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.

• 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.

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

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