Title 42
SECTION 402.205
402.205 Length of exclusion.
§ 402.205 Length of exclusion.The length of exclusion from participation in Medicare, Medicaid, and, where applicable, other Federal health care programs, is contingent upon the specific violation of the Medicare statute. A full description of the specific violations identified in the sections of the Act are cross-referenced in the regulatory sections listed in the table in paragraph (a) of this section.
(a) In no event will the period of exclusion exceed 5 years for violation of the following sections of the Act:
| Social Security Act paragraph |
Code of Federal
Regulations section |
|---|---|
| 1833(h)(5)(D) in repeated cases | § 402.1(c)(1) |
| 1833(q)(2)(B) in repeated cases | § 402.1(c)(3) |
| 1834(a)(11)(A) | § 402.1(c)(4) |
| 1834(a)(18)(B) | § 402.1(c)(5) |
| 1834(b)(5)(C) | § 402.1(c)(6) |
| 1834(c)(4)(C) | § 402.1(c)(7) |
| 1834(h)(3) | § 402.1(c)(8) |
| 1834(j)(4) | § 402.1(c)(10) |
| 1834(k)(6) | § 402.1(c)(31) |
| 1834(l)(6) | § 402.1(c)(32) |
| 1842(b)(18)(B) | § 402.1(c)(11) |
| 1842(k) | § 402.1(c)(12) |
| 1842(l)(3) | § 402.1(c)(13) |
| 1842(m)(3) | § 402.1(c)(14) |
| 1842(n)(3) | § 402.1(c)(15) |
| 1842(p)(3)(B) in repeated cases | § 402.1(c)(16) |
| 1848(g)(1)(B) in repeated cases | § 402.1(c)(17) |
| 1848(g)(3)(B) | § 402.1(c)(18) |
| 1848(g)(4)(B)(ii) in repeated cases | § 402.1(c)(19) |
| 1879(h) | § 402.1(c)(23) |
(b) For violation of the following sections, there is no maximum time limit for the period of exclusion.
| Social Security Act paragraph |
Code of Federal
Regulations section |
|---|---|
| 1834(a)(17)(c) for a pattern of contacts | § 402.1(e)(2)(i) |
| 1834(h)(3) for a pattern of contacts | § 402.1(e)(2)(ii) |
| 1877(g)(5) | § 402.1(c)(22) |
| 1882(a)(2) | § 402.1(c)(24) |
| 1882(p)(8) | § 402.1(c)(25) |
| 1882(p)(9)(C) | § 402.1(c)(26) |
| 1882(q)(5)(C) | § 402.1(c)(27) |
| 1882(r)(6)(A) | § 402.1(c)(28) |
| 1882(s)(4) | § 402.1(c)(29) |
| 1882(t)(2) | § 402.1(c)(30) |
(c) For a person excluded under any of the grounds specified in paragraph (a) of this section, notwithstanding any other requirements in this section, reinstatement occurs -
(1) At the expiration of the period of exclusion, if the exclusion was imposed for a period of 5 years; or
(2) At the expiration of 5 years from the effective date of the exclusion, if the exclusion was imposed for a period of less than 5 years and the initiating agency did not receive the appropriate written request for reinstatement as specified in § 402.300.