payment, received under title II, title VIII, or title XVI of the Social Security Act for the use and benefit of another individual, while acting in the capacity of a representative payee for that individual, to a use that such person knew or should have known was other than for the use and benefit of such other individual; or
  - (3) Misuse certain Social Security program words, letters, symbols, and emblems; or
  - (4) With limited exceptions, charge a fee for a product or service that is available from SSA free of charge without including a written notice stating the product or service is available from SSA free of charge.

# §498.101. Definitions.


As used in this part:

Agency means the Social Security Administration.

Assessment means the amount described in [§ 498.104](/cfr/20/498.104.md), and includes the plural of that term.

Commissioner means the Commissioner of Social Security or his or her designees.

Department means the U.S. Department of Health and Human Services.

General Counsel means the General Counsel of the Social Security Administration or his or her designees.

Inspector General means the Inspector General of the Social Security Administration or his or her designees.

Material fact means a fact which the Commissioner of Social Security may consider in evaluating whether an applicant is entitled to benefits under title II or eligible for benefits or payments under title VIII or title XVI of the Social Security Act.

Otherwise withhold disclosure means the failure to come forward to notify the SSA of a material fact when such person knew or should have known that the withheld fact was material and that such withholding was misleading for purposes of determining eligibility or Social Security benefit amount for that person or another person.

Penalty means the amount described in [§ 498.103](/cfr/20/498.103.md) and includes the plural of that term.

Person means an individual, organization, agency, or other entity.

Respondent means the person upon whom the Commissioner or the Inspector General has imposed, or intends to impose, a penalty and assessment, as applicable.

Secretary means the Secretary of the U.S. Department of Health and Human Services or his or her designees.

SSA means the Social Security Administration.

SSI means Supplemental Security Income.


# §498.102. Basis for civil monetary penalties and assessments.

- (a) The Office of the Inspector General may impose a penalty and assessment, as applicable, against any person who it determines in accordance with this part—
  - (1) Has made, or caused to be made, a statement or representation of a material fact for use in determining any initial or continuing right to or amount of:
    - (i) Monthly insurance benefits under title II of the Social Security Act; or
    - (ii) Benefits or payments under title VIII or title XVI of the Social Security Act; and
  - (2)
    - (i) Knew, or should have known, that the statement or representation was false or misleading, or
    - (ii) Made such statement with knowing disregard for the truth; or
  - (3) Omitted from a statement or representation, or otherwise withheld disclosure of, a material fact for use in determining any initial or continuing right to or amount of benefits or payments, which the person knew or should have known was material for such use and that such omission or withholding was false or misleading.
- (b) The Office of the Inspector General may impose a penalty and assessment, as applicable, against any representative payee who receives a payment under title II, title VIII, or title XVI for the use and benefit of another individual and who converts such payment, or any part thereof, to a use that such representative payee knew or should have known was other than for the use and benefit of such other individual.
- (c) The Office of the Inspector General may impose a penalty against any person who it determines in accordance with this part has made use of certain Social Security program words, letters, symbols, or emblems in such a manner that the person knew or should have known would convey, or in a manner which reasonably could be interpreted or construed as conveying, the false impression that a solicitation, advertisement or other communication was authorized, approved, or endorsed by the Social Security Administration, or that such person had some connection with, or authorization from, the Social Security Administration.
  - (1) Civil monetary penalties may be imposed for misuse, as set forth in [paragraph (c)](#c) of this section, of—
    - (i) The words “Social Security,” “Social Security Account,” “Social Security Administration,” “Social Security System,” “Supplemental Security Income Program,” “Death Benefits Update,” “Federal Benefit Information,” “Funeral Expenses,” “Final Supplemental Program,” or any combination or variation of such words; or
    - (ii) The letters “SSA,” or “SSI,” or any other combination or variation of such letters; or
    - (iii) A symbol or emblem of the Social Security Administration (including the design of, or a reasonable facsimile of the design of, the Social Security card, the check used for payment of benefits under title II, or envelopes or other stationery used by the Social Security Administration) or any other combination or variation of such symbols or emblems.
  - (2) Civil monetary penalties will not be imposed against any agency or instrumentality of a State, or political subdivision of a State, that makes use of any words, letters, symbols or emblems of the Social Security Administration or instrumentality of the State or political subdivision.
- (d) The Office of the Inspector General may impose a penalty against any person who offers, for a fee, to assist an individual in obtaining a product or service that the person knew or should have known the Social Security Administration provides free of charge, unless:
  - (1) The person provides sufficient notice before the product or service is provided to the individual that the product or service is available free of charge and:
    - (i) In a printed solicitation, advertisement or other communication, such notice is clearly and prominently placed and written in a font that is distinguishable from the rest of the text;
    - (ii) In a broadcast or telecast such notice is clearly communicated so as not to be construed as misleading or deceptive.
  - (2) Civil monetary penalties will not be imposed under [paragraph (d)](#d) of this section with respect to offers—
    - (i) To serve as a claimant representative in connection with a claim arising under title II, title VIII, or title XVI; or
    - (ii) To prepare, or assist in the preparation of, an individual's plan for achieving self-support under title XVI.
- (e) The use of a disclaimer of affiliation with the United States Government, the Social Security Administration or its programs, or any other agency or instrumentality of the United States Government will not be considered as a defense in determining a violation of [section 1140](/cfr/20/1140.md) of the Social Security Act.

