License revocations or termination of participation in federal programs is the administrative death penalty. Agencies use these as a last resort. In most cases, the agency will enter an administrative order specifying what must be done to eliminate the violation. This may be to clean up the refrigerator in the hospital kitchen, to build fire escapes, or to stop billing for work that the health care practitioner is not personally supervising. Many agencies may also assess fines or other civil penalties, such as reimbursement for improper payments. These penalties can run to tens of millions of dollars if they involve systematic improper billing to the federal government. A hospital would have little choice but to pay the penalty because termination of its participation in federal programs will put it out of business.