[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: 42CFR1001.3002]



[Page 1167-1168]

 

                         TITLE 42--PUBLIC HEALTH

 

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

 

PART 1001_PROGRAM INTEGRITY_MEDICARE AND STATE HEALTH CARE PROGRAMS--

 

                Subpart F_Reinstatement into the Programs

 

Sec.  1001.3002  Basis for reinstatement.



    (a)(1) The OIG will authorize reinstatement if it determines that--

    (i) The period of exclusion has expired;

    (ii) There are reasonable assurances that the types of actions that 

formed the basis for the original exclusion have not recurred and will 

not recur; and

    (iii) There is no additional basis under sections 1128(a) or (b) or 

1128A of the Act for continuation of the exclusion.

    (2) Submitting claims or causing claims to be submitted or payments 

to be made by the programs for items or services furnished, ordered or 

prescribed, including administrative and management services or salary, 

may serve as the basis for denying reinstatement. This section applies 

regardless of whether an individual or entity has obtained a program 

provider number or equivalent, either as an individual or as a member of 

a group, prior to being reinstated.

    (b) In making the reinstatement determination, the OIG will 

consider--

    (1) Conduct of the individual or entity occurring prior to the date 

of the notice of exclusion, if not known to the OIG at the time of the 

exclusion;

    (2) Conduct of the individual or entity after the date of the notice 

of exclusion;

    (3) Whether all fines, and all debts due and owing (including 

overpayments) to any Federal, State or local government that relate to 

Medicare, Medicaid and all other Federal health care programs, have been 

paid or satisfactory arrangements have been made to fulfill obligations;

    (4) Whether CMS has determined that the individual or entity 

complies with, or has made satisfactory arrangements to fulfill, all of 

the applicable conditions of participation or supplier conditions for 

coverage under the statutes and regulations; and

    (5) [Reserved]

    (6) Whether the individual or entity has, during the period of 

exclusion,



[[Page 1168]]



submitted claims, or caused claims to be submitted or payment to be made 

by any Federal health care program, for items or services the excluded 

party furnished, ordered or prescribed, including health care 

administrative services.

    (c) If the OIG determines that the criteria in paragraphs (a)(1)(ii) 

and (iii) of this section have been met, an entity excluded in 

accordance with Sec.  1001.1001 will be reinstated upon a determination 

by the OIG that the individual whose conviction, exclusion or civil 

money penalty was the basis for the entity's exclusion--

    (1) Has properly reduced his or her ownership or control interest in 

the entity below 5 percent;

    (2) Is no longer an officer, director, agent or managing employee of 

the entity; or

    (3) Has been reinstated in accordance with paragraph (a) of this 

section or Sec.  1001.3005.

    (d) Reinstatement will not be effective until the OIG grants the 

request and provides notice under Sec.  1001.3003(a) of this part. 

Reinstatement will be effective as provided in the notice.

    (e) A determination with respect to reinstatement is not appealable 

or reviewable except as provided in Sec.  1001.3004.

    (f) An ALJ may not require reinstatement of an individual or entity 

in accordance with this chapter.



[57 FR 3330, Jan. 29, 1992, as amended at 63 FR 46691, Sept. 2, 1998; 64 

FR 39427, July 22, 1999]