# §498.103. Amount of penalty.

- (a) Under [§ 498.102(a)](/cfr/20/498.102.md?p=a), the Office of the Inspector General may impose a penalty of not more than $5,000 for each false statement or representation, omission, or receipt of payment or benefit while withholding disclosure of a material fact.
- (b) Under [§ 498.102(b)](/cfr/20/498.102.md?p=b), the Office of the Inspector General may impose a penalty of not more than $5,000 against a representative payee for each time the representative payee receives a payment under title II, title VIII, or title XVI of the Social Security Act for the use and benefit of another individual, and who converts such payment, or any part thereof, to a use that such representative payee knew or should have known was other than for the use and benefit of such other individual.
- (c) Under [§ 498.102(c)](/cfr/20/498.102.md?p=c), the Office of the Inspector General may impose a penalty of not more than $5,000 for each violation resulting from the misuse of Social Security Administration program words, letters, symbols, or emblems relating to printed media and a penalty of not more than $25,000 for each violation in the case that such misuse related to a broadcast or telecast.
- (d) Under [§ 498.102(d)](/cfr/20/498.102.md?p=d), the Office of the Inspector General may impose a penalty of not more than $5,000 for each violation resulting from insufficient notice relating to printed media regarding products or services provided free of charge by the Social Security Administration and a penalty of not more than $25,000 for each violation in the case that such insufficient notice relates to a broadcast or telecast.
- (e) **For purposes of paragraphs (c) and (d) of this section, a violation is defined as—**
  - (1) In the case of a mailed solicitation, advertisement, or other communication, each separate piece of mail which contains one or more program words, letters, symbols, or emblems or insufficient notice related to a determination under § [498.102(c)](/cfr/20/498.102.md?p=c) or [(d)](/cfr/20/498.102.md?p=d); and
  - (2) In the case of a broadcast or telecast, each airing of a single commercial or solicitation related to a determination under § [498.102(c)](/cfr/20/498.102.md?p=c) or [(d)](/cfr/20/498.102.md?p=d).
- (f) [Reserved]
- (g)
  - (1) The amount of the penalties described in [paragraphs (a) through (d)](#a..d) of this section are the maximum penalties which may be assessed under these paragraphs for violations made after June 16, 2006, but before August 1, 2016.
  - (2)
    - (i) After August 1, 2016 penalties are adjusted in accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990 (Pub. L. 101-410), as amended by the Debt Collection Improvement Act of 1996 (Pub. L. 104-134), as further amended by the Bipartisan Budget Act of 2015, [Section 701](/cfr/20/701.md): Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 ([Section 701](/cfr/20/701.md) of Pub. L. 114-74).
    - (ii) The maximum penalties which may be assessed under this section is the larger of:
      - (A) The amount for the previous calendar year; or
      - (B) An amount adjusted for inflation, calculated by multiplying the amount for the previous calendar year by the percentage by which the Consumer Price Index for all urban consumers for the month of October preceding the current calendar year exceeds the Consumer Price Index for all urban consumers for the month of October of the calendar year two years prior to the current calendar year, adding that amount to the amount for the previous calendar year, and rounding the total to the nearest dollar.
    - (iii) Notice of the maximum penalty which may be assessed under this section for calendar years after 2016 will be published in the Federal Register on an annual basis on or before January 15 of each calendar year.

