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(d) a fine of one thousand dollars for a fourth violation within a twenty-four-month period

Note the yellow color on the margin of the lesions

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We note that, under 413.40(d)(3), an excluded hospital that continues to be paid under the TEFRA system and whose costs exceed 110 percent of its rate-of-increase limit receives its rate-of-increase limit plus the lesser of: (1) 50 percent of its reasonable costs in excess of 110 percent of the limit