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. § 1004.60

QIO finding of a violation

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

(a) On the basis of any additional information received, the QIO will affirm or modify its finding. If the QIO affirms its finding, it may suggest in writing a method for correcting the situation and a time period for corrective action. This CAP could correspond with, or be a continuation of, a prior CAP or be a new proposal based on additional information received by the QIO. If the finding has been resolved to the QIO's satisfaction, the QIO may modify its initial finding or recommendation or close the case.

(b) The QIO must give written notice to the practitioner or other person of any action it takes as a result of the additional information received, as specified in § 1004.70.

(c) At least one member of the QIO participating in the process which resulted in a recommendation to the OIG that a practitioner or other person be sanctioned should practice in a similar geographic area, e.g. urban or rural, and at least one member of the panel must be in the same medical specialty. Both requirements can be met by a single individual. In addition, no one at the QIO who is a participant in such a finding may be in direct economic competition with, or have a substantial bias for or against, that practitioner or other person being recommended for sanction.

Notes of Decisions
Cited in 4 cases, 1987–1993 · 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). “42 C.F.R. § 1004.60 (b)(1), (2). Once the OIG receives the PRO’S report and recommendation, the OIG must review the report and recommendation to determine whether (1) the PRO is following its procedure; (2) a violation has occurred; and (3) the practitioner has demonstrated an…”
Papendick v. Bowen, 658 F. Supp. 1425 (W.D. Wis. 1987). “42 C.F.R. § 1004.60 (b)(1), (2). Once the OIG receives the PRO’S report and recommendation, the OIG must review the report and recommendation to determine whether (1) the PRO is following its procedure; (2) a violation has occurred; and (3) the practitioner has demonstrated an…”
Doyle v. Sec'y of Health & Human Servs., 848 F.2d 296 (1st Cir. 1988). “42 C.F.R. § 1004.60 . After the Inspector General acts, the doctor is entitled to a full evidentiary hearing before an AU, and to appellate agency review.”
Assar v. Crescent Counties Found. for Med. Care, 13 F.3d 215 (7th Cir. 1993). “42 C.F.R. § 1004.60 (b)(2). OIG then reviews the determination and recommended sanction ( 42 C.”
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.