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 E—Notice and Appeals

42 C.F.R. § 1001.2007

Appeal of exclusions

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(a)(1) Except as provided in § 1001.2003, an individual or entity excluded under this part may file a request for a hearing before an ALJ only on the issues of whether:

(i) The basis for the imposition of the sanction exists, and

(ii) The length of exclusion is unreasonable.

(2) When the OIG imposes an exclusion under subpart B of this part for a period of 5 years, paragraph (a)(1)(ii) of this section will not apply.

(3) The request for a hearing should contain the information set forth in § 1005.2(d) of this chapter.

(b) The excluded individual or entity has 60 days from the receipt of notice of exclusion provided for in § 1001.2002 to file a request for such a hearing.

(c) The standard of proof at a hearing is preponderance of the evidence.

(d) When the exclusion is based on the existence of a criminal conviction or a civil judgment imposing liability by Federal, State or local court, a determination by another Government agency, or any other prior determination where the facts were adjudicated and a final decision was made, the basis for the underlying conviction, civil judgment or determination is not reviewable and the individual or entity may not collaterally attack it either on substantive or procedural grounds in this appeal.

(e) The procedures in part 1005 of this chapter will apply to the appeal.

[57 FR 3330, Jan. 29, 1992, as amended at 67 FR 11935, Mar. 18, 2002]
Notes of Decisions
Cited in 15 cases (4 in the last 5 years), 1995–2025 · leading case: Lasher v. Dep't of Health & Human Servs., 369 F. Supp. 3d 243 (D.C. Cir. 2019).
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Lasher v. Dep't of Health & Human Servs., 369 F. Supp. 3d 243 (D.C. Cir. 2019). · cites it 5× “" 42 C.F.R. § 1001.2007 (a)(1). The parties to this proceeding are the petitioner and the IG.”
David E. Sternberg v. Sec'y, Dep't of Health & Human Servs., 299 F.3d 1201 (10th Cir. 2002). “Pursuant to 42 C.F.R. §§ 1001.2007 and 1005.2, an Administrative Law Judge (“ALJ”) heard Sternberg’s appeal.”
Kostenko v. U.S. Dep't of Health & Human Servs., 916 F. Supp. 2d 661 (S.D.W. Va 2013). · cites it 2× “The enclosure detailed his right to and procedure for appeal in accordance with 42 CFR 1001.2007. (Id. at 4). It stated that “[a request for a hearing before an administrative law judge] must be made in writing within 60 days of [his] receiving the OIG’s letter of exclusion.”
Leonard R. FRIEDMAN, M.D., Plaintiff, Appellant, v. Donna E. SHALALA, Sec'y of Health & Human Servs., Et Al., Defendant, Appellee, 46 F.3d 115 (1st Cir. 1995). · cites it 2× “Compare 42 C.F.R. § 1001.2007 (a)(i) & (ii) (the only issues before an ALJ in an exclusion hearing are whether the basis for the imposition of the sanction exists and whether the length of the exclusion is reasonable).”
Quayum v. United States Dep't of Health & Human Servs., 34 F. Supp. 2d 141 (E.D.N.Y 1998). “See 42 C.F.R. § 1001.2007 (a)(1). When the exclusion is based on the existence of a conviction, a plaintiff may not attack collaterally the determination on either substantive or procedural grounds.”
Lasher v. Dep't of Health & Human Servs. (D.D.C. 2019). · cites it 4× “” 42 C.F.R. § 1001.2007 (a)(1). The parties to this proceeding are the petitioner and the IG.”
Fuentes v. Becerra (W.D. Va. 2021). · cites it 3× “” 42 C.F.R. § 1001.2007 (a) (emphasis added).”
Figueroa v. Dep't of Health & Human Servs. (M.D. Fla. 2025). · cites it 2× “7–8); see also 42 C.F.R. § 1001.2007 (a) (stating that excluded parties may request a hearing before an ALJ only on the issues of whether the basis for the imposition of the sanction exists and the length of the exclusion is unreasonable).”
Fuentes v. Azar (D.D.C. 2020). “” See 42 C.F.R. § 1001.2007 (a). The parties to such proceeding are the petitioner and the Inspector General.”
Bailey v. Azar (D.D.C. 2020). “42 C.F.R. § 1001.2007 (a)(1). Should the ALJ affirm the Secretary’s determination, he may then appeal the ALJ’s decision to the Appellate Division of the Board.”
Lane v. Azar (D. Maryland 2020). “However, the ALJ’s examination of Lane’s arguments does not constitute a meritorious resolution of either (1) the reason for Lane’s exclusion or (2) the reasonableness of its length—the only bases for requesting a hearing under 42 C.F.R. § 1001.2007 . At bottom, Lane did not…”
Ali v. U.S. Dep't of Health & Human Servs. (E.D. Mich. 2022). “42 C.F.R. § 1001.2007 (a)(1). Any party may appeal the ALJ’s decision to the Appellate Division of the DAB.”
Show all 15 citing cases →
— 42 C.F.R. § 1001.2007(a)(i) — 2 cases
Friedman v. Shalala (1st Cir. 1995).
Friedman v. Shalala (1st Cir. 1995).
— 42 C.F.R. § 1001.2007(d) — 2 cases
Friedman v. Shalala (1st Cir. 1995).
Friedman v. Shalala (1st Cir. 1995).
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