# Justice Manual § 9-42.451: Plea Bargaining in Medicare-Medicaid Frauds

> Federal · Agency guidance · In force

URL: https://www.frixlaw.com/law-library/statutes/JM_S9-42.451

## Section

- **Citation:** Justice Manual § 9-42.451
- **Heading:** Plea Bargaining in Medicare-Medicaid Frauds
- **Jurisdiction:** Federal
- **Kind:** Agency guidance
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** DOJ Justice Manual / Title 9: Criminal / 9-42.000 - Fraud Against the Government / Justice Manual § 9-42.451

## Text

A potential problem area has been identified regarding the practice of plea bargaining as it relates to administrative sanctions available to the Health Care Financing Administration, United States Department of Health and Human Services (HHS), in Medicare-Medicaid fraud cases.

Specifically, provision 229 of Pub. L. No. 92-603, enacted on October 30, 1972, amended Sections 1862 and 1866(b) of the Social Security Act to enable the Secretary of HHS to deny payment under Title XVIII of the act upon determining that a provider or person has committed fraud or abuse against the Medicare program. Subsequent to such determinations, Section 1903(i)(2) of the act also prohibits Federal financial participation (FFP) for payments to these providers or persons in the Medicaid program. In addition, the legislation (Pub. L. No. 95-142, Medicare-Medicaid Anti-Fraud and Abuse Amendments) enacted on October 25, 1977, contains a provision (Section 7) that requires the Secretary of HHS to suspend program participation for a physician or individual practitioner convicted of a criminal offense involving the Medicare or Medicaid programs. Suspension from program participation is immediate and applicable to both programs. The Section 7 provision is incorporated in the Code of Federal Regulations at 42 C.F.R. § 405.315-2 for Title XVIII and at 42 C.F.R. § 450.85 for Title XIX.

Since the administrative sanction would generally be effectuated after any criminal proceedings, plea bargains that include commitments to forego or restrict administrative remedies, which the HHS may elect to pursue under the aforementioned provisions, should be rare and made only after obtaining prior explicit approval from the Criminal Division.

See
JM 9-16.000
et seq. and 9-27.000 et seq. for additional guidance regarding plea agreements.

[updated January 2020] [cited in
JM 9-16.040
]

## Nearby sections

- [Justice Manual § 9-42.001 Introduction](https://www.frixlaw.com/law-library/statutes/JM_S9-42.001.md)
- [Justice Manual § 9-42.010 Coordination of Criminal and Civil Fraud Against the Government Cases](https://www.frixlaw.com/law-library/statutes/JM_S9-42.010.md)
- [Justice Manual § 9-42.160 False Statements to a Federal Criminal Investigator](https://www.frixlaw.com/law-library/statutes/JM_S9-42.160.md)
- [Justice Manual § 9-42.191 Application of Appropriate Statute](https://www.frixlaw.com/law-library/statutes/JM_S9-42.191.md)
- [Justice Manual § 9-42.420 Federal Procurement Fraud Unit](https://www.frixlaw.com/law-library/statutes/JM_S9-42.420.md)
- [Justice Manual § 9-42.430 Department of Defense Voluntary Disclosure Program](https://www.frixlaw.com/law-library/statutes/JM_S9-42.430.md)
- [Justice Manual § 9-42.440 Provisions for the Handling of Qui Tam Suits Filed Under the False Claims Act](https://www.frixlaw.com/law-library/statutes/JM_S9-42.440.md)
- [Justice Manual § 9-42.451 Plea Bargaining in Medicare-Medicaid Frauds](https://www.frixlaw.com/law-library/statutes/JM_S9-42.451.md)
- [Justice Manual § 9-42.500 Referral Procedures—Relationship and Coordination With the Statutory Inspectors General](https://www.frixlaw.com/law-library/statutes/JM_S9-42.500.md)
- [Justice Manual § 9-42.510 Social Security Fraud](https://www.frixlaw.com/law-library/statutes/JM_S9-42.510.md)
- [Justice Manual § 9-42.530 Department of Defense Memorandum of Understanding](https://www.frixlaw.com/law-library/statutes/JM_S9-42.530.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/JM_S9-42.451. Check the current official text before relying on it. Not legal advice.