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Code of Federal Regulations (Last Updated: July 5, 2024) |
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Title 42 - Public Health |
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Chapter V - Office of Inspector General-Health Care, Department of Health and Human Services |
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SubChapter B - OIG Authorities |
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Part 1003 - Civil Money Penalties, Assessments and Exclusions |
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Subpart B - CMPs, Assessments, and Exclusions for False or Fraudulent Claims and Other Similar Misconduct |
§ 1003.220 - Determinations regarding the amount of penalties and assessments and the period of exclusion.
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§ 1003.220 Determinations regarding the amount of penalties and assessments and the period of exclusion.
In considering the factors listed in § 1003.140 -
(a) It should be considered a mitigating circumstance if all the items or services or violations included in the action brought under this part were of the same type and occurred within a short period of time, there were few such items or services or violations, and the total amount claimed or requested for such items or services was less than $5,000.
(b) Aggravating circumstances include -
(1) The violations were of several types or occurred over a lengthy period of time;
(2) There were many such items or services or violations (or the nature and circumstances indicate a pattern of claims or requests for payment for such items or services or a pattern of violations);
(3) The amount claimed or requested for such items or services, or the amount of the overpayment was $50,000 or more;
(4) The violation resulted, or could have resulted, in patient harm, premature discharge, or a need for additional services or subsequent hospital admission; or
(5) The amount or type of financial, ownership, or control interest or the degree of responsibility a person has in an entity was substantial with respect to an action brought under § 1003.200(b)(3).