C.F.R. » Title 42 » CHAPTER V—OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—OIG AUTHORITIES › PART 1002—PROGRAM INTEGRITY—STATE-INITIATED EXCLUSIONS FROM MEDICAID › Subpart C—Procedures for State-Initiated Exclusions

42 C.F.R. § 1002.213

Appeals of exclusions

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Before imposing an exclusion under § 1002.210, the State agency must give the individual or entity the opportunity to submit documents and written argument against the exclusion. The individual or entity must also be given any additional appeals rights that would otherwise be available under procedures established by the State.

Notes of Decisions
Cited in 11 cases (1 in the last 5 years), 2009–2025 · leading case: Planned Parenthood of AR, etc. v. Cindy Gillespie, 867 F.3d 1034 (8th Cir. 2017).
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Planned Parenthood of AR, etc. v. Cindy Gillespie, 867 F.3d 1034 (8th Cir. 2017). · cites it 5× “§§ 1396a(a)(4), (39); 42 C.F.R. § 1002.213 . Under Arkansas law, a provider who is terminated has a right to file an administrative appeal within thirty days of the termination, and then to seek judicial review.”
Planned Parenthood of Grt TX v. Courtney Ph, 981 F.3d 347 (5th Cir. 2020). “§ 1396a(a)(4)(A); 42 C.F.R. § 1002.213 . The statute thus does not contemplate—either by its express terms or its administrative implementation—enforcement through private-patient lawsuits.”
Planned Parenthood v. Joshua Baker, 941 F.3d 687 (4th Cir. 2019). “§ 1396a(a)(4); 42 C.F.R. § 1002.213 ; and (3) a state administrative process for Medicaid recipients to challenge a claim denial, 42 U.”
Planned Parenthood of Greater Tex. Fam. Plan. & Preventative Health Servs., Inc v. Smith, 913 F.3d 551 (5th Cir. 2019). · cites it 2× “It is highly doubtful that Congress intended a loophole whereby providers could use patients as litigation proxies to avoid the state’s remedial procedures and develop separate, potentially conflicting judicial standards of compliance.”
Planned Parenthood Arizona, Inc. v. Betlach, 899 F. Supp. 2d 868 (D. Ariz. 2012). “212 , and an opportunity to appeal the exclusion before it is imposed, 42 C.F.R. § 1002.213 . A state’s authority to exclude providers is not, therefore, coextensive with the state’s authority to set generally applicable provider qualifications.”
River Nile Invalid Coach & Ambulance, Inc. v. Velez, 601 F. Supp. 2d 609 (D.N.J. 2009). “” 42 C.F.R. § 1002.213 . Under the RFP, the broker must consult with the OIG website to ensure that it does not contract with an excluded provider, but it does not have the power to put a provider on the exclusion list.”
River Nile Invalid Coach & Ambulance v. Velez, 601 F. Supp. 2d 609 (D.N.J. 2009). “" 42 C.F.R. § 1002.213 . Under the RFP, the broker must consult with the OIG website to ensure that it does not contract with an excluded provider, but it does not have the power to put a provider on the exclusion list.”
Planned Parenthood of Grt TX v. Courtney Ph (5th Cir. 2020). “§ 1396a(a)(4)(A); 42 C.F.R. § 1002.213 . The statute thus does not contemplate—either by its express terms or its administrative implementation—enforcement through private-patient lawsuits.”
Planned Parenthood of Grt TX v. Courtney Ph (5th Cir. 2020). “§ 1396a(a)(4)(A); 42 C.F.R. § 1002.213 . The statute thus does not contemplate—either by its express terms or its administrative implementation—enforcement through private-patient lawsuits.”
Planned Parenthood of Grt TX v. Courtney Ph (5th Cir. 2020). “§ 1396a(a)(4)(A); 42 C.F.R. § 1002.213 . The statute thus does not contemplate—either by its express terms or its administrative implementation—enforcement through private-patient lawsuits.”
Planned Parenthood Great Rivers v. Mo Dept of Soc. Servs. Cases 24-4157-CV-C-BP, 24-4158-CV-C-BP & 24-4159-CV-C-BP are Consol. into a single case. All filings shall be made in 24-4157-CV-C-BP. (W.D. Mo. 2025). “§§ 1396a(a)(4), (39); 42 C.F.R. § 1002.213 ). Missouri has established such procedures, which start with a proceeding in the AHC.”
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