Health care programs; fraud and abuse: Health Insurance Portability and Accountability Act— Medicare and State health care programs; exclusions; legal authorities; correction,

[Federal Register: October 29, 1998 (Volume 63, Number 209)]

[Rules and Regulations]

[Page 57918-57919]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr29oc98-8]

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Inspector General

42 CFR Part 1001

Health Care Programs: Fraud and Abuse; Revised OIG Exclusion Authorities Resulting From Public Law 104-191; Correction

AGENCY: Office of Inspector General (OIG), HHS.

ACTION: Final Rule; correcting amendment.

SUMMARY: This document contains corrections to the final regulations which were published in the Federal Register of Wednesday, September 2, 1998 (63 FR 46676). The regulations addressed revisions to the OIG's administrative sanction authorities resulting from the Health Insurance Portability and Accountability Act of 1996, along with technical and conforming changes to the OIG exclusion authorities. A number of inadvertent errors appeared in the text of the regulations relating to program integrity for the Medicare and State health care programs. As a result, we are making corrections to two sections addressing the length of exclusion and notice of intent to exclude in order to assure the technical correctness of these regulations.

EFFECTIVE DATE: October 29, 1998.

FOR FURTHER INFORMATION CONTACT: Joel Schaer, (202) 619-0089, OIG Regulations Officer.

SUPPLEMENTARY INFORMATION: The HHS Office of Inspector General (OIG) issued final regulations on September 2, 1998 (63 FR 46676) that addressed revisions to the OIG's administrative sanction authorities resulting from the Health Insurance Portability and Accountability Act of 1996, along with technical and conforming changes to the OIG exclusion authorities. In that final rule, two inadvertent errors appeared in 42 CFR part 1001 and are now being corrected.

In Sec. 1001.2001, addressing the elimination of in-person hearings prior to when an exclusion is proposed, the regulatory language was intended to be consistent with the preamble discussion on page 46682, and state that when an exclusion was proposed under Sec. 1001.701 or Sec. 1001.801, the individual or entity would be permitted to request, in conjunction with their written submission, an opportunity to present oral argument to an OIG official. In order to correctly emphasize that a request to present oral argument to an OIG official can only be made in cases involving exclusion under sections 1128(b)(6) (B) and (C) of the Social Security Act, we are correcting the regulatory text that was set forth in Sec. 1001.2001.

In addition, we are correcting a typographical error that appeared on page 46686, column 3 in Sec. 1001.102(b)(4). Specifically, in line 4 of paragraph (b)(4), the words ``or behavior'' are being corrected to read as ``of behavior.''

List of Subjects in 42 CFR Part 1001

Administrative practice and procedure, Fraud, Grant programs-- health, Health facilities, Health professions, Maternal and child health, Medicaid, Medicare, Social security.

Accordingly, 42 CFR part 1001 is corrected by making the following correcting amendments:

PART 1001--PROGRAM INTEGRITY--MEDICARE AND STATE HEALTH CARE PROGRAMS

1. The authority citation for part 1001 continues to read as follows:

   Authority: 42 U.S.C. 1302, 1320a-7, 1320a-7b, 1395u(j), 1395y(d), 1395y(e), 1395cc(b)(2) (D), (E) and (F), and 1395hh; and sec. 2455, Pub.L. 103-355, 108 Stat. 3327 (31 U.S.C. 6101 note).

2. Section 1001.102 is amended by republishing paragraph (b) introductory text and by revising paragraph (b)(4) to read as follows:

   Sec. 1001.102 Length of exclusion.

   * * * * *

   (b) Any of the following factors may be considered to be aggravating and a basis for lengthening the period of exclusion-- * * * * *

   (4) In convictions involving patient abuse or neglect, the action that resulted in the conviction was premeditated, was part of a continuing pattern of behavior, or consisted of non-consensual sexual acts; * * * * *

3. Section 1001.2001 is amended by revising paragraph (a), by redesignating paragraphs (b) and (c) as paragraphs (c) and (d), respectively, and by adding a new paragraph (b) to read as follows:

   Sec. 1001.2001 Notice of intent to exclude.

   (a) Except as provided in paragraph (c) of this section, if the OIG proposes to exclude an individual or entity in accordance with subpart C of this part, or in accordance with subpart B of this part where the exclusion is for a period exceeding 5 years, it will send written notice of its intent, the basis for the

   [[Page 57919]]

   proposed exclusion and the potential effect of an exclusion. Within 30 days of receipt of notice, which will be deemed to be 5 days after the date on the notice, the individual or entity may submit documentary evidence and written argument concerning whether the exclusion is warranted and any related issues.

   (b) If the OIG proposes to exclude an individual or entity under the provisions of Sec. 1001.701 or 1001.801 of this part, in conjunction with the submission of documentary evidence and written argument, an individual or entity may request an opportunity to present oral argument to an OIG official. * * * * *

   Dated: October 20, 1998. Joel Schaer, OIG Regulations Officer.

   [FR Doc. 98-28736Filed10-28-98; 8:45 am]

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