This chapter establishes standards for the imposition of civil money penalties against an organization or program determined to be in violation of this subtitle. In this chapter, the following terms have the meanings indicated. Material and Egregious Violation “Material violation” means any course of conduct, including a single incident, that may cause a program, individual, or organization to fail to comply with any statutory, regulatory, or contractual requirement. “Material and egregious violation” includes but is not limited to: Fraudulent or other behavior which influences or may influence the payment or receipt of money or other property; Practices which affect or may affect the health or safety of any individual; or Practices which violate or may violate participant rights. The Department may impose a civil money penalty against an organization for a material violation of a State or federal law or regulation in any of its programs. The Department may additionally cite violations of accreditation standards in support of an identified violation of law or regulation. A civil money penalty may be imposed regardless of whether any other civil, criminal, or administrative action is taken against the organization or program by any State, federal, or Departmental agency for the same covered period or violation. If a violation occurs at multiple site locations of an organization, each location will constitute a separate violation. If there are multiple services at a location and the violation occurs with multiple services, each service will constitute a separate violation. If the Department determines that a material deficiency, or continuing pattern of deficiencies which together amount to a material and egregious violation, exists, the Department shall notify the organization of the deficiency or deficiencies and may: Permit the organization the opportunity to correct the deficiencies by a specified date; or Impose a civil money penalty of up to $500 per day not to exceed $15,000 in one month until compliance is achieved. If the Department permits an organization the opportunity to correct the deficiencies by a specific date, and the organization fails to comply, the Department may impose a civil penalty of up to $500 for each day of violation until the organization has submitted sufficient documentation of correction of the deficiency not to exceed $15,000 in 1 month. In determining whether a civil money penalty is to be imposed and in setting the amount of the civil money penalty, the Department shall consider each of the following: The number, nature, and seriousness of the violation or violations; The extent to which the deficiency or deficiencies are part of an ongoing pattern; The organization’s history with the Department, including any prior history of compliance or any prior actions that would indicate whether the violation is an isolated occurrence or represents a pattern of behavior; The efforts made by the organization to correct the violations and any continuation of conduct after notification of possible violations; The organization’s level of cooperation with the Department or its agents as it relates to the review of the program; The degree of risk to the health, life, or safety of individuals as a result of the violations; and Any other reasonable mitigating factors. The Department shall give consideration to the extent to which the organization’s size, operations, or financial condition: May have contributed to the violations; and May affect the organization’s ability to provide care and continue program operations after payment of a civil money penalty. If the civil money penalty is imposed under this chapter, the Department shall issue a written notice to the organization operating the program that: States the total amount of the civil money penalties being imposed; and Includes the following information: Each regulation or statute violated; The amount of each civil money penalty imposed for each violation; The manner in which the amount of the civil money penalty was calculated; and The organization’s right to request a hearing in accordance with COMAR 10.63.06; and The organization’s appeal rights. The notice shall be sent to the organization, owner, resident agent, and Board of Directors, as appropriate, by certified mail. An organization that operates or purports to operate a service or site without a license that is required pursuant to this subtitle may be assessed a civil money penalty by the Department of $1,000 per day of operation per location site or service. An organization aggrieved by the imposition of a civil money penalty may appeal the action by filing a request for a hearing in accordance with COMAR 10.63.06. If the hearing affirms the imposition of the penalty, the Secretary shall issue a final order which shall state the basis on which the order is made, the amount of the civil money penalty imposed, and the manner in which the amount of the civil money penalty was calculated. After exhaustion of all appeals, an organization shall pay a civil money penalty to the Department within 10 days after the organization receives a final order that affirms the imposition of the civil money penalty. The Department, at its discretion, may agree to accept a repayment schedule, which may include a discount for timely payments. If an organization does not pay the civil money penalty to the Department after receiving the final order or according to a negotiated repayment schedule: The balance due shall be referred to the Central Collection Unit; and The organization and its programs may be subject to licensing action. Health-General Article, §§7.5-205(b)(2)—(3), (d), 7.5-402(a)(6), Annotated Code of Maryland Effective date: April 14, 2025 (52:7 Md. R. 323)