C.F.R. » Title 42 » CHAPTER V—OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—OIG AUTHORITIES › PART 1004—IMPOSITION OF SANCTIONS ON HEALTH CARE PRACTITIONERS AND PROVIDERS OF HEALTH CARE SERVICES BY A QUALITY IMPROVEMENT ORGANIZATION › Subpart C—QIO Responsibilities

42 C.F.R. § 1004.40

Action on identification of a violation

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

When a QIO identifies a violation, it must—

(a) Indicate whether the violation is a gross and flagrant violation or is a substantial violation in a substantial number of cases; and

(b) Send the practitioner or other person written notice of the identification of a violation containing the following information—

(1) The obligation(s) involved;

(2) The situation, circumstances or activity that resulted in a violation;

(3) The authority and responsibility of the QIO to report violations of any obligation under section 1156(a) of the Act;

(4) A suggested method for correcting the situation and a time period for corrective action, if appropriate;

(5) The sanction that the QIO could recomment to the OIG;

(6) The right of the practitioner or other person to submit to the QIO within 30 days of receipt of the notice additional information or a written request for a meeting with the QIO to review and discuss the finding, or both. The date of receipt is presumed to be 5 days after the date on the notice, unless there is a reasonable showing to the contrary. The notice will also state that if a meeting is requested—

(i) It will be held within 30 days of receipt by the QIO of the request, but may be extended for good cause;

(ii) The practitioner or other person may have an attorney present; and

(iii) The attorney, if present, will be permitted to make opening and closing remarks, ask clarifying questions at the meeting and assist the practitioner or other person in presenting the testimony of expert witnesses who may appear on the practitioner's or other person's behalf; and

(7) A copy of the material used by the QIO in arriving at its finding except for QIO deliberations, as set forth in § 480.139 of this part.

[60 FR 63640, Dec. 12, 1995, as amended at 85 FR 72910, Nov. 16, 2020]
Notes of Decisions
Cited in 4 cases, 1987–1997 · leading case: Lavapies v. Bowen, 687 F. Supp. 1193 (S.D. Ohio 1988).
Sort: Relevance Newest Treatment
Lavapies v. Bowen, 687 F. Supp. 1193 (S.D. Ohio 1988). · cites it 2× “42 C.F.R. § 1004.40 . If the PRO determines that the violation is a gross and flagrant one, the PRO must give the practitioner written notice setting out this determination, the basis for it, and the sanction that will be recommended.”
Assar v. Crescent Counties Found. for Med. Care, 13 F.3d 215 (7th Cir. 1993). · cites it 3× “” 42 C.F.R. § 1004.40 (b) (emphasis added).”
Papendick v. Bowen, 658 F. Supp. 1425 (W.D. Wis. 1987). “42 C.F.R. § 1004.40 . If *1429 the PRO determines that the violation is a gross and flagrant one, the PRO must give the practitioner written notice setting out this determination, the basis for it, and the sanction that will be recommended.”
Corkill v. Shalala, 109 F.3d 1348 (9th Cir. 1997). “” 42 C.F.R. § 1004.40 (c)(6) (emphasis added).”
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.