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e-CFR data is current as of November 27, 2020

Title 42Chapter VSubchapter BPart 1001


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

rule

Subpart A—GENERAL PROVISIONS

§1001.1
Scope and purpose.
§1001.2
Definitions.
rule

Subpart B—MANDATORY EXCLUSIONS

§1001.101
Basis for liability.
§1001.102
Length of exclusion.
rule

Subpart C—PERMISSIVE EXCLUSIONS

§1001.201
Conviction relating to program or health care fraud.
§1001.301
Conviction relating to obstruction of an investigation or audit.
§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.
§1001.1101
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.
§1001.1551
Exclusion of individuals with ownership or control interest in sanctioned entities.
§1001.1552
Making false statements or misrepresentation of material facts.
§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
rule

Subpart D—WAIVERS AND EFFECT OF EXCLUSION

§1001.1801
Waivers of exclusions.
§1001.1901
Scope and effect of exclusion.
rule

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.
rule

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
Withdrawal of exclusion for reversed or vacated decisions.

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