[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR1001.101]



[Page 1124]

 

                         TITLE 42--PUBLIC HEALTH

 

      GENERAL--HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

PART 1001_PROGRAM INTEGRITY_MEDICARE AND STATE HEALTH CARE PROGRAMS--

 

                     Subpart B_Mandatory Exclusions

 

Sec.  1001.101  Basis for liability.





    The OIG will exclude any individual or entity that--

    (a) Has been convicted of a criminal offense related to the delivery 

of an item or service under Medicare or a State health care program, 

including the performance of management or administrative services 

relating to the delivery of items or services under any such program;

    (b) Has been convicted, under Federal or State law, of a criminal 

offense related to the neglect or abuse of a patient, in connection with 

the delivery of a health care item or service, including any offense 

that the OIG concludes entailed, or resulted in, neglect or abuse of 

patients (the delivery of a health care item or service includes the 

provision of any item or service to an individual to meet his or her 

physical, mental or emotional needs or well-being, whether or not 

reimbursed under Medicare, Medicaid or any Federal health care program);

    (c) Has been convicted, under Federal or State law, of a felony that 

occurred after August 21, 1996, relating to fraud, theft, embezzlement, 

breach of fiduciary responsibility, or other financial misconduct--

    (1) In connection with the delivery of a health care item or 

service, including the performance of management or administrative 

services relating to the delivery of such items or services, or

    (2) With respect to any act or omission in a health care program 

(other than Medicare and a State health care program) operated by, or 

financed in whole or in part, by any Federal, State or local government 

agency; or

    (d) Has been convicted, under Federal or State law, of a felony that 

occurred after August 21, 1996 relating to the unlawful manufacture, 

distribution, prescription or dispensing of a controlled substance, as 

defined under Federal or State law. This applies to any individual or 

entity that--

    (1) Is, or has ever been, a health care practitioner, provider or 

supplier;

    (2) Holds, or has held, a direct or indirect ownership or control 

interest (as defined in section 1124(a)(3) of the Act) in an entity that 

is a health care provider or supplier, or is, or has ever been, an 

officer, director, agent or managing employee (as defined in section 

1126(b) of the Act) of such an entity; or

    (3) Is, or has ever been, employed in any capacity in the health 

care industry.



[63 FR 46686, Sept. 2, 1998, as amended at 67 FR 11932, Mar. 18, 2002]