5 C.F.R. § 890.1013 Deciding whether to propose a permissive debarment.
Title 5 - Administrative Personnel
(a) Review factors. The factors OPM shall consider in deciding whether to propose a provider's debarment under a permissive debarment authority are: (1) The nature of any claims involved in the basis for the proposed debarment and the circumstances under which they were presented to FEHBP carriers; (2) The improper conduct involved in the basis for the proposed debarment, and the provider's degree of culpability and history of prior offenses; (3) The extent to which the provider poses or may pose a risk to the health and safety of FEHBP-covered individuals or to the integrity of FEHBP transactions; and (4) Other factors specifically relevant to the provider's debarment that shall be considered in the interests of fairness. (b) Absence of a factor. The absence of a factor shall be considered neutral, and shall have no effect on OPM's decision. (c) Specialized review in certain cases. In determining whether to propose debarment under 5 U.S.C 8902a(c)(4) for providing items or services substantially in excess of the needs of a covered individual or for providing items or services that fail to meet professionally-recognized quality standards, OPM shall obtain the input of trained reviewers, based on written medical protocols developed by physicians. If OPM cannot reach a decision on this basis, it shall consult with a physician in an appropriate specialty area.
Title 5: Administrative Personnel
PART 890—FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
Subpart J—Administrative Sanctions Imposed Against Health Care Providers
Permissive Debarments
§ 890.1013 Deciding whether to propose a permissive debarment.
