[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: 42CFR1003.109]



[Page 1185-1186]

 

                         TITLE 42--PUBLIC HEALTH

 

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

 

PART 1003_CIVIL MONEY PENALTIES, ASSESSMENTS AND EXCLUSIONS--Table 

 

Sec.  1003.109  Notice of proposed determination.



    (a) If the Inspector General proposes a penalty and, when 

applicable, assessment, or proposes to exclude a respondent from 

participation in a Federal health care program, as applicable, in 

accordance with this part, he or she must deliver or send by certified 

mail, return receipt requested, to the respondent written notice of his 

or her intent to impose a penalty, assessment and exclusion, as 

applicable. The notice includes--

    (1) Reference to the statutory basis for the penalty, assessment and 

exclusion;



[[Page 1186]]



    (2) A description of the claims, requests for payment, or incidents 

with respect to which the penalty, assessment and exclusion are proposed 

(except in cases where the Inspector General is relying upon statistical 

sampling in accordance with Sec.  1003.133 in which case the notice 

shall describe those claims and requests for payment comprising the 

sample upon which the Inspector General is relying and will also briefly 

describe the statistical sampling technique utilized by the Inspector 

General);

    (3) The reason why such claims, requests for payments or incidents 

subject the respondent to a penalty, assessment and exclusion;

    (4) The amount of the proposed penalty, assessment and the period of 

proposed exclusion (where applicable);

    (5) Any circumstances described in Sec.  1003.106 that were 

considered when determining the amount of the proposed penalty and 

assessment and the period of exclusion;

    (6) Instructions for responding to the notice, including--

    (i) A specific statement of respondent's right to a hearing, and

    (ii) A statement that failure to request a hearing within 60 days 

permits the imposition of the proposed penalty, assessment and exclusion 

without right of appeal; and

    (7) In the case of a notice sent to a respondent who has an 

agreement under section 1866 of the Act, the notice also indicates that 

the imposition of an exclusion may result in the termination of the 

provider's agreement in accordance with section 1866(b)(2)(C) of the 

Act.

    (b) Any person upon whom the Inspector General has proposed the 

imposition of a penalty, assessment or exclusion may appeal such 

proposed penalty, assessment or exclusion to the DAB in accordance with 

Sec.  1005.2 of this chapter. The provisions of part 1005 of this 

chapter govern such appeals.

    (c) If the respondent fails, within the time permitted, to exercise 

his or her right to a hearing under this section, any exclusion, 

penalty, or assessment becomes final.



[57 FR 3348, Jan. 29, 1992, as amended at 59 FR 32126, June 22, 1994; 64 

FR 39429, July 22, 1999; 65 FR 24418, Apr. 26, 2000]