1001.3005—Reversed or vacated decisions.
(a)
An individual or entity will be reinstated into Medicare, Medicaid and other Federal health care programs retroactive to the effective date of the exclusion when such exclusion is based on—
(2)
An action by another agency, such as a State agency or licensing board, that is reversed or vacated on appeal; or
(3)
An OIG exclusion action that is reversed or vacated at any stage of an individual's or entity's administrative appeal process.
(b)
If an individual or entity is reinstated in accordance with paragraph (a) of this section, CMS and other Federal health care programs will make payment for services covered under such program that were furnished or performed during the period of exclusion.
(c)
The OIG will give notice of a reinstatement under this section in accordance with § 1001.3003(a).
(d)
An action taken by the OIG under this section will not require any other Federal health care program to reinstate the individual or entity if such program has imposed an exclusion under its own authority.
(e)
If an action which results in the retroactive reinstatement of an individual or entity is subsequently overturned, the OIG may reimpose the exclusion for the initial period of time, less the period of time that was served prior to the reinstatement of the individual or entity.
Code of Federal Regulations
Code of Federal Regulations
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