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42 C.F.R. PART 1001--PROGRAM INTEGRITY--MEDICARE AND STATE HEALTH CARE PROGRAMS

TITLE 42--Public Health

CHAPTER V--OFFICE OF INSPECTOR GENERAL--HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B--OIG AUTHORITIES

PART 1001--PROGRAM INTEGRITY--MEDICARE AND STATE HEALTH CARE PROGRAMS

Subpart A--GENERAL PROVISIONS

�1001.1

Scope and purpose.

�1001.2

Definitions.

Subpart B--MANDATORY EXCLUSIONS

�1001.101

Basis for liability.

�1001.102

Length of exclusion.

Subpart C--PERMISSIVE EXCLUSIONS

�1001.201

Conviction relating to program or health care fraud.

�1001.301

Conviction relating to obstruction of an investigation.

�1001.401

Conviction relating to controlled substances.

�1001.501

License revocation or suspension.

�1001.601

Exclusion or suspension under a Federal or State health care program.

�1001.701

Excessive claims or furnishing of unnecessary or substandard items and services.

�1001.801

Failure of HMOs and CMPs to furnish medically necessary items and services.

�1001.901

False or improper claims.

�1001.951

Fraud and kickbacks and other prohibited activities.

�1001.952

Exceptions.

�1001.1001

Exclusion of entities owned or controlled by a sanctioned person.

�1001.1051

Exclusion of individuals with ownership or control interest in sanctioned entities.

�1001.1101

Failure to disclose certain information.

�1001.1201

Failure to provide payment information.

�1001.1301

Failure to grant immediate access.

�1001.1401

Violations of PPS corrective action.

�1001.1501

Default of health education loan or scholarship obligations.

�1001.1601

Violations of the limitations on physician charges.

�1001.1701

Billing for services of assistant at surgery during cataract operations.

Appendix

Appendix A to Subpart C of Part 1001

Subpart D--WAIVERS AND EFFECT OF EXCLUSION

�1001.1801

Waivers of exclusions.

�1001.1901

Scope and effect of exclusion.

Subpart E--NOTICE AND APPEALS

�1001.2001

Notice of intent to exclude.

�1001.2002

Notice of exclusion.

�1001.2003

Notice of proposal to exclude.

�1001.2004

Notice to State agencies.

�1001.2005

Notice to State licensing agencies.

�1001.2006

Notice to others regarding exclusion.

�1001.2007

Appeal of exclusions.

Subpart F--REINSTATEMENT INTO THE PROGRAMS

�1001.3001

Timing and method of request for reinstatement.

�1001.3002

Basis for reinstatement.

�1001.3003

Approval of request for reinstatement.

�1001.3004

Denial of request for reinstatement.

�1001.3005

Reversed or vacated decisions.