Title 42, Part 1001 — Program Integrity—medicare and State Health Care Programs
38 sections
Section 1001.1
Scope and purpose.
Section 1001.2
Definitions.
Section 1001.101
Basis for liability.
Section 1001.102
Length of exclusion.
Section 1001.201
Conviction relating to program or health care fraud.
Section 1001.301
Conviction relating to obstruction of an investigation or audit.
Section 1001.401
Conviction relating to controlled substances.
Section 1001.501
License revocation or suspension.
Section 1001.601
Exclusion or suspension under a Federal or State health care program.
Section 1001.701
Excessive claims or furnishing of unnecessary or substandard items and services.
Section 1001.801
Failure of HMOs and CMPs to furnish medically necessary items and services.
Section 1001.901
False or improper claims.
Section 1001.951
Fraud and kickbacks and other prohibited activities.
Section 1001.952
Exceptions.
Section 1001.1001
Exclusion of entities owned or controlled by a sanctioned person.
Section 1001.1101
Failure to disclose certain information.
Section 1001.1201
Failure to provide payment information.
Section 1001.1301
Failure to grant immediate access.
Section 1001.1401
Violations of PPS corrective action.
Section 1001.1501
Default of health education loan or scholarship obligations.
Section 1001.1551
Exclusion of individuals with ownership or control interest in sanctioned entities.
Section 1001.1552
Making false statements or misrepresentation of material facts.
Section 1001.1601
Violations of the limitations on physician charges.
Section 1001.1701
Billing for services of assistant at surgery during cataract operations.
Section 1001.1801
Waivers of exclusions.
Section 1001.1901
Scope and effect of exclusion.
Section 1001.2001
Notice of intent to exclude.
Section 1001.2002
Notice of exclusion.
Section 1001.2003
Notice of proposal to exclude.
Section 1001.2004
Notice to State agencies.
Section 1001.2005
Notice to State licensing agencies.
Section 1001.2006
Notice to others regarding exclusion.
Section 1001.2007
Appeal of exclusions.
Section 1001.3001
Timing and method of request for reinstatement.
Section 1001.3002
Basis for reinstatement.
Section 1001.3003
Approval of request for reinstatement.
Section 1001.3004
Denial of request for reinstatement.
Section 1001.3005
Withdrawal of exclusion for reversed or vacated decisions.