Title 42

PART 1001

Part 1001 - Program Integrity - Medicare And State Health Care Programs

PART 1001 - PROGRAM INTEGRITY - MEDICARE AND STATE HEALTH CARE PROGRAMS Authority:42 U.S.C. 1302; 1320a-7; 1320a-7b; 1395u(j); 1395u(k); 1395w-104(e)(6), 1395y(d); 1395y(e); 1395cc(b)(2)(D), (E), and (F); 1395hh; 1842(j)(1)(D)(iv), 1842(k)(1), and sec. 2455, Pub. L. 103-355, 108 Stat. 3327 (31 U.S.C. 6101 note). Source:57 FR 3330, Jan. 29, 1992, unless otherwise noted.

42:5.0.2.5.2.1SUBPART A
Subpart A - General Provisions
42:5.0.2.5.2.1.69.1SECTION 1001.1
   1001.1 Scope and purpose.
42:5.0.2.5.2.1.69.2SECTION 1001.2
   1001.2 Definitions.
42:5.0.2.5.2.2SUBPART B
Subpart B - Mandatory Exclusions
42:5.0.2.5.2.2.69.1SECTION 1001.101
   1001.101 Basis for liability.
42:5.0.2.5.2.2.69.2SECTION 1001.102
   1001.102 Length of exclusion.
42:5.0.2.5.2.3SUBPART C
Subpart C - Permissive Exclusions
42:5.0.2.5.2.3.69.1SECTION 1001.201
   1001.201 Conviction relating to program or health care fraud.
42:5.0.2.5.2.3.69.2SECTION 1001.301
   1001.301 Conviction relating to obstruction of an investigation or audit.
42:5.0.2.5.2.3.69.3SECTION 1001.401
   1001.401 Conviction relating to controlled substances.
42:5.0.2.5.2.3.69.4SECTION 1001.501
   1001.501 License revocation or suspension.
42:5.0.2.5.2.3.69.5SECTION 1001.601
   1001.601 Exclusion or suspension under a Federal or State health care program.
42:5.0.2.5.2.3.69.6SECTION 1001.701
   1001.701 Excessive claims or furnishing of unnecessary or substandard items and services.
42:5.0.2.5.2.3.69.7SECTION 1001.801
   1001.801 Failure of HMOs and CMPs to furnish medically necessary items and services.
42:5.0.2.5.2.3.69.8SECTION 1001.901
   1001.901 False or improper claims.
42:5.0.2.5.2.3.69.9SECTION 1001.951
   1001.951 Fraud and kickbacks and other prohibited activities.
42:5.0.2.5.2.3.69.10SECTION 1001.952
   1001.952 Exceptions.
42:5.0.2.5.2.3.69.11SECTION 1001.1001
   1001.1001 Exclusion of entities owned or controlled by a sanctioned person.
42:5.0.2.5.2.3.69.12SECTION 1001.1101
   1001.1101 Failure to disclose certain information.
42:5.0.2.5.2.3.69.13SECTION 1001.1201
   1001.1201 Failure to provide payment information.
42:5.0.2.5.2.3.69.14SECTION 1001.1301
   1001.1301 Failure to grant immediate access.
42:5.0.2.5.2.3.69.15SECTION 1001.1401
   1001.1401 Violations of PPS corrective action.
42:5.0.2.5.2.3.69.16SECTION 1001.1501
   1001.1501 Default of health education loan or scholarship obligations.
42:5.0.2.5.2.3.69.17SECTION 1001.1551
   1001.1551 Exclusion of individuals with ownership or control interest in sanctioned entities.
42:5.0.2.5.2.3.69.18SECTION 1001.1552
   1001.1552 Making false statements or misrepresentation of material facts.
42:5.0.2.5.2.3.69.19SECTION 1001.1601
   1001.1601 Violations of the limitations on physician charges.
42:5.0.2.5.2.3.69.20SECTION 1001.1701
   1001.1701 Billing for services of assistant at surgery during cataract operations.
42:5.0.2.5.2.3.69.21.1APPENDIX Appendix A
   Appendix A to Subpart C of Part 1001
42:5.0.2.5.2.4SUBPART D
Subpart D - Waivers and Effect of Exclusion
42:5.0.2.5.2.4.69.1SECTION 1001.1801
   1001.1801 Waivers of exclusions.
42:5.0.2.5.2.4.69.2SECTION 1001.1901
   1001.1901 Scope and effect of exclusion.
42:5.0.2.5.2.5SUBPART E
Subpart E - Notice and Appeals
42:5.0.2.5.2.5.69.1SECTION 1001.2001
   1001.2001 Notice of intent to exclude.
42:5.0.2.5.2.5.69.2SECTION 1001.2002
   1001.2002 Notice of exclusion.
42:5.0.2.5.2.5.69.3SECTION 1001.2003
   1001.2003 Notice of proposal to exclude.
42:5.0.2.5.2.5.69.4SECTION 1001.2004
   1001.2004 Notice to State agencies.
42:5.0.2.5.2.5.69.5SECTION 1001.2005
   1001.2005 Notice to State licensing agencies.
42:5.0.2.5.2.5.69.6SECTION 1001.2006
   1001.2006 Notice to others regarding exclusion.
42:5.0.2.5.2.5.69.7SECTION 1001.2007
   1001.2007 Appeal of exclusions.
42:5.0.2.5.2.6SUBPART F
Subpart F - Reinstatement into the Programs
42:5.0.2.5.2.6.69.1SECTION 1001.3001
   1001.3001 Timing and method of request for reinstatement.
42:5.0.2.5.2.6.69.2SECTION 1001.3002
   1001.3002 Basis for reinstatement.
42:5.0.2.5.2.6.69.3SECTION 1001.3003
   1001.3003 Approval of request for reinstatement.
42:5.0.2.5.2.6.69.4SECTION 1001.3004
   1001.3004 Denial of request for reinstatement.
42:5.0.2.5.2.6.69.5SECTION 1001.3005
   1001.3005 Withdrawal of exclusion for reversed or vacated decisions.