Health care programs: fraud and abuse; revisions to the PRO sanctions process--HHS. Final rule.
This final rule revises and updates the procedures governing the imposition and adjudication of program sanctions predicted on recommendations of State Utilization and Quality Control Peer Review Organizations (PROs). These changes are being made as a result of statutory revisions designed to address health care fraud and abuse issues and the OIG sanctions process. In addition, this final rule sets forth new appeal and reinstatement procedures for practitioners and other persons excluded by the OIG based on a PRO recommendation.
D005607:Fraud / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence* / Q000592:standards; D011366:Professional Review Organizations / Q000331:legislation & jurisprudence*; D011786:Quality Control; D014481:United States; D014483:United States Dept. of Health and Human Services