42 C.F.R. PART 1001--PROGRAM INTEGRITY--MEDICARE AND STATE HEALTH CARE PROGRAMS
TITLE 42--Public Health
CHAPTER V--OFFICE OF INSPECTOR GENERAL--HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B--OIG AUTHORITIES
PART 1001--PROGRAM INTEGRITY--MEDICARE AND STATE HEALTH CARE PROGRAMS
Subpart A--GENERAL PROVISIONS
Subpart B--MANDATORY EXCLUSIONS
Subpart C--PERMISSIVE EXCLUSIONS
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| Conviction relating to program or health care fraud.
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| Conviction relating to obstruction of an investigation.
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| Conviction relating to controlled substances.
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| License revocation or suspension.
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| Exclusion or suspension under a Federal or State health care program.
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| Excessive claims or furnishing of unnecessary or substandard items and services.
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| Failure of HMOs and CMPs to furnish medically necessary items and services.
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| False or improper claims.
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| Fraud and kickbacks and other prohibited activities.
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| Exclusion of entities owned or controlled by a sanctioned person.
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| Exclusion of individuals with ownership or control interest in sanctioned entities.
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| Failure to disclose certain information.
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| Failure to provide payment information.
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| Failure to grant immediate access.
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| Violations of PPS corrective action.
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| Default of health education loan or scholarship obligations.
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| Violations of the limitations on physician charges.
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| Billing for services of assistant at surgery during cataract operations.
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Subpart D--WAIVERS AND EFFECT OF EXCLUSION
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| Scope and effect of exclusion.
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Subpart E--NOTICE AND APPEALS
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| Notice of intent to exclude.
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| Notice of proposal to exclude.
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| Notice to State agencies.
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| Notice to State licensing agencies.
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| Notice to others regarding exclusion.
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Subpart F--REINSTATEMENT INTO THE PROGRAMS
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| Timing and method of request for reinstatement.
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| Approval of request for reinstatement.
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| Denial of request for reinstatement.
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| Reversed or vacated decisions.
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