Author: Ashley Morgan, Christin Thompson
(December 20, 2023): Most health care providers and suppliers are familiar with the fact that as a participating provider in the Medicare and / or Medicaid programs, certain criminal convictions, adverse licensure actions, and various types of prohibited conduct may subject the provider to exclusion from participation in Federal health care programs[1] by the Department of Health and Human Services, Office of Inspector General (HHS OIG).[2] However, they may not fully appreciate the fact that a number of other Federal agencies have also been vested with the authority to debar[3] or suspend a health care providers from doing business with their agency and the programs they administer.
The Federal Employee Health Benefits Program (FEHBP) is the largest employer sponsored group health plan in the world, providing coverage for nearly 9 million Federal employees, their eligible family members, and retirees.[4] The authority to safeguard the FEHBP program from waste, fraud and abuse has been delegated from OPM’s Director to the agency’s Office of Inspector General (OPM OIG). One of the many tools that OPM OIG utilizes to safeguard the health and safety of FEHBP beneficiaries and protect the financial integrity of the program is the agency’s debarment program. This article focuses on the debarment and suspension authority of the Office of Personnel Management, Office of Inspector General (OPM OIG or agency) with respect to the FEHBP. We also cover points you should consider if you are faced with a proposed debarment action.
I. Historical Overview of OPM Debarment and Suspension Authorities:
As far back as 1982, the heads of Federal executive agencies have been required to establish and maintain systems of internal control to safeguard agency assets and programs against "waste, loss, unauthorized use and misappropriation." [5] By the early to mid-1980’s it became clear that existing systems to protect the financial integrity of the FEHBP[6] program were insufficient to prevent program-related fraud, waste and abuse. Early instances of wrongdoing included:
- 1982: Approximately $35,000 was embezzled by an official of FEHBP funded postal employee health care payor plan. The official responsible for improper conduct was subsequently prosecuted.
- 1984: More than $1,000,000 was embezzled by officials of an FEHBP funded postal health care payor plan. As in the earlier case, the officials responsible for improper conduct were subsequently prosecuted.
- 1984: An OPM audit of funds claims paid to a postal employee health care payor plan found that approximately $1,000,000 was improperly paid. The plan settled the matter by repaying the funds, along with additional civil penalties.[7]
In light of these incidents and other violations, Congress took action and passed the "Federal Employees Health Benefits Amendments Act of 1988.” [8] Under this legislation, OPM was given the authority to exclude health care providers found guilty of criminal fraud or unethical practices from participating in the FEHBP program. Unfortunately, the agency failed to follow through with regulations implementing the sanction authorities authorized under this 1988 legislation.
Not surprisingly, by the late 1980’s, several Members of Congress remained concerned that there still weren’t sufficient safeguards in place to protect the FEHBP program from health care fraud and abuse. In a Congressional hearing held on May 24, 1989, the General Accounting Office (GAO) reported that upon audit, the GAO found that in addition to the already-identified financial risks on the payor side, OPM had not taken steps to require FEHBP payor plans to monitor claims at the provider and beneficiary levels in an effort to further detect and prevent fraud and abuse.
