42 C.F.R. § 1003.420

Current through November 30, 2024
Section 1003.420 - Determinations regarding the amount of penalties and assessments

In considering the factors listed in § 1003.140 , aggravating circumstances include-

(a) Such violations were of several types or occurred over a lengthy period of time;
(b) There were many such violations (or the nature and circumstances indicate a pattern of incidents);
(c) The amount of money, remuneration, damages, or tainted claims involved in the violation was $15,000 or more; or
(d) Patient harm, premature discharge, or a need for additional services or subsequent hospital admission resulted, or could have resulted, from the incident; and
(e) 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.

42 C.F.R. §1003.420

81 FR 88357 , 1/6/2017