§890.1013. Deciding whether to propose a permissive debarment.
5 C.F.R. § 890.1013
Review factors. The factors OPM shall consider in deciding whether to propose a provider's debarment under a permissive debarment authority are:
The nature of any claims involved in the basis for the proposed debarment and the circumstances under which they were presented to FEHBP carriers;
The improper conduct involved in the basis for the proposed debarment, and the provider's degree of culpability and history of prior offenses;
The extent to which the provider poses or may pose a risk to the health and safety of FEHBP-covered individuals or to the integrity of FEHBP transactions; and
Other factors specifically relevant to the provider's debarment that shall be considered in the interests of fairness.
Absence of a factor. The absence of a factor shall be considered neutral, and shall have no effect on OPM's decision.
Specialized review in certain cases. In determining whether to propose debarment under 5 U.S.C 8902a(c)(4) for providing items or services substantially in excess of the needs of a covered individual or for providing items or services that fail to meet professionally-recognized quality standards, OPM shall obtain the input of trained reviewers, based on written medical protocols developed by physicians. If OPM cannot reach a decision on this basis, it shall consult with a physician in an appropriate specialty area.
Notes, amendments, and revision history
Authority
Authority: 5 U.S.C. 8902a.
Source
Source: 68 FR 5475, Feb. 3, 2003, unless otherwise noted.
Authority
Authority: 5 U.S.C. 8913. Sec. 890.102 also issued under sections 11202(f), 11232(e), and 11246(b) of Pub. L. 105-33, 111 Stat. 251. Sec. 890.111 also issued under 36 U.S.C. 5522. Sec. 890.112 also issued under 2 U.S.C. 2051. Sec. 890.113 also issued under section 1110 of Pub. L. 116-92, 133 Stat. 1198 (5 U.S.C. 8702 note). Sec. 890.301 also issued under 26 U.S.C. 9801. Sec. 890.302(b) also issued under 42 U.S.C. 300gg-14. Sec. 890.803 also issued under 50 U.S.C. 3516 (formerly 50 U.S.C. 403p); 22 U.S.C. 4069c and 4069c-1. Subpart L also issued under section 599C of Pub. L. 101-513, 104 Stat. 2064 (5 U.S.C. 5561 note). Subpart M also issued under 10 U.S.C. 1108; 25 U.S.C. 1647b. Subpart P also issued under 5 U.S.C. 8903c.
Source
Source: 33 FR 12510, Sept. 4, 1968, unless otherwise noted.