In response to a Congressional request, the GAO reviewed the fraud and abuse controls current in place for the FEHBP. As the GAO’s 1991 report [9] reflects, the GAO concluded that:
"OPM needs to (1) ensure that Inspector General recommendations for correcting deficiencies are implemented by the carriers and (2) develop an aggressive program wide antifraud policy for pursuing enrollee and provider fraud. OPM also needs to implement its statutory authority to administratively penalize providers who commit fraud or program-related offenses." (Emphasis added).[10]
Ultimately, OPM determined that the earlier sanctions legislation passed in 1988 was flawed and unworkable. Therefore, in May 1993, as an interim remedial measure, the agency adopted the "Governmentwide Nonprocurement Suspension and Debarment Common Rule" (Common Rule). This rule was first established in 1986 under Executive Order 12549,[11] titled "Debarment and Suspension." This standardized regulatory program permitted OPM to effectuate sanctions issued by other agencies (including those issued by the HHS OIG in connection with Medicare and Medicaid exclusion actions. After literally years of working on possible health care provider sanction language, OPM was able to propose language that satisfied Congressional concerns. This language was included as part of the "Federal Employees Health Care Protection Act of 1998" (Public Law. 105-266).[12]
II. OPM OIG’s Mandatory and Permissive Debarment Authorities:
In 2001, OPM issued a Proposed Rule,[13] followed by a Final Rule in 2003[14] superseding previous administrative sanction requirements and implementing the legislative mandates of Public Law 105-266. Notably, the sanction authorities implemented under the Final Rule were much broader than those provided under the Common Rule (previously adopted by OPM in 1993). As outlined under the Final Rule, both mandatory and permissive bases for debarment were established.
A. OPM Mandatory Debarment Authorities
As detailed below, OPM is required to debar a health care provider who falls within one of the categories of offense described in 5 USC §8902a(b)(1)-(5). Each of these mandatory debarment authorities are outlined below.
| 5 U.S.C. Section | Mandatory Debarment Bases |
|---|---|
| 5 USC §8902a(b)(1) | Any provider that has been convicted, under Federal or State law, of a criminal offense relating to fraud, corruption, breach of fiduciary responsibility, or other financial misconduct in connection with the delivery of a health care service or supply. (Generally, see 5 CFR § 890.1004(a)). |
| 5 USC §8902a(b)(2) | Any provider that has been convicted, under Federal or State law, of a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care service or supply. (Generally, see 5 CFR § 890.1004(a)). |
| 5 USC §8902a(b)(3) | Any provider that has been convicted, under Federal or State law, in connection with the interference with or obstruction of an investigation or prosecution of a criminal offense described in paragraph (1) or (2). (Generally, see 5 CFR § 890.1004(a)). |
| 5 USC §8902a(b)(4) | Any provider that has been convicted, under Federal or State law, of a criminal offense relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance. (Generally, see 5 CFR § 890.1004(a)). |
B. OPM Permissive Debarment Authorities
In addition to the mandatory bases for debarment set out above, OPM OIG has also been delegated a number of permissive debarment authorities which it may exercise at its discretion. These permissive debarment bases are set out in the chart below.
| 5 U.S.C. Section | Permissive Debarment Bases |
|---|---|
| 5 USC §8902a(c)(1) | Licensure actions. OPM may debar a health care provider to whom the provisions of 5 U.S.C. 8902a(c)(1) apply. OPM may take this action even if the provider retains current and valid professional licensure in another State(s). (See 5 CFR § 890.1011(a)). |
| 5 USC §8902a(c)(2) | Ownership or control interests. OPM may debar a health care provider based on ownership or control of or by a debarred provider, as set forth in 5 U.S.C. 8902a(c)(2) and (3). (See 5 CFR § 890.1011(b)). |
| 5 USC §8902a(c)(3) | False, deceptive, or wrongful claims practices. OPM may debar a provider who commits claims-related violations as set forth in 5 U.S.C. 8902a(c)(4) and (5) and 5 U.S.C. 8902a(d)(1) and (2). (See 5 CFR § 890.1011(c)). |
| 5 USC §8902a(c)(4) | Failure to furnish required information. OPM may debar a provider who knowingly fails to provide information requested by an FEHBP carrier or OPM, as set forth in 5 U.S.C. 8902a(d)(3). (See 5 CFR § 890.1011(d)). |
| 5 USC §8902a(c)(5) | Commission of prohibited acts. OPM may debar any provider that the Office has determined committed acts described in subsection (d). As this section provides:
“(d) Whenever the Office determines—
|
III. OPM OIG’s Suspension Authorities:
Separate and apart from its mandatory and permissive authorities, OPM OIG’s Administrative Sanctions Group is also responsible for imposing suspension actions against health care providers. Notably, when the Proposed Rule setting out the agency’s intention to planned suspension authority was first published, at least one commenter (a professional association) objected, arguing that such authorities were not authorized under Public Law. 105-266. Therefore, the commenting association argued that the proposed provisions covering suspension actions should be removed. Responding to this criticism, the agency wrote:
"While Public Law 105–266 does not contain the term ‘‘suspension’’ it does provide authority for OPM to issue the type of sanctions that are characterized as suspensions in the proposed 890.1030–1041." [15]
As the agency noted, the purpose of imposing a suspension action is to both protect the safety of program participants and to safeguard the financial integrity of the FEHBP program. From a practical standpoint, the imposition of a suspension has the same effect as that of a debarment action. A suspended health care provider cannot receive payment from the FEHPB program, either directly or indirectly while the suspension is in place. [16] The regulatory bases for suspending a FEHBP health care provider’s payment privileges are discussed below.
