[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: 42CFR1001.301]



[Page 1126-1127]

 

                         TITLE 42--PUBLIC HEALTH

 

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

 

PART 1001_PROGRAM INTEGRITY_MEDICARE AND STATE HEALTH CARE PROGRAMS--

 

                     Subpart C_Permissive Exclusions

 

Sec.  1001.301  Conviction relating to obstruction of an investigation.



    (a) Circumstance for exclusion. The OIG may exclude an individual or 

entity that has been convicted, under Federal or State law, in 

connection with the interference with or obstruction of any 

investigation into any criminal offense described in Sec. Sec.  1001.101 

or 1001.201.



[[Page 1127]]



    (b) Length of exclusion. (1) An exclusion imposed in accordance with 

this section will be for a period of 3 years, unless aggravating or 

mitigating factors listed in paragraphs (b)(2) and (b)(3) of this 

section form the basis for lengthening or shortening that period.

    (2) Any of the following factors may be considered to be aggravating 

and a basis for lengthening the period of exclusion--

    (i) The interference with, or obstruction of, the investigation 

caused the expenditure of significant additional time or resources;

    (ii) The interference or obstruction had a significant adverse 

mental, physical or financial impact on program beneficiaries or other 

individuals or on the Medicare, Medicaid or other Federal health care 

programs;

    (iii) The interference or obstruction also affected a civil or 

administrative investigation;

    (iv) The sentence imposed by the court included incarceration;

    (v) Whether the individual or entity has a documented history of 

criminal, civil or administrative wrongdoing; or

    (vi) Whether the individual or entity was convicted of other 

offenses besides those which formed the basis for the exclusion, or has 

been the subject of any other adverse action by any Federal, State or 

local government agency or board, if the adverse action is based on the 

same set of circumstances that serves as the basis for the imposition of 

the exclusion.

    (3) Only the following factors may be considered as mitigating and a 

basis for reducing the period of exclusion--

    (i) The record of the criminal proceedings, including sentencing 

documents, demonstrates that the court determined that the individual 

had a mental, emotional or physical condition, before or during the 

commission of the offense, that reduced the individual's culpability;

    (ii) The individual's or entity's cooperation with Federal or State 

officials resulted in--

    (A) Others being convicted or excluded from Medicare, Medicaid and 

all other Federal health care programs,

    (B) Additional cases being investigated or reports being issued by 

the appropriate law enforcement agency identifying program 

vulnerabilities or weaknesses, or

    (C) The imposition of a civil money penalty against others; or

    (iii) Alternative sources of the type of health care items or 

services furnished by the individual or entity are not available.



[57 FR 3329, Jan. 29, 1992; 57 FR 9669, Mar. 20, 1992; 63 FR 46687, 

Sept. 2, 1998; 64 FR 39426, July 22, 1999]