---
kind: "section"
citation: "42 C.F.R. § 1004.80"
title: "42"
number: "1004.80"
heading: "QIO report to the OIG."
url: "https://uscodex.org/cfr/42/1004.80"
---

# §1004.80. QIO report to the OIG.

- (a) **Manner of reporting.** If the violation(s) identified by the QIO have not been resolved, it must submit a report and recommendation to the OIG at the field office with jurisdiction.
- (b) **Content of report.** The QIO report must include the following information—
  - (1) Identification of the practitioner or other person and, when applicable, the name of the director, administrator or owner of the entity involved;
  - (2) The type of health care services involved;
  - (3) A description of each failure to comply with an obligation, including specific dates, places, circumstances and other relevant facts;
  - (4) Pertinent documentary evidence;
  - (5) Copies of written correspondence, including reports of conversations with the practitioner or other person regarding the violation and, if applicable, a copy of the verbatim transcript of the meeting with the practitioner or other person;
  - (6) The QIO's finding that an obligation under section 1156(a) of the Act has been violated and that the violation is substantial and has occurred in a substantial number of cases or is gross and flagrant;
  - (7) A case-by-case analysis and evaluation of any additional information provided by the practitioner or other person in response to the QIO's initial finding;
  - (8) A copy of the CAP that was developed and documentation of the results of such plan;
  - (9) The number of admissions by the practitioner or other person reviewed by the QIO during the period in which the violation(s) were identified;
  - (10) The professional qualifications of the QIO's reviewers; and
  - (11) **The QIO's sanction recommendation.**
- (c) **QIO recommendation.** The QIO must specify in its report—
  - (1) The sanction recommended;
  - (2) The amount of the monetary penalty recommended, if applicable;
  - (3) The period of exclusion recommended, if applicable;
  - (4) The availability of alternative sources of services in the community, with supporting information; and
  - (5) **The county or counties in which the practitioner or other person furnishes services.**

## Notes

### Amendments

[60 FR 63640, Dec. 12, 1995, as amended at 62 FR 23143, Apr. 29, 1997]

### Authority

Authority: 42 U.S.C. 1302 and 1320c-5.

### Source

Source: 60 FR 63640, Dec. 12, 1995, unless otherwise noted.

### Amendments

[60 FR 63640, Dec. 12, 1995, as amended at 62 FR 23143, Apr. 29, 1997]