| 5 CFR Section | Evidence Constituting Grounds for a Suspension |
|---|---|
| 5 CFR §890.1031(b)(1) | Indictment or conviction of a provider for a criminal offense that is a basis for mandatory debarment under this subpart. |
| 5 CFR §890.1031(b)(2) | Indictment or conviction of a provider for a criminal offense that reflects a risk to the health, safety, or well-being of FEHBP-covered individuals. |
| 5 CFR §890.1031(b)(3) | Other credible evidence indicating, in the judgment of the suspending official, that a provider has committed a violation that would warrant debarment under this subpart. This may include but is not limited to: (i) Civil judgments; (ii) Notice that a Federal, State, or local government agency has debarred, suspended, or excluded a provider from participating in a program or revoked or declined to renew a professional license; or (iii) Other official findings by Federal, State, or local bodies that determine factual or legal matters. |
Since the issuance of the Final Rule in 2003, several modifications and enhancements to OPM’s debarment and suspension practices have been implemented. Most notably, in 2013, OPM issued notice in the Federal Register[17] that it would be adopting the policies and procedures set out in the Federal Acquisition Regulation (FAR), Subpart 9.4, which covers the debarment and suspension of government contractors.
IV. Frequently Asked Questions
A. General OIG Debarment and Suspension Questions
Question #1 – Does OPM maintain its own public registry of individuals and entities who have been debarred or suspended from the FEHBP program? No. When a provider is debarred and suspended from the FEHBP provider, the provider is reported to the General Services Administration (GSA) for inclusion in GSA’s System for Award Management (SAM) database. The GSA SAM system is essentially a registry of individuals and entities that have been debarred and are typically not eligible to do business with the government. OPM OIG is one of many Federal agencies that submit debarment and suspension actions to GSA for posting in the agency’s GSA SAM database.
Question #2 – How many individuals and entities are currently debarred and / or suspended from the FEHBP program? To date, OPM OIG has not released figures covering Fiscal Year (FY) 2023. As of the end of FY 2022, more than 38,000 health care providers were currently suspended or debarred from participating in the FEHBP. The number of new debarment / suspension actions taken by OPM OIG is estimated to be almost 1000 per year.
Question #3 – Is OPM obligated to debar health care providers who have been excluded from participation in the Medicare program? Yes, as required by 5 USC §8902a(b)(5) and 5 CFR §890.l004(b), OPM is required to propose the debarment of any health care provider who has been excluded by HHS OIG. At a minimum, the term of debarment will be the same as the length of the Medicare exclusion action.
