[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: 42CFR1001.3005]



[Page 1168-1169]

 

                         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.  1001.3005  Reversed or vacated decisions.



    (a) An individual or entity will be reinstated into Medicare, 

Medicaid and other Federal health care programs retroactive to the 

effective date of the exclusion when such exclusion is based on--

    (1) A conviction that is reversed or vacated on appeal;

    (2) An action by another agency, such as a State agency or licensing 

board, that is reversed or vacated on appeal; or

    (3) An OIG exclusion action that is reversed or vacated at any stage 

of an individual's or entity's administrative appeal process.

    (b) If an individual or entity is reinstated in accordance with 

paragraph



[[Page 1169]]



(a) of this section, CMS and other Federal health care programs will 

make payment for services covered under such program that were furnished 

or performed during the period of exclusion.

    (c) The OIG will give notice of a reinstatement under this section 

in accordance with Sec.  1001.3003(a).

    (d) An action taken by the OIG under this section will not require 

any other Federal health care program to reinstate the individual or 

entity if such program has imposed an exclusion under its own authority.

    (e) If an action which results in the retroactive reinstatement of 

an individual or entity is subsequently overturned, the OIG may reimpose 

the exclusion for the initial period of time, less the period of time 

that was served prior to the reinstatement of the individual or entity.



[57 FR 3330, Jan. 29, 1992, as amended at 64 FR 39428, July 22, 1999; 67 

FR 11935, Mar. 18, 2002]