(a) Acknowledgement. The OIG will inform the QIO of the date it received the QIO's report and recommendation.
(b) Review. The OIG will review the QIO report and recommendation to determine whether—
(1) The QIO has followed the regulatory requirements of this part; and
(2) A violation has occurred.
(c) Rejection of the QIO recommendation. If the OIG decides that a sanction is not warranted, it will notify the QIO that recommended the sanction, the affected practitioner or other person, and the licensing board informed by the QIO of the sanction recommendation that the recommendation is rejected.
(d) Decision to sanction. If the OIG decides that a violation of obligations has occurred, it will determine the appropriate sanction by considering—
(1) The recommendation of the QIO;
(2) The type of offense;
(3) The severity of the offense;
(4) The previous sanction record of the practitioner or other person;
(5) The availability of alternative sources of services in the community;
(6) Any prior problems the Medicare or State health care programs have had with the practitioner or other person; and
(7) Any other matters relevant to the particular case.
(e) Exclusion sanction. If the QIO submits a recommendation for exclusion to the OIG, and a determination is not made by the 120th day after actual receipt by the OIG, the exclusion sanction recommended will become effective and the OIG will provide notice in accordance with § 1004.110(f).
(f) Monetary penalty. If the QIO recommendation is to assess a monetary penalty, the 120-day provision does not apply and the OIG will provide notice in accordance with § 1004.110 (a)-(e).
[60 FR 63640, Dec. 12, 1995, as amended at 62 FR 23143, Apr. 29, 1997]
Notes of Decisions
Cited in
6
cases, 1987–1993 · leading case:
Lavapies v. Bowen, 687 F. Supp. 1193 (S.D. Ohio 1988).
Lavapies v. Bowen, 687 F. Supp. 1193 (S.D. Ohio 1988).
· cites it 4× “42 C.F.R. § 1004.100 . The sanction is effective 15 days from receipt of the notice.”
Papendick v. Bowen, 658 F. Supp. 1425 (W.D. Wis. 1987).
· cites it 4× “42 C.F.R. § 1004.100 . The sanction is effective 15 days from receipt of the notice.”
Hussain v. Sec'y of Health & Human Resources, 748 F. Supp. 277 (D.N.J. 1990).
· cites it 3× “See 42 C.F.R. § 1004.100 . The exclusion takes effect 15 days after the health care provider receives notification of exclusion which is presumed to occur five days after the exclusion is mailed.”
Cassim v. Bowen, 824 F.2d 791 (9th Cir. 1987).
“§ 1320c-5(b)(2) (1982); 42 C.F.R. § 1004.100 (1986). Finally, OIG told Cassim of his right to appeal the ruling to an administrative law judge (ALJ).”
Varandani v. Bowen, 824 F.2d 307 (4th Cir. 1987).
“52 (d) (1985), now codified at 42 C.F.R. § 1004.100 (d) (1986). Dr. Varandani filed this suit just before the suspension became effective, and the district court preliminarily enjoined the suspension.”
Assar v. Crescent Counties Found. for Med. Care, 13 F.3d 215 (7th Cir. 1993).
· cites it 2× “90 ) and notifies both the provider and the public of its decision ( 42 C.F.R. § 1004.100 ). Finally, the regulations provide: The determination and notice of sanction provided for in this section constitute an “initial determination” and a “notice of initial determination” for…”
— 42 C.F.R. § 1004.100(d) — 2 cases
Lavapies v. Bowen, 687 F. Supp. 1193 (S.D. Ohio 1988).
“42 C.F.R. § 1004.100 . The sanction is effective 15 days from receipt of the notice.”
Papendick v. Bowen, 658 F. Supp. 1425 (W.D. Wis. 1987).
“42 C.F.R. § 1004.100 . The sanction is effective 15 days from receipt of the notice.”
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.