130 CMR, § 450.239 - Sanctions: Calculation of Administrative Fine
(A) The MassHealth agency may assess an
administrative fine not to exceed the greater of
(1) $100 for each instance of violation of
the rules, regulations, standards, or laws governing MassHealth;
(2) $100 for each day of violation of the
rules, regulations, standards, or laws governing MassHealth; or
(3) three times the payable amount of each
claim, in accordance with 130 CMR 450.239.
(B) In determining the amount of any
administrative fine, the MassHealth agency considers the following factors.
(1)
Nature and Circumstances of
the Claim. The MassHealth agency considers the circumstances to be
mitigating if the violations were of the same type and occurred within a short
period of time; there were only a few such instances; there was no history of
similar types of violations; and the total monetary value of these instances
was less than $1,000. Conversely, the MassHealth agency considers the
circumstances to be aggravating if the violations were of a single type or
several types and occurred over a lengthy period of time; there were many such
instances; there was a history of similar types of violations; and the total
monetary value of these instances was $1,000 or more.
(2)
Prior Offenses.
The MassHealth agency may consider the circumstances to be aggravating if the
provider previously had been held liable for criminal, civil, or administrative
sanctions relating to MassHealth.
(3)
Financial Condition and
Member-access Considerations. The MassHealth agency considers the
circumstances to be mitigating if the imposition of a full penalty will
jeopardize the ability of the provider to continue as a health-care provider
and if the provider's inability to continue as a health-care provider would
result in a demonstrable access problem for members in the provider's
geographic region. The provider has the burden of demonstrating such access
problem.
(4)
Other
Factors. The MassHealth agency will consider other mitigating or
aggravating circumstances. If there are substantial mitigating circumstances,
the MassHealth agency will decrease the administrative fine to be assessed.
Conversely, if there are substantial aggravating circumstances, the MassHealth
agency will increase the administrative fine to be assessed.
Notes
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