[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: 42CFR1001.2003]



[Page 1165-1166]

 

                         TITLE 42--PUBLIC HEALTH

 

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

 

PART 1001_PROGRAM INTEGRITY_MEDICARE AND STATE HEALTH CARE PROGRAMS--

 

                      Subpart E_Notice and Appeals

 

Sec.  1001.2003  Notice of proposal to exclude.



    (a) Except as provided in paragraph (c) of this section, if the OIG 

proposes to exclude an individual or entity in accordance with 

Sec. Sec.  1001.901, 1001.951, 1001.1601 or 1001.1701, it will send 

written notice of this decision to the affected individual or entity. 

The written notice will provide the same information set forth in Sec.  

1001.2002(c). If an entity has a provider agreement under section 1866 

of the Act, and the OIG also proposes to terminate that agreement in 

accordance with section 1866(b)(2)(C) of the Act, the notice will so 

indicate. The exclusion will be effective 60 days after the receipt of 

the notice (as defined in Sec.  1005.2 of this chapter) unless, within 

that period, the individual or entity files a written request for a 

hearing in accordance with part 1005 of this chapter. Such request must 

set forth--

    (1) The specific issues or statements in the notice with which the 

individual or entity disagrees;

    (2) The basis for that disagreement;

    (3) The defenses on which reliance is intended;

    (4) Any reasons why the proposed length of exclusion should be 

modified; and

    (5) Reasons why the health or safety of individuals receiving 

services under Medicare or any of the State health care programs does 

not warrant the exclusion going into effect prior to the completion of 

an administrative law judge (ALJ) proceeding in accordance with part 

1005 of this chapter.

    (b)(1) If the individual or entity does not make a written request 

for a hearing as provided for in paragraph (a) of this section, the OIG 

will send a notice of exclusion as described in Sec.  1001.2002.

    (2) If the individual or entity makes a timely written request for a 

hearing and the OIG determines that the health or safety of individuals 

receiving services under Medicare or any of the State health care 

programs does not warrant immediate exclusion, an exclusion will only go 

into effect, with the date of the ALJ's decision, if the ALJ upholds the 

decision to exclude.

    (c) If, prior to issuing a notice of proposal to exclude under 

paragraph (a) of this section, the OIG determines that



[[Page 1166]]



the health or safety of individuals receiving services under Medicare or 

any of the State health care programs warrants the exclusion taking 

place prior to the completion of an ALJ proceeding in accordance with 

part 1005 of this chapter, the OIG will proceed under Sec. Sec.  

1001.2001 and 1001.2002.



[57 FR 3330, Jan. 29, 1992, as amended at 63 FR 46690, Sept. 2, 1998; 65 

FR 24414, Apr. 26, 2000]