Civil Monetary Penalties: What Should Providers Do When DOJ Imposes Monetary Penalties

When the Department of Justice (DOJ) has evidence of unlawful conduct–whether that takes the form of unlawful kickbacks, billing fraud, illegal prescribing, or other fraud and compliance issues–they may pursue an enforcement action. If the DOJ finds that their allegations are justified, they may impose significant civil penalties on healthcare entities and/or individual owners and providers. Civil monetary penalties (CMPs) allow the government to penalize healthcare providers for civil and criminal violations. The DOJ is especially fond of issuing CMPs against DEA registrants who violate controlled substance prescription laws as well as providers who violate the False Claims Act (FCA). If you’ve been hit with a CMP, what are your options? How should you respond? Continue reading for a discussion of civil monetary penalties from a seasoned California healthcare regulatory compliance lawyer.

The DOJ’s Initial Calculation Is Not the Final Word

Even if the Justice Department finds a violation of the healthcare laws, that does not mean that they have carte blanche to impose whatever monetary penalties they see fit. DOJ’s authority to impose fines and penalties is circumscribed by federal laws and regulations, as well as by judicial opinions. The DOJ might initially seek a massive penalty well out of proportion to the actual conduct committed, but the ultimate fine will be decided either by the court or through a settlement between the DOJ and the target.

When evaluating CMPs, courts will typically consider a number of factors, including:

• The defendant’s level of culpability, i.e., negligence vs. recklessness vs. willful violation
• The extent of public harm caused by the defendant’s conduct
• The extent of harm caused to government agencies caused by the defendant’s conduct
• The defendant’s profits gained through the violations
• The defendant’s capacity to pay a significant penalty

A Savvy Healthcare Law Defense Attorney Can Help Reduce the Penalty

There are many tactics useful in reducing the ultimate penalty for violation of a law or regulation. A seasoned healthcare lawyer can help you chart a path toward limiting your ultimate liability.

Complying with the DOJ’s investigation, conducting internal audits, and otherwise working with the agency to root out any unlawful conduct within your entity can go a long way in reducing your ultimate penalty. If the DOJ determines to seek CMPs regardless, your attorney and the DOJ lawyers can work to negotiate a settlement that saves the government time and energy prosecuting your case, while still serving to penalize your organization sufficiently for unlawful conduct. If the matter proceeds to court, your healthcare law defense lawyer will help you present a strong argument for more limited penalties based on your level of culpability, limitations on the actual harm caused, and other factors.

If you are facing an investigation by the DOJ, call an experienced healthcare compliance and investigation defense attorney as soon as possible for comprehensive representation. Your lawyer can work to whittle down the government’s case and negotiate a significantly more palatable penalty than whatever the DOJ might initially claim.

Call an Experienced Healthcare Law and Regulatory Compliance Attorney for Help Responding to Agency Investigations

For help responding to kickback allegations or regulatory compliance issues, assistance with building your medical practice, or advice and representation concerning internal investigations, auditing, employment matters, governance issues, business disputes, licensing, or any other California healthcare law matter, contact the Law Offices of Art Kalantar in Los Angeles or California statewide at 310-773-0001.