Part 1001 — Program Integrity—Medicare and State Health Care Programs
Current through Oct 8, 2026
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.
Sections
- § 1001.1 Scope and purpose.
- § 1001.2 Definitions.
- § 1001.101 Basis for liability.
- § 1001.102 Length of exclusion.
- § 1001.201 Conviction relating to program or health care fraud.
- § 1001.301 Conviction relating to obstruction of an investigation or audit.
- § 1001.401 Conviction relating to controlled substances.
- § 1001.501 License revocation or suspension.
- § 1001.601 Exclusion or suspension under a Federal or State health care program.
- § 1001.701 Excessive claims or furnishing of unnecessary or substandard items and services.
- § 1001.801 Failure of HMOs and CMPs to furnish medically necessary items and services.
- § 1001.901 False or improper claims.
- § 1001.951 Fraud and kickbacks and other prohibited activities.
- § 1001.952 Exceptions.
- § 1001.1001 Exclusion of entities owned or controlled by a sanctioned person.
- § 1001.1101 Failure to disclose certain information.
- § 1001.1201 Failure to provide payment information.
- § 1001.1301 Failure to grant immediate access.
- § 1001.1401 Violations of PPS corrective action.
- § 1001.1501 Default of health education loan or scholarship obligations.
- § 1001.1551 Exclusion of individuals with ownership or control interest in sanctioned entities.
- § 1001.1552 Making false statements or misrepresentation of material facts.
- § 1001.1601 Violations of the limitations on physician charges.
- § 1001.1701 Billing for services of assistant at surgery during cataract operations.
- Appendix A to Subpart C of Part 1001
- § 1001.1801 Waivers of exclusions.
- § 1001.1901 Scope and effect of exclusion.
- § 1001.2001 Notice of intent to exclude.
- § 1001.2002 Notice of exclusion.
- § 1001.2003 Notice of proposal to exclude.
- § 1001.2004 Notice to State agencies.
- § 1001.2005 Notice to State licensing agencies.
- § 1001.2006 Notice to others regarding exclusion.
- § 1001.2007 Appeal of exclusions.
- § 1001.3001 Timing and method of request for reinstatement.
- § 1001.3002 Basis for reinstatement.
- § 1001.3003 Approval of request for reinstatement.
- § 1001.3004 Denial of request for reinstatement.
- § 1001.3005 Withdrawal of exclusion for reversed or vacated decisions.