The length of exclusion from participation in Medicare, Medicaid, and, where applicable, other Federal health care programs, is contingent upon the specific violation of the Medicare statute. A full description of the specific violations identified in the sections of the Act are cross-referenced in the regulatory sections listed in the table in paragraph (a) of this section.
(a) In no event will the period of exclusion exceed 5 years for violation of the following sections of the Act:
| Social Security Act paragraph |
Code of Federal Regulations section |
|---|---|
| 1833(h)(5)(D) in repeated cases | §402.1(c)(1) |
| 1833(q)(2)(B) in repeated cases | §402.1(c)(3) |
| 1834(a)(11)(A) | §402.1(c)(4) |
| 1834(a)(18)(B) | §402.1(c)(5) |
| 1834(b)(5)(C) | §402.1(c)(6) |
| 1834(c)(4)(C) | §402.1(c)(7) |
| 1834(h)(3) | §402.1(c)(8) |
| 1834(j)(4) | §402.1(c)(10) |
| 1834(k)(6) | §402.1(c)(31) |
| 1834(l)(6) | §402.1(c)(32) |
| 1842(b)(18)(B) | §402.1(c)(11) |
| 1842(k) | §402.1(c)(12) |
| 1842(l)(3) | §402.1(c)(13) |
| 1842(m)(3) | §402.1(c)(14) |
| 1842(n)(3) | §402.1(c)(15) |
| 1842(p)(3)(B) in repeated cases | §402.1(c)(16) |
| 1848(g)(1)(B) in repeated cases | §402.1(c)(17) |
| 1848(g)(3)(B) | §402.1(c)(18) |
| 1848(g)(4)(B)(ii) in repeated cases | §402.1(c)(19) |
| 1879(h) | §402.1(c)(23) |
(b) For violation of the following sections, there is no maximum time limit for the period of exclusion.
| Social Security Act paragraph |
Code of Federal Regulations section |
|---|---|
| 1834(a)(17)(c) for a pattern of contacts | §402.1(e)(2)(i) |
| 1834(h)(3) for a pattern of contacts | §402.1(e)(2)(ii) |
| 1877(g)(5) | §402.1(c)(22) |
| 1882(a)(2) | §402.1(c)(24) |
| 1882(p)(8) | §402.1(c)(25) |
| 1882(p)(9)(C) | §402.1(c)(26) |
| 1882(q)(5)(C) | §402.1(c)(27) |
| 1882(r)(6)(A) | §402.1(c)(28) |
| 1882(s)(4) | §402.1(c)(29) |
| 1882(t)(2) | §402.1(c)(30) |
(c) For a person excluded under any of the grounds specified in paragraph (a) of this section, notwithstanding any other requirements in this section, reinstatement occurs—
(1) At the expiration of the period of exclusion, if the exclusion was imposed for a period of 5 years; or
(2) At the expiration of 5 years from the effective date of the exclusion, if the exclusion was imposed for a period of less than 5 years and the initiating agency did not receive the appropriate written request for reinstatement as specified in §402.300.
Tried the LawStack mobile app?
Join thousands and try LawStack mobile for FREE today.
- Carry the law offline, wherever you go.
- Download CFR, USC, rules, and state law to your mobile device.
