[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: 42CFR1004.10]



[Page 1189-1190]

 

                         TITLE 42--PUBLIC HEALTH

 

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

 

PART 1004_IMPOSITION OF SANCTIONS ON HEALTH CARE PRACTITIONERS AND 

 

      Subpart B_Sanctions Under the QIO Program; General Provisions

 

Sec.  1004.10  Statutory obligations of practitioners and other persons.





    It is the obligation of any health care practitioner or other person 

who furnishes or orders health care services that may be reimbursed 

under the Medicare or State health care programs to ensure, to the 

extent of his or her or its authority, that those services are--

    (a) Provided economically and only when, and to the extent, 

medically necessary;

    (b) Of a quality that meets professionally recognized standards of 

health care; and

    (c) Supported by evidence of medical necessity and quality in the 

form and



[[Page 1190]]



fashion and at such time that the reviewing QIO may reasonably require 

(including copies of the necessary documentation and evidence of 

compliance with pre-admission or pre-procedure review requirements) to 

ensure that the practitioner or other person is meeting the obligations 

imposed by section 1156(a) of the Act.