C.F.R. » Title 42 » 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 C—Permissive Exclusions

42 C.F.R. § 1001.1001

Exclusion of entities owned or controlled by a sanctioned person

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(a) Circumstance for exclusion. The OIG may exclude an entity:

(1) If a person with a relationship with such entity—

(i) Has been convicted of a criminal offense as described in sections 1128(a) and 1128(b)(1), (2), or (3) of the Act;

(ii) Has had civil money penalties or assessments imposed under section 1128A of the Act; or

(iii) Has been excluded from participation in Medicare or any State health care program, and

(2) Such a person has a direct or indirect ownership or control interest in the entity, or formerly held an ownership or control interest in the entity but no longer holds an ownership or control interest because of a transfer of the interest to an immediate family member or a member of the person's household in anticipation of or following a conviction, imposition of a civil money penalty or assessment under section 1128A of the Act, or imposition of an exclusion.

(b) Length of exclusion. (1) Except as provided in § 1001.3002(c), exclusions under this section will be for the same period as that of the individual whose relationship with the entity is the basis for this exclusion, if the individual has been or is being excluded.

(2) If the individual was not excluded, the length of the entity's exclusion will be determined by considering the factors that would have been considered if the individual had been excluded.

(3) An entity excluded under this section may apply for reinstatement at any time in accordance with the procedures set forth in § 1001.3001(a)(2).

[57 FR 3330, Jan. 29, 1992, as amended at 64 FR 39427, July 22, 1999; 82 FR 4114, Jan. 12, 2017]
Notes of Decisions
Cited in 6 cases, 2012–2020 · leading case: United States Ex Rel. Williams v. Renal Care Grp., Inc., 696 F.3d 518 (6th Cir. 2012).
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United States Ex Rel. Williams v. Renal Care Grp., Inc., 696 F.3d 518 (6th Cir. 2012). · cites it 2× “See 42 C.F.R. § 1001.1001 (allowing the Office of Inspector General to exclude entities from participation if certain individuals have a direct or indirect ownership of five or more percent in the entity); 42 C.”
Planned Parenthood of Grt TX v. Courtney Ph, 981 F.3d 347 (5th Cir. 2020). “See 42 C.F.R. § 1001.1001 (a)(1)(iii) (States “may exclude an entity .”
Planned Parenthood of Greater Texas Fam. Plan. & Preventative Health Servs., Inc. v. Smith, 236 F. Supp. 3d 974 (W.D. Tex. 2017). · cites it 2× “In contrast, HHSC argues federal law permits the termination of entities based on their affiliation, citing 42 C.F.R. § 1001.1001 (a)(i)(c). Defs.’ Proposed Findings [# 94] at ¶ 47.”
Planned Parenthood of Grt TX v. Courtney Ph (5th Cir. 2020). “See 42 C.F.R. § 1001.1001 (a)(1)(iii) (States “may exclude an entity .”
Planned Parenthood of Grt TX v. Courtney Ph (5th Cir. 2020). “See 42 C.F.R. § 1001.1001 (a)(1)(iii) (States “may exclude an entity .”
Planned Parenthood of Grt TX v. Courtney Ph (5th Cir. 2020). “See 42 C.F.R. § 1001.1001 (a)(1)(iii) (States “may exclude an entity .”
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