Question #4 – What is the potential impact of an OPM debarment action? Unfortunately, there are a number of negative, collateral consequences that may arise as a result of an OPM debarment action. In addition to being added to the GSA SAM database, a debarment action can adversely affect a provider’s hospital admitting privileges, result in the termination of a provider’s participation in one or more payor plans and / or result in the initiation of a State Medical Board investigation. As expressly requires, when OPM debars or suspends a provider, the agency is obligated to notify:
- All FEHBP carriers;
- The General Services Administration, for publication in the comprehensive Governmentwide list of Federal agency exclusions;
- Other Federal agencies that administer health care or health benefits programs; and
- State and local agencies, authorities, boards, or other organizations with health care licensing or certification responsibilities.[18]
B. OPM Mandatory Debarment Action Questions
- Question #1 – Can OPM OIG impose mandatory debarment even though the underlying conduct had nothing to do with the FEHBP program? Yes. It is important to keep in mind that the conduct giving rise to a provider’s mandatory debarment action need not have involved an FEHBP covered individual, transaction or an OPM program.[19]
- Question #2 – How long does OPM have to initiate a proposed mandatory debarment action against a provider? For example, can OPM initiate a mandatory debarment action against a provider for a felony fraud conviction that occurred 10 years ago? It depends. Under existing regulations, if OPM intends to pursue a mandatory debarment action, it must send written notice of the proposed debarment within 6 years of the event that gave rise to the debarment action (in this case, the felony fraud conviction). In this example, OPM’s proposed debarment action would fall outside of the regulatory period to bring such an action. However, if OPM’s proposed debarment action is a reciprocal action, based on the suspension or debarment or exclusion of the provider by another agency, OPM’s notice of proposed debarment must only be within the effective date of the other agency’s adverse action.[20]
- Question #3 – What is the minimum period of time that a mandatory debarment action can be imposed?Great question. The minimum length of a mandatory debarment depends on the specific basis for the action. For example, if a debarment is based on a conviction, the statutory minimum period of mandatory debarment is three years. If a mandatory debarment action is based on another agency’s debarment, suspension or exclusion action, the period of debarment must remain in place until the other agency lifts the underlying adverse act
- Question #4 – What is the maximum period of time that a mandatory debarment action can be imposed? There is no limit on the maximum period of a mandatory debarment action that has been based on a conviction.
- Question #5 – What are considered “Aggravating and Mitigating Factors” that are considered by a debarring official when determining the length of a mandatory debarment action? There are a number of aggravating circumstances that are to be considered by a debarring official[21] when deciding whether to debar a provider for longer than the 3-year minimum period imposed in mandatory debarment cases. Aggravating factors considered include:
- Whether the FEHBP incurred a financial loss as the result of the acts underlying the conviction, or similar acts that were not adjudicated, and the level of such loss. In determining the amount of financial loss, OPM shall not consider any amounts of restitution that a provider may have paid;
- Whether the sentence imposed by the court included incarceration;
- Whether the underlying offense(s), or similar acts not adjudicated, occurred repeatedly over a period of time, and whether there is evidence that the offense(s) was planned in advance;
- Whether the provider has a prior record of criminal, civil, or administrative adjudication of related offenses or similar acts; or
- Whether the actions underlying the conviction, or similar acts that were not adjudicated, adversely affected the physical, mental, or financial well-being of one or more covered individuals or other persons.
While mandatory debarment actions require a minimum debarment of at least three years, to the extent that aggravating facts may be present, a debarring official may also consider any mitigating factors which be present (and possibly serve to offset some or all of the period added due to aggravating factors). Mitigating factors to be considered include:
- Whether the conviction(s) on which the debarment is based consist entirely or primarily of misdemeanor offenses;
- Whether court records, including associated sentencing reports, contain an official determination that the provider had a physical, mental, or emotional condition before or during the commission of the offenses underlying the conviction that reduced his level of culpability; or
- Whether the provider’s cooperation with Federal and/or State investigative officials resulted in criminal convictions, civil recoveries, or administrative actions against other individuals, or served as the basis for identifying program weaknesses. Restitution made by the provider for funds wrongfully, improperly, or illegally received from Federal or State programs may also be considered as a mitigating circumstance.