# §498.104. Amount of assessment.


A person subject to a penalty determined under [§ 498.102(a)](/cfr/20/498.102.md?p=a) may be subject, in addition, to an assessment of not more than twice the amount of benefits or payments paid under title II, title VIII or title XVI of the Social Security Act as a result of the statement, representation, omission, or withheld disclosure of a material fact which was the basis for the penalty. A representative payee subject to a penalty determined under [§ 498.102(b)](/cfr/20/498.102.md?p=b) may be subject, in addition, to an assessment of not more than twice the amount of benefits or payments received by the representative payee for the use and benefit of another individual and converted to a use other than for the use and benefit of such other individual. An assessment is in lieu of damages sustained by the United States because of such statement, representation, omission, withheld disclosure of a material fact, or conversion, as referred to in § [498.102(a)](/cfr/20/498.102.md?p=a) and [(b)](/cfr/20/498.102.md?p=b).


# §498.105. Reserved



# §498.106. Determinations regarding the amount or scope of penalties and assessments.

- (a) In determining the amount or scope of any penalty and assessment, as applicable, in accordance with § [498.103(a)](/cfr/20/498.103.md?p=a) and [(b)](/cfr/20/498.103.md?p=b) and [498.104](/cfr/20/498.104.md), the Office of the Inspector General will take into account:
  - (1) The nature of the statements, representations, or actions referred to in § [498.102(a)](/cfr/20/498.102.md?p=a) and [(b)](/cfr/20/498.102.md?p=b) and the circumstances under which they occurred;
  - (2) The degree of culpability of the person committing the offense;
  - (3) The history of prior offenses of the person committing the offense;
  - (4) The financial condition of the person committing the offense; and
  - (5) Such other matters as justice may require.
- (b) In determining the amount of any penalty in accordance with § [498.103(c)](/cfr/20/498.103.md?p=c) and [(d)](/cfr/20/498.103.md?p=d), the Office of the Inspector General will take into account—
  - (1) The nature and objective of the advertisement, solicitation, or other communication, and the circumstances under which they were presented;
  - (2) The frequency and scope of the violation, and whether a specific segment of the population was targeted;
  - (3) The prior history of the individual, organization, or entity in their willingness or refusal to comply with informal requests to correct violations;
  - (4) The history of prior offenses of the individual, organization, or entity in their misuse of program words, letters, symbols, and emblems;
  - (5) The financial condition of the individual or entity; and
  - (6) Such other matters as justice may require.
- (c) In cases brought under section 1140 of the Social Security Act, the use of a disclaimer of affiliation with the United States Government, the Social Security Administration or its programs will not be considered as a mitigating factor in determining the amount of a penalty in accordance with § 498.106.

# §498.107. Reserved



# §498.108. Penalty and assessment not exclusive.


Penalties and assessments, as applicable, imposed under this part are in addition to any other penalties prescribed by law.


# §498.109. Notice of proposed determination.

- (a) If the Office of the Inspector General seeks to impose a penalty and assessment, as applicable, it will serve written notice of the intent to take such action. The notice will include:
  - (1) Reference to the statutory basis for the proposed penalty and assessment, as applicable;
  - (2) A description of the false statements, representations, other actions (as described in § [498.102(a)](/cfr/20/498.102.md?p=a) and [(b)](/cfr/20/498.102.md?p=b)), and incidents, as applicable, with respect to which the penalty and assessment, as applicable, are proposed;
  - (3) The amount of the proposed penalty and assessment, as applicable;
  - (4) Any circumstances described in [§ 498.106](/cfr/20/498.106.md) that were considered when determining the amount of the proposed penalty and assessment, as applicable; and
  - (5) Instructions for responding to the notice, including
    - (i) A specific statement of respondent's right to a hearing; and
    - (ii) A statement that failure to request a hearing within 60 days permits the imposition of the proposed penalty and assessment, as applicable, without right of appeal.
- (b) Any person upon whom the Office of the Inspector General has proposed the imposition of a penalty and assessment, as applicable, may request a hearing on such proposed penalty and assessment.
- (c) If the respondent fails to exercise the respondent's right to a hearing within the time permitted under this section, and does not demonstrate good cause for such failure before an administrative law judge, any penalty and assessment, as applicable, becomes final.

