Determining the amounts of penalties and assessments to be imposed on a provider.

CFR · 2024-01-01 · US · Title 5

(a) (b) (1) The Government's interests in being fully compensated for all damages, losses, and costs associated with the provider's violations, including: (i) Amounts wrongfully paid from FEHBP funds as the result of the provider's violations and interest on those amounts, at rates determined by the Department of the Treasury; (ii) All costs incurred by OPM in investigating a provider's sanctionable misconduct; and (iii) All costs incurred in OPM's administrative review of the case, including every phase of the administrative sanctions processes described by this subpart; (2) The Government's interests in deterring future misconduct by health care providers; (3) The provider's personal financial situation, or, in the case of an entity, the entity's financial situation; (4) All of the factors set forth in § 890.1062(b) and (c); and (5) The presence of aggravating or less serious circumstances, as described in paragraphs (c)(1) through (c)(7) of this section. (c) (1) The existence of many separate violations, or of violations committed over an extended period of time, constitutes an aggravating circumstance. OPM may consider conduct involving a small number of violations, committed either infrequently or within a brief period of time, to be less serious. (2) Violations for which a provider had direct knowledge of the material facts (for example, submitting claims that the provider knew to contain false, inaccurate, or misleading information), or for which the provider did not c

official document · source cfr-2024 · id 5:§ 890.1064