Health Care Programs: Fraud and Abuse; Revisions to the PRO Sanctions Process

Resumo

This proposed rule would revise and update the procedures governing the imposition and adjudication of program sanctions predicated on recommendations of State Utilization and Quality Control Peer Review Organizations (PROs). These changes are necessitated by statutory revisions addressing health care fraud and abuse issues and the OIG sanctions process. In addition, this proposed rule also sets forth new appeal and reinstatement procedures for practitioners and other persons excluded by the OIG based on a PRO recommendation.