# §498.110. Failure to request a hearing.


If the respondent does not request a hearing within the time prescribed by [§ 498.109(a)](/cfr/20/498.109.md?p=a), the Office of the Inspector General may seek the proposed penalty and assessment, as applicable, or any less severe penalty and assessment. The Office of the Inspector General shall notify the respondent by certified mail, return receipt requested, of any penalty and assessment, as applicable, that has been imposed and of the means by which the respondent may satisfy the amount owed.


# §498.114. Collateral estoppel.


In a proceeding under section 1129 of the Social Security Act that—

- (a) Is against a person who has been convicted (whether upon a verdict after trial or upon a plea of guilty or nolo contendere) of a Federal or State crime; and
- (b) Involves the same transactions as in the criminal action, the person is estopped from denying the essential elements of the criminal offense.

# §498.115-498.125. Reserved



# §498.126. Settlement.


The Inspector General has exclusive authority to settle any issues or case, without the consent of the administrative law judge or the Commissioner, at any time prior to a final determination. Thereafter, the Commissioner or his or her designee has such exclusive authority.


# §498.127. Judicial review.


Sections 1129 and 1140 of the Social Security Act authorize judicial review of any penalty and assessment, as applicable, that has become final. Judicial review may be sought by a respondent only in regard to a penalty and assessment, as applicable, with respect to which the respondent requested a hearing, unless the failure or neglect to urge such objection is excused by the court because of extraordinary circumstances.


# §498.128. Collection of penalty and assessment.

- (a) Once a determination has become final, collection of any penalty and assessment, as applicable, will be the responsibility of the Commissioner or his or her designee.
- (b) In cases brought under section 1129 of the Social Security Act, a penalty and assessment, as applicable, imposed under this part may be compromised by the Commissioner or his or her designee and may be recovered in a civil action brought in the United States District Court for the district where the violation occurred or where the respondent resides.
- (c) In cases brought under section 1140 of the Social Security Act, a penalty imposed under this part may be compromised by the Commissioner or his or her designee and may be recovered in a civil action brought in the United States district court for the district where, as determined by the Commissioner, the:
  - (1) Violations referred to in § [498.102(c)](/cfr/20/498.102.md?p=c) or [(d)](/cfr/20/498.102.md?p=d) occurred; or
  - (2) Respondent resides; or
  - (3) Respondent has its principal office; or
  - (4) Respondent may be found.
- (d) As specifically provided under the Social Security Act, in cases brought under section 1129 of the Social Security Act, the amount of a penalty and assessment, as applicable, when finally determined, or the amount agreed upon in compromise, may also be deducted from:
  - (1) Monthly title II, title VIII, or title XVI payments, notwithstanding section 207 of the Social Security Act as made applicable to title XVI by section 1631(d)(1) of the Social Security Act;
  - (2) A tax refund to which a person is entitled to after notice to the Secretary of the Treasury under [31 U.S.C. § 3720A](/usc/31/3720A.md);
  - (3) By authorities provided under the Debt Collection Act of 1982, as amended, [31 U.S.C. 3711](/usc/31/3711.md), to the extent applicable to debts arising under the Social Security Act; or
  - (4) **Any combination of the foregoing.**
- (e) Matters that were raised or that could have been raised in a hearing before an administrative law judge or in an appeal to the United States Court of Appeals under sections 1129 or 1140 of the Social Security Act may not be raised as a defense in a civil action by the United States to collect a penalty and assessment, as applicable, under this part.

# §498.129. Notice to other agencies.


As provided in section 1129 of the Social Security Act, when a determination to impose a penalty and assessment, as applicable, with respect to a physician or medical provider becomes final, the Office of the Inspector General will notify the Secretary of the final determination and the reasons therefore.


# §498.132. Limitations.


The Office of the Inspector General may initiate a proceeding in accordance with [§ 498.109(a)](/cfr/20/498.109.md?p=a) to determine whether to impose a penalty and assessment, as applicable—

- (a) In cases brought under section 1129 of the Social Security Act, after receiving authorization from the Attorney General pursuant to procedures agreed upon by the Inspector General and the Attorney General; and
- (b) **Within 6 years from the date on which the violation was committed.**