§1003.420. Determinations regarding the amount of penalties and assessments.
42 C.F.R. § 1003.420
In considering the factors listed in § 1003.140, aggravating circumstances include—
Such violations were of several types or occurred over a lengthy period of time;
There were many such violations (or the nature and circumstances indicate a pattern of incidents);
The amount of money, remuneration, damages, or tainted claims involved in the violation was $15,000 or more; or
Patient harm, premature discharge, or a need for additional services or subsequent hospital admission resulted, or could have resulted, from the incident; and
The contracting organization knowingly or routinely engaged in any prohibited practice that acted as an inducement to reduce or limit medically necessary services provided with respect to a specific enrollee in the organization.
Notes, amendments, and revision history
Source
Source: 81 FR 88357, Dec. 7, 2016, unless otherwise noted.
Authority
Authority: 42 U.S.C. 262a, 300jj-52, 1302, 1320a-7, 1320a-7a, 1320b-10, 1395u(j), 1395u(k), 1395cc(j), 1395w-141(i)(3), 1395dd(d)(1), 1395mm, 1395nn(g), 1395ss(d), 1396b(m), 11131(c), and 11137(b)(2).
Source
Source: 51 FR 34777, Sept. 30, 1986, unless otherwise noted.