[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: 42CFR1001.901]



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                         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.  1001.901  False or improper claims.



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

or entity that it determines has committed an act described in section 

1128A of the Act. The imposition of a civil money penalty or assessment 

is not a prerequisite for an exclusion under this section.

    (b) Length of exclusion. In determining the length of an exclusion 

imposed in accordance with this section, the OIG will consider the 

following factors--

    (1) The nature and circumstances surrounding the actions that are 

the basis for liability, including the period of time over which the 

acts occurred, the number of acts, whether there is evidence of a 

pattern and the amount claimed;

    (2) The degree of culpability;

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

criminal, civil or administrative wrongdoing (The lack of any prior 

record is to be considered neutral);

    (4) The individual or entity 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; or

    (5) Other matters as justice may require.



[57 FR 3330, Jan. 29, 1992, as amended at 63 FR 46689, Sept. 2, 1998]



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