<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.66.01.03" title_num="10" subtitle_num="66" chapter_num="01" heading="Civil Money Remedy — Imposition.">
  <paragraph num="A.">
    <text>A civil money remedy may be imposed against a provider for violation of a State or federal law governing the conditions of payment for any service or item for which the provider submitted a claim for payment and received payment.</text>
  </paragraph>
  <paragraph num="B.">
    <text>It is within the sole discretion of the Inspector General as to whether a civil money remedy is imposed.</text>
  </paragraph>
  <paragraph num="C.">
    <text>A civil money remedy may not be imposed if otherwise prohibited by State or federal law.</text>
  </paragraph>
  <paragraph num="D.">
    <text>A civil money remedy imposed under this chapter:</text>
    <paragraph num="(1)">
      <text>Is in lieu of full payment or full adjustment of the paid claim and not in addition to repayment of the claim;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>May not be less than the federal financial participation share of the identified improper claim amount unless good cause is shown;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>May not exceed the amount of reimbursement that the provider received for the paid claim;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Is only available if the provider has not been subjected to a:</text>
      <paragraph num="(a)">
        <text>Repayment penalty or fine;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Criminal action; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Civil false claims action under either federal or State law for the same claim; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>May not be imposed if the claim was included in the universe of claims under an extrapolation calculation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>A claim may be made on the basis of more than one violation, but there shall be only one civil money remedy per claim, regardless of the number of violations on which the claim is based.</text>
  </paragraph>
  <paragraph num="F.">
    <text>In determining whether a civil money remedy is to be imposed and in setting the amount of the civil money remedy, the Inspector General shall consider:</text>
    <paragraph num="(1)">
      <text>The number, nature, and seriousness of the violation or violations;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider’s history of compliance;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The efforts made by the provider to correct the violations and any continuation of conduct after notification of possible violations;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The provider’s level of cooperation with the Department or Inspector General as it relates to the review of the claim;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The degree of risk to the health, life, or safety of consumers as a result of the violations; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Any other reasonable factors as fairness may require.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>The Inspector General shall give special consideration to the extent to which the provider’s size, operations, or financial condition:</text>
    <paragraph num="(1)">
      <text>May have contributed to the violations; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>May affect the provider’s ability to provide care and continue operations after payment of a civil money remedy.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>If the civil money remedy is imposed under this chapter, the Inspector General shall issue a written notice and order to the provider that:</text>
    <paragraph num="(1)">
      <text>States the total amount of the civil money remedies being imposed; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Includes the following information:</text>
      <paragraph num="(a)">
        <text>The basis on which the order is made;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Each regulation or statute violated;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The amount of each civil money remedy imposed for each claim;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The number of claims and total value of the claims identified with errors;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The manner in which the amount of the civil money remedy was calculated; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>The provider’s appeal rights.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>The notice and order shall be sent to the provider by certified mail.</text>
  </paragraph>
</regulation>