- Question #6 – If OPM has proposed a mandatory debarment against you, do you have any appeal rights? Absolutely, a provider’s debarment action appeal rights are set out under 5 CFR §890.1009. There are several things to keep in mind when assessing whether or not to appeal a proposed mandatory debarment action. These include, but are not limited to:
- Proposed debarment cases can be quite complex – engage experienced health care counsel to represent your interests. Should you receive a letter from OPM advising you that the agency is proposing to debar you from the FEHBP program, we strongly recommend that you engage a qualified health lawyer to represent your interests. Deadlines in OPM debarment cases are very tight and the failure to file a timely appeal can make it extremely difficult to have the appeal reinstated. As described in Section VI below, the debarment action may be merely the first of many administrative challenges that you are likely to face.
- A provider cannot re-litigate the action giving rise to a conviction. If the proposed mandatory debarment action is based on a conviction action, a provider will not be permitted to challenge the underlying conviction. In other words, the prior conviction action will be dispositive and will fully satisfy the standard of proof needed for a mandatory debarment action to proceed.
- A provider can appeal mandatory debarment periods which exceed the mandatory minimum period required under the regulations. For example, in a mandatory debarment matter based on a conviction action, a provider can appeal the imposition of time which exceeds the minimum period required under the regulations.
C. OPM Permissive Debarment Action Questions
- Question #1 – How long can permissive debarment action last? As with mandatory debarment actions, there is neither a minimum nor a maximum period of time that permissive debarment action must extend. The length of time imposed is set by an agency debarring official after considering the factors set out 5 CFR §890.1016, along with any applicable factors set out under 5 CFR §§890.1017-1021.
- Question #2 – How long can a permissive debarment action last if it has been based on the revocation or suspension of a provider’s professional license? Simply put, the length of time a permissive debarment action may extend typically tracks the period that a provider’s license is revoked, suspended, restricted, etc. Having said that, a debarring official will still consider any aggravating factors that may be present and can extend the period of debarment beyond the period of a licensure action.
- Question #3 – What are considered “Aggravating and Mitigating Factors” that are considered by a debarring official when determining the length of permissive debarment action? As set out under the regulations, aggravating circumstances that are to be considered by the debarring official include:
- Whether the provider’s actions underlying the basis for the debarment, or similar acts, had an adverse impact on the physical or mental health or well-being of one or more FEHBP-covered individuals or other persons.
- Whether the provider has a documented history of prior criminal wrongdoing; civil violations related to health care items or services; improper conduct; or administrative violations addressed by a Federal or State agency. OPM may consider matters involving violence, patient abuse, drug abuse, or controlled substances convictions or violations to be particularly serious.
- Whether the provider’s actions underlying the basis for the debarment, or similar acts, resulted in financial loss to the FEHBP, FEHBP-covered individuals, or other persons. In determining whether, or to what extent, a financial loss occurred, OPM shall not consider any amounts of restitution that the provider may have paid.
- Whether the provider’s false, wrongful, or improper claims to FEHBP carriers were numerous, submitted over a prolonged period of time,
- Whether the provider was specifically aware of or directly responsible for the acts constituting the basis for the debarment.
- Whether the provider attempted to obstruct, hinder, or impede official inquiries into the wrongful conduct underlying the debarment.
In contrast to the above, the debarring official may also consider the impact of any mitigating factors that would support an agency decision to shorten the length of a debarment action. Mitigating factors to be considered by the OPM debarring official include:
- Whether the provider’s cooperation with Federal, State, or local authorities resulted in criminal convictions, civil recoveries, or administrative actions against other violators, or served as the basis for official determinations of program weaknesses or vulnerabilities. Restitution that the provider made for funds wrongfully, improperly, or illegally received from Federal or State programs may also be considered as a mitigating factor.
- Whether official records of judicial proceedings or the proceedings of State licensing authorities contain a formal determination that the provider had a physical, mental, or emotional condition that reduced his level of culpability before or during the period in which he committed the violations in question.
