Subpart J. Subpart J—Administrative Sanctions Imposed Against Health Care Providers

• General Provisions and Definitions

  • SECTION § 890.1001 - Scope and purpose.
  • SECTION § 890.1002 - Use of terminology.
  • SECTION § 890.1003 - Definitions.

• Mandatory Debarments

  • SECTION § 890.1004 - Bases for mandatory debarments.
  • SECTION § 890.1005 - Time limits for OPM to initiate mandatory debarments.
  • SECTION § 890.1006 - Notice of proposed mandatory debarment.
  • SECTION § 890.1007 - Minimum length of mandatory debarments.
  • SECTION § 890.1008 - Mandatory debarment for longer than the minimum length.
  • SECTION § 890.1009 - Contesting proposed mandatory debarments.
  • SECTION § 890.1010 - Debarring official's decision of contest.

• Permissive Debarments

  • SECTION § 890.1011 - Bases for permissive debarments.
  • SECTION § 890.1012 - Time limits for OPM to initiate permissive debarments.
  • SECTION § 890.1013 - Deciding whether to propose a permissive debarment.
  • SECTION § 890.1014 - Notice of proposed permissive debarment.
  • SECTION § 890.1015 - Minimum and maximum length of permissive debarments.
  • SECTION § 890.1016 - Aggravating and mitigating factors used to determine the length of permissive debarments.
  • SECTION § 890.1017 - Determining length of debarment based on revocation or suspension of a provider's professional licensure.
  • SECTION § 890.1018 - Determining length of debarment for an entity owned or controlled by a sanctioned provider.
  • SECTION § 890.1019 - Determining length of debarment based on ownership or control of a sanctioned entity.
  • SECTION § 890.1020 - Determining length of debarment based on false, wrongful, or deceptive claims.
  • SECTION § 890.1021 - Determining length of debarment based on failure to furnish information needed to resolve claims.
  • SECTION § 890.1022 - Contesting proposed permissive debarments.
  • SECTION § 890.1023 - Information considered in deciding a contest.
  • SECTION § 890.1024 - Standard and burden of proof for deciding contests.
  • SECTION § 890.1025 - Cases where additional fact-finding is not required.
  • SECTION § 890.1026 - Procedures if a fact-finding proceeding is not required.
  • SECTION § 890.1027 - Cases where an additional fact-finding proceeding is required.
  • SECTION § 890.1028 - Conducting a fact-finding proceeding.
  • SECTION § 890.1029 - Deciding a contest after a fact-finding proceeding.

• Suspension

  • SECTION § 890.1030 - Effect of a suspension.
  • SECTION § 890.1031 - Grounds for suspension.
  • SECTION § 890.1032 - Length of suspension.
  • SECTION § 890.1033 - Notice of suspension.
  • SECTION § 890.1034 - Counting a period of suspension as part of a subsequent debarment.
  • SECTION § 890.1035 - Provider contests of suspensions.
  • SECTION § 890.1036 - Information considered in deciding a contest.
  • SECTION § 890.1037 - Cases where additional fact-finding is not required.
  • SECTION § 890.1038 - Deciding a contest without additional fact-finding.
  • SECTION § 890.1039 - Cases where additional fact-finding is required.
  • SECTION § 890.1040 - Conducting a fact-finding proceeding.
  • SECTION § 890.1041 - Deciding a contest after a fact-finding proceeding.

• Effect of Debarment

  • SECTION § 890.1042 - Effective dates of debarments.
  • SECTION § 890.1043 - Effect of debarment on a provider.

• Notifying Outside Parties About Debarment and Suspension Actions

  • SECTION § 890.1044 - Entities notified of OPM-issued debarments and suspensions.
  • SECTION § 890.1045 - Informing persons covered by FEHBP about debarment or suspension of their provider.

• Exceptions to the Effect of Debarments

  • SECTION § 890.1046 - Effect of debarment or suspension on payments for services furnished in emergency situations.
  • SECTION § 890.1047 - Special rules for institutional providers.
  • SECTION § 890.1048 - Waiver of debarment for a provider that is the sole source of health care services in a community.

• Special Exceptions To Protect Covered Persons

  • SECTION § 890.1049 - Claims for non-emergency items or services furnished by a debarred or suspended provider.
  • SECTION § 890.1050 - Exception to a provider's debarment for an individual enrollee.

• Reinstatement

  • SECTION § 890.1051 - Applying for reinstatement when period of debarment expires.
  • SECTION § 890.1052 - Reinstatements without application.
  • SECTION § 890.1053 - Table of procedures and effective dates for reinstatements.
  • SECTION § 890.1054 - Agencies and entities to be notified of reinstatements.
  • SECTION § 890.1055 - Contesting a denial of reinstatement.

• Civil Monetary Penalties and Financial Assessments

  • SECTION § 890.1060 - Purpose and scope of civil monetary penalties and assessments.
  • SECTION § 890.1061 - Bases for penalties and assessments.
  • SECTION § 890.1062 - Deciding whether to impose penalties and assessments.
  • SECTION § 890.1063 - Maximum amounts of penalties and assessments.
  • SECTION § 890.1064 - Determining the amounts of penalties and assessments to be imposed on a provider.
  • SECTION § 890.1065 - Deciding whether to suspend or debar a provider in a case that also involves penalties and assessments.
  • SECTION § 890.1066 - Notice of proposed penalties and assessments.
  • SECTION § 890.1067 - Provider contests of proposed penalties and assessments.
  • SECTION § 890.1068 - Effect of not contesting proposed penalties and assessments.
  • SECTION § 890.1069 - Information the debarring official must consider in deciding a provider's contest of proposed penalties and assessments.
  • SECTION § 890.1070 - Deciding contests of proposed penalties and assessments.
  • SECTION § 890.1071 - Further appeal rights after final decision to impose penalties and assessments.
  • SECTION § 890.1072 - Collecting penalties and assessments.