Section 516.3 - Determination of the amount of the penalty.

516.3 Determination of the amount of the penalty. (a) In determining the amount of the penalty to be imposed, the department must take into consideration the following:

(1) the number and total value of the claims for payment from the MA program which were the underlying basis of the determination to impose a monetary penalty;

(2) the effect, if any, on the quality of medical care provided to recipients of MA as a result of the acts of the person;

(3) the degree of culpability of the person in committing the proscribed actions and any mitigating circumstances;

(4) any prior violations committed by the person relating to the MA program, Medicare or other social services programs which resulted in either a criminal or administrative sanction or penalty; and

(5) any other facts relating to the nature and seriousness of the violations including any exculpatory facts.


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