D. OPM Suspension Action Questions
- Question #1 -- Why would OPM suspend me or my practice from the FEHBP program? The purpose of a suspension action is to immediately stop any additional payments from being made by the FEHBP program to a problematic provider until OPM (often working with law enforcement) can determine whether further administrative, civil or criminal enforcement action is needed.
- Question #2 -- What are the primary reasons OPM suspends a provider’s payments? Although indictment and conviction actions remain some of the primary reasons OPM suspends a provider’s payments, the agency is increasingly initiating suspension actions based on audits and investigations of a provider’s billing and coding practices. For example, the suspension action may be based on credible evidence which suggests that a provider committed a violation that may warrant debarment. For example:
- OPM may allege that a series of improper claims submitted for payment by a provider constitute a credible allegation of fraud.
- An OPM suspension may be based on prior audit findings that an overpayment exists, payments may not be correct, services may be non-covered, or claims may be miscoded.
- Question #3 – What is the length of an FEHBP suspension action? The initial period of an FEHBP suspension action may be up to 12 months. If no formal legal or administrative proceeding is taken within 12 months of the effective date of the suspension action, OPM may terminate the suspension action. However, if an extension of the suspension action is requested by the Department of Justice or another Federal or State law enforcement agency, the action may be extended for up to six additional months. [22]
V. Overview of the Potential Penalties and Assessments:
Subsequent to publishing the agency’s regulations on debarment and suspension of health care in 2003, OPM issued a Final Rule[23] outlining the Civil Monetary Penalties (CMPs) that may be imposed on health care providers for violations listed in 5 CFR §890.1061. OPM may also impose an assessment that is intended to recognize monetary losses, costs, and damages sustained by OPM as a result of a provider’s violations. Notably, in addition to imposing CMPs and assessments, OPM may concurrently debar or suspend a provider from participating in the FEHBP program based on the same violations.
Generally, OPM may impose Civil Monetary Penalties (CMPs) and assessments in three situations: [24]
- Improper claims. If a health care provider (including, but not limited to a physician, hospital, or other individual or entity which furnishes health care services or supplies), presents a claim to the FEHBP program for payment that the provider knows or should have known involves:
- Items or service not provided as claimed;
- Charges in violation of applicable charge limitations under 5 USC §8904(b); or
- An item or service furnished during a period in which the provider was debarred from participation under this chapter pursuant to a determination by the Office under this section, other than as permitted under 5 USC §8902(g)(2)(B).[25]
- False or misleading statements. OPM may impose penalties and assessments on a provider who makes a false statement or misrepresentation as set forth in 5 USC §8902a(d)(2).
- Failing to provide claims related information. OPM may impose penalties and assessments on a provider who knowingly fails to provide claims-related information as otherwise required by law.
As a final point, in recent cases pursued by OPM, the agency has threatened to go beyond mere administrative sanctions and to pursue damages under the False Claims Act (through the Department of Justice) against providers who knowingly submit FEHBP claims to a payor after the provider has been debarred from participation in the program.
VI. Reducing Your Level of Regulatory Risk
In 2024, we expect to see a continued level of heightened scrutiny of FEHBP participating providers by OPM OIG. If your FEHBP claims (or that of your practice) are audited or investigated by OPM OIG, we recommend that you engage experienced legal counsel to represent you.
What further steps can you take to reduce your level of risk? Screen your employees, vendors and contractors on a monthly basis against the OIG LEIE, State Medicaid exclusion databases and the GSA SAM (which includes OPM debarment and suspension actions). Failure to do so may result in administrative penalties, assessments, and potentially result in even more sever adverse consequences.
Need help? Give us a call. A number of our health lawyers are Certified Professional Coders (CPCs) and / or Certified Medical Reimbursement Specialists (CMRSs). Our attorneys have extensive experience representing health care providers in exclusion, debarment, suspension and termination actions. Additionally, several of our attorneys have held significant positions as Federal prosecutors with the U.S. Department of Justice. To the extent that a civil or criminal investigation has been initiated by the government, our attorneys will diligently work to attempt to obtain a favorable outcome in your case. For a free consultation, please give us a call: 1 (800) 475-1906.
