[Code of Federal Regulations]
[Title 5, Volume 2]
[Revised as of January 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR890.1016]

[Page 489-490]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 890_FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
Subpart J_Administrative Sanctions Imposed Against Health Care Providers
 
Sec. 890.1016  Aggravating and mitigating factors used to determine the 
length of permissive debarments.

    (a) Aggravating factors. The presence of aggravating circumstances 
may support an OPM determination to increase the length of a debarment 
beyond the nominal periods set forth in Sec. Sec. 890.1017 through 
890.1021. The factors that OPM considers as aggravating are:
    (1) Whether the provider's actions underlying the basis for the 
debarment, or similar acts, had an adverse impact on the physical or 
mental health or well-being of one or more FEHBP-covered individuals or 
other persons.
    (2) Whether the provider has a documented history of prior criminal 
wrongdoing; civil violations related to health care items or services; 
improper conduct; or administrative violations addressed by a Federal or 
State agency. OPM may consider matters involving violence, patient 
abuse, drug abuse, or controlled substances convictions or violations to 
be particularly serious.
    (3) Whether the provider's actions underlying the basis for the 
debarment, or similar acts, resulted in financial loss to the FEHBP, 
FEHBP-covered individuals, or other persons. In determining whether, or 
to what extent, a financial loss occurred, OPM shall not

[[Page 490]]

consider any amounts of restitution that the provider may have paid.
    (4) Whether the provider's false, wrongful, or improper claims to 
FEHBP carriers were numerous, submitted over a prolonged period of time, 
or part of an on-going pattern of wrongful acts.
    (5) Whether the provider was specifically aware of or directly 
responsible for the acts constituting the basis for the debarment.
    (6) Whether the provider attempted to obstruct, hinder, or impede 
official inquiries into the wrongful conduct underlying the debarment.
    (b) Mitigating factors. The presence of mitigating circumstances may 
support an OPM determination to shorten the length of a debarment below 
the nominal periods set forth in Sec. Sec. 890.1017 through 890.1021, 
respectively. The factors that OPM considers as mitigating are:
    (1) Whether the provider's cooperation with Federal, State, or local 
authorities resulted in criminal convictions, civil recoveries, or 
administrative actions against other violators, or served as the basis 
for official determinations of program weaknesses or vulnerabilities. 
Restitution that the provider made for funds wrongfully, improperly, or 
illegally received from Federal or State programs may also be considered 
as a mitigating factor.
    (2) Whether official records of judicial proceedings or the 
proceedings of State licensing authorities contain a formal 
determination that the provider had a physical, mental, or emotional 
condition that reduced his level of culpability before or during the 
period in which he committed the violations in question.
    (c) Absence of factors. The absence of aggravating or mitigating 
factors shall have no effect to either increase or lower the nominal 
period of debarment.