; or (ii) is engaged in a violation of such subsection that raises an issue of significant public importance. (B) Cases by referral The Director may determine, based on a pattern of complaints, a pattern of violations, a review of data reported by a health care provider covered by subsection (a), or any other means, that there is reasonable cause to believe a health care provider is engaged in a pattern or practice that violates subsection (a). If the Director makes such a determination, the Director shall refer the related findings to the Attorney General. If the Attorney General finds that such reasonable cause exists, the Attorney General may commence a civil action in any appropriate district court of the United States. (2) Enforcement of subpoenas The Attorney General, on behalf of the Director, or another party at whose request a subpoena is issued under this subsection, may enforce such subpoena in appropriate proceedings in the district court of the United States for the district in which the person to whom the subpoena was addressed resides, was served, or transacts business. (3) Relief which may be granted in civil actions (A) In general In a civil action under paragraph (1), the court— (i) may award such preventive relief, including a permanent or temporary injunction, temporary restraining order, or other order against the person responsible for a violation of subsection (a) as is necessary to assure the full enjoyment of the rights granted by this subsection; (ii) may award such other relief as the court determines to be appropriate, including monetary damages, to aggrieved persons; and (iii) may, to vindicate the public interest, assess punitive damages against the respondent— (I) in an amount not exceeding $500,000, for a first violation