[Code of Federal Regulations]

[Title 45, Volume 1]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 45CFR61.10]



[Page 154-156]

 

                        TITLE 45--PUBLIC WELFARE

 

                    SUBTITLE A--DEPARTMENT OF HEALTH

                           AND HUMAN SERVICES

 

PART 61_HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE 

INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS--Table 

of Contents

 

                   Subpart B_Reporting of Information

 

Sec.  61.10  Reporting exclusions from participation in Federal or State 

health care programs.



    (a) Who must report. Federal and State Government agencies must 

report health care providers, suppliers, or practitioners excluded from 

participating in Federal or State health care programs, including 

exclusions that were made in a matter in which there was also a 

settlement that is not reported because no findings or admissions of 

liability have been made (regardless of whether the exclusion is the 

subject of a pending appeal) .

    (b) Entities described in paragraph (a) of this section must report 

the following information:

    (1) If the subject is an individual, personal identifiers, 

including:

    (i) Name;

    (ii) Social Security Number (or ITIN);



[[Page 155]]



    (iii) Home address or address of record;

    (iv) Sex; and

    (v) Date of birth.

    (2) If the subject is an individual, that individual's employment or 

professional identifiers, including:

    (i) Organization name and type;

    (ii) Occupation and specialty, if applicable; and

    (iii) National Provider Identifier (NPI), when issued by theCenters 

for Medicare & Medicaid Services (CMS).

    (3) If the subject is an organization, identifiers, including:

    (i) Name;

    (ii) Business address;

    (iii) Federal Employer Identification Number (FEIN), or Social 

Security Number (or ITIN) when used by the subject as a Taxpayer 

Identification Number (TIN);

    (iv) The NPI, when issued by CMS; and

    (v) Type of organization.

    (4) For all subjects:

    (i) A narrative description of the acts or omissions and injuries 

upon which the reported action was based;

    (ii) Classification of the acts or omissions in accordance with a 

reporting code adopted by the Secretary;

    (iii) Classification of the action taken in accordance with a 

reporting code adopted by the Secretary, and the amount of any monetary 

penalty resulting from the reported action;

    (iv) The date the action was taken, its effective date and duration;

    (v) If the action is on appeal;

    (vi) Name of the agency taking the action;

    (vii) Name and address of the reporting entity; and

    (viii) The name, title and telephone number of the responsible 

official submitting the report on behalf of the reporting entity.

    (c) Entities described in paragraph (a) of this section should 

report, if known, the following information:

    (1) If the subject is an individual, personal identifiers, 

including:

    (i) Other name(s) used;

    (ii) Other address;

    (iii) FEIN, when used by the individual as a TIN;

    (iv) Name of each professional school attended and year of 

graduation; and

    (v) If deceased, date of death.

    (2) If the subject is an individual, that individual's employment or 

professional identifiers, including:

    (i) State professional license (including professional registration 

and certification) number(s), field(s) of licensure, and the name(s) of 

the State or Territory in which the license is held;

    (ii) Other numbers assigned by Federal or State agencies, to 

include, but not limited to Drug Enforcement Administration (DEA) 

registration number(s), Unique Physician Identification Number(s) 

(UPIN), and Medicaid and Medicare provider number(s);

    (iii) Name(s) and address(es) of any health care entity with which 

the subject is affiliated or associated; and

    (iv) Nature of the subject's relationship to each associated or 

affiliated health care entity.

    (3) If the subject is an organization, identifiers, including:

    (i) Other name(s) used;

    (ii) Other address(es) used;

    (iii) Other FEIN(s) or Social Security Numbers(s) (or ITINs) used;

    (iv) Other NPI(s) used;

    (v) State license (including registration and certification) 

number(s) and the name(s) of the State or territory in which the license 

is held;

    (vi) Other numbers assigned by Federal or State agencies, to 

include, but not limited to Drug Enforcement Administration (DEA) 

registration number(s), Clinical Laboratory Improvement Act (CLIA) 

number(s), Food and Drug Administration (FDA) number(s), and Medicaid 

and Medicare provider number(s);

    (vii) Names and titles of principal officers and owners;

    (viii) Name(s) and address(es) of any health care entity with which 

the subject is affiliated or associated; and

    (ix) Nature of the subject's relationship to each associated or 

affiliated health care entity.

    (4) For all subjects:

    (i) If the subject will be automatically reinstated; and

    (ii) The date of appeal, if any.

    (d) Sanctions for failure to report. The Secretary will provide for 

publication of a public report that identifies those Government agencies 

that have failed to report information on exclusions or



[[Page 156]]



debarments as required to be reported under this section.



[64 FR 57758, Oct. 26, 1999, as amended at 69 FR 33869, June 17, 2004]