[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: 42CFR1001.501]



[Page 1128-1129]

 

                         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.  1001.501  License revocation or suspension.



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

entity that has--

    (1) Had a license to provide health care revoked or suspended by any 

State licensing authority, or has otherwise lost such a license 

(including the right to apply for or renew such a license), for reasons 

bearing on the individual's or entity's professional competence, 

professional performance or financial integrity; or

    (2) Has surrendered such a license while a formal disciplinary 

proceeding concerning the individual's or entity's professional 

competence, professional performance or financial integrity was pending 

before a State licensing authority.

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

this section will not be for a period of time less than the period 

during which an individual's or entity's license is revoked, suspended 

or otherwise not in effect as a result of, or in connection with, a 

State licensing agency action.

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

basis for lengthening the period of exclusion--

    (i) The acts that resulted in the revocation, suspension or loss of 

the individual's or entity's license to provide health care had or could 

have had a significant adverse physical, emotional or financial impact 

on one or more program beneficiaries or other individuals;

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

criminal, civil or administrative wrongdoing;

    (iii) The acts, or similar acts, had or could have had a significant 

adverse impact on the financial integrity of the programs; or

    (iv) The individual or entity has been the subject of any other 

adverse action by any other 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 if any of the aggravating factors listed in paragraph 

(b)(2) of this section justifies a longer exclusion may mitigating 

factors be considered as a basis for reducing the period of exclusion to 

a period not less than that set forth in paragraph (b)(1) of this 

section. Only the following factors may be considered mitigating--

    (i) The individual's or entity's cooperation with a State licensing 

authority resulted in--

    (A) The sanctioning of other individuals or entities, or

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

the appropriate law enforcement agency identifying program 

vulnerabilities or weaknesses; or

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

services furnished



[[Page 1129]]



by the individual or entity are not available.

    (4) When an individual or entity has been excluded under this 

section, the OIG will consider a request for reinstatement in accordance 

with Sec.  1001.3001 if the individual or entity obtains a valid license 

in the State where the license was originally revoked, suspended, 

surrendered or otherwise lost.



[57 FR 3330, Jan. 29, 1992, as amended at 63 FR 46688, Sept. 2, 1998]