- [1] The term "Federal Health Care Program" means "any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government (other than the Federal Employees Health Benefits Program), or any State health care program as defined in this section". See 42 CFR §1000.10
- [2] Exclusion authority was delegated to the Office of Inspector General for the Department of Health and Human Services (OIG or HHS/OIG) pursuant to 53 Fed. Reg. 12,993 on April 20, 1988. See also, 42 CFR §1003.150.
- [3] As set out under 5 CFR §890.1003, the term “Debarment” means: ". . . a decision by OPM's debarring official to prohibit payment of FEHBP funds to a health care provider, based on 5 USC 8902a (b), (c), or (d) and this subpart.”
- [4] Federal Employees Health Benefits (FEHB) Facts, (July 2008).
- [5] See "The Federal Managers’ Financial Integrity Act (FMFIA) of 1982." Public Law No.: 97-255. Essentially, the FIA amended the "Accounting and Auditing Act of 1950" to require Federal agencies to establish internal accounting and administrative controls to: (1) prevent waste or misuse of agency funds or property; and (2) assure the accountability of assets.
- [6] At this time, approximately 8 million Federal employees, annuitants and their dependents were covered under FEHBP sponsored health care payor plans.
- [7] General Accounting Office (GAO) Report GAO-T-GGD-89-26. This report memorializes the testimony of Bernard L. Ungard, Director, Federal Human Resource Management Issues, General Government Division. Testimony was before the Subcommittee on Compensation and Employee Benefits, Committee on Post Office and Civil Service, House of Representatives. May 24, 1989,
- [8] See "Federal Employee Health Benefits Amendments Act of 1988." Public Law No.: 100-654. Among its provisions, this legislation:
- • Authorized OPM to bar from participation in the Federal health benefits program any provider of health care services or supplies that has been convicted, under Federal or State law, of a criminal offense relating to: (1) fraud, corruption, breach of fiduciary responsibility, or other financial misconduct in connection with the delivery of a health care service or supply; (2) neglect or abuse of patients in connection with the delivery of a health care service or supply; or (3) the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance.
- • Bars from program participation any provider that has been convicted in connection with the interference with or obstruction of an investigation or prosecution of a criminal offense described under this Act.
- • Bars from program participation any provider: (1) whose license to provide health care services or supplies has been revoked, suspended, restricted, or not renewed by a State licensing authority for reasons relating to the provider's professional competence, professional performance, or financial integrity; or (2) that surrendered such a license while a formal disciplinary proceeding was pending before such an authority, if the proceeding concerned the provider's professional competence, professional performance, or financial integrity.
- [9] General Accounting Office (GAO) Report GAO GGD–91–95, "Fraud and Abuse: Stronger Controls Needed in Federal Employees Health Benefits Program"
- [10] Ibid. Page 5.
- [11] Executive Order 12549, "Debarment and Suspension" was issued by President Ronald Reaghan on February 18, 1986.
- [12] Public Law 105-266, enacted October 19, 1998.
- [13] See Federal Register 66 FR 64160 (December 12, 2001).
- [14] See Federal Register 68 FR 5470 (February 3, 2003).
- [15] Federal Register 68 FR 5470, 5474, (February 3, 2003).
- [16] See 5 CFR § 890.1030(c).
- [17] Federal Register 78 FR 12106 (February 21, 2013).
- [18] See 5 CFR §890.1044(a)-(d).
- [19] See 5 CFR §890.1004(b).
- [20] See 5 CFR §890.1005.
- [21] An agency “Debarment Official” is an OPM employee who is authorized to issue debarments and financial sanctions under the regulations. See 5 CFR §890.1003.
- [22] See 5 CFR §890.1032(a)-(b).
- [23] See Federal Register 69 FR 9919 (March 3, 2004).
- [24] See 5 CFR §890.1061.
- [25] See 5 USC §8902a.