[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: 42CFR1004.100]



[Page 1193]

 

                         TITLE 42--PUBLIC HEALTH

 

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

 

PART 1004_IMPOSITION OF SANCTIONS ON HEALTH CARE PRACTITIONERS AND 

 

                     Subpart D_OIG Responsibilities

 

Sec.  1004.100  Acknowledgement and review of report.





    (a) Acknowledgement. The OIG will inform the QIO of the date it 

received the QIO's report and recommendation.

    (b) Review. The OIG will review the QIO report and recommendation to 

determine whether--

    (1) The QIO has followed the regulatory requirements of this part; 

and

    (2) A violation has occurred.

    (c) Rejection of the QIO recommendation. If the OIG decides that a 

sanction is not warranted, it will notify the QIO that recommended the 

sanction, the affected practitioner or other person, and the licensing 

board informed by the QIO of the sanction recommendation that the 

recommendation is rejected.

    (d) Decision to sanction. If the OIG decides that a violation of 

obligations has occurred, it will determine the appropriate sanction by 

considering--

    (1) The recommendation of the QIO;

    (2) The type of offense;

    (3) The severity of the offense;

    (4) The previous sanction record of the practitioner or other 

person;

    (5) The availability of alternative sources of services in the 

community;

    (6) Any prior problems the Medicare or State health care programs 

have had with the practitioner or other person; and

    (7) Any other matters relevant to the particular case.

    (e) Exclusion sanction. If the QIO submits a recommendation for 

exclusion to the OIG, and a determination is not made by the 120th day 

after actual receipt by the OIG, the exclusion sanction recommended will 

become effective and the OIG will provide notice in accordance with 

Sec.  1004.110(f).

    (f) Monetary penalty. If the QIO recommendation is to assess a 

monetary penalty, the 120-day provision does not apply and the OIG will 

provide notice in accordance with Sec.  1004.110 (a)-(e).



[60 FR 63640, Dec. 12, 1995, as amended at 62 FR 23143, Apr. 29, 1997]