CFR > Title 42 - Public Health > CHAPTER V—OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER B—OIG AUTHORITIES (parts 1001 to 1008) > PART 1004—IMPOSITION OF SANCTIONS ON HEALTH CARE PRACTITIONERS AND PROVIDERS OF HEALTH CARE SERVICES BY A QUALITY IMPROVEMENT ORGANIZATION > SUBPART B—Sanctions Under the QIO Program; General Provisions (§1004.10 to §1004.20) > 1004.10—Statutory obligations of practitioners and other persons.

1004.10—Statutory obligations of practitioners and other persons.

It is the obligation of any health care practitioner or other person who furnishes or orders health care services that may be reimbursed under the Medicare or State health care programs to ensure, to the extent of his or her or its authority, that those services are—
(a) Provided economically and only when, and to the extent, medically necessary;
(b) Of a quality that meets professionally recognized standards of health care; and
(c) Supported by evidence of medical necessity and quality in the form and fashion and at such time that the reviewing QIO may reasonably require (including copies of the necessary documentation and evidence of compliance with pre-admission or pre-procedure review requirements) to ensure that the practitioner or other person is meeting the obligations imposed by section 1156(a) of the Act.