Code of Federal Regulations (Last Updated: October 10, 2024) |
Title 42 - Public Health |
Chapter V - Office of Inspector General-Health Care, Department of Health and Human Services |
SubChapter B - OIG Authorities |
Part 1004 - Imposition of Sanctions on Health Care Practitioners and Providers of Health Care Services by a Quality Improvement Organization |
Subpart C - QIO Responsibilities |
§ 1004.50 - Meeting with a practitioner or other person.
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§ 1004.50 Meeting with a practitioner or other person.
If the practitioner or other person requests a meeting with the QIO -
(a) The QIO panel that meets with the practitioner or other person must consist of a minimum of 3 physicians;
(b) No physician member of the QIO panel may be in direct economic competition with the practitioner or other person being considered for sanction;
(c) The QIO must ensure that no physician member of the QIO panel has a substantial bias for or against the practitioner or other person being considered for sanction;
(d) At least one member of the QIO panel meeting with the practitioner or other person should practice in a similar area, e.g., urban or rural, and at least one member of the panel must be in the same specialty (both requirements could be met by a single individual);
(e) If the practitioner or other person has an attorney present, that attorney will be permitted to make opening and closing remarks, ask clarifying questions and assist the practitioner or other person in presenting the testimony of expert witnesses who may appear on the practitioner's or other person behalf;
(f) The physician who recommends to the QIO that a practitioner or other person be sanctioned may not vote on that recommendation at the meeting;
(g) The QIO may allow the practitioner or other person 5 working days after the meeting to provide the QIO additional relevant information that may affect its finding; and
(h) A verbatim record must be made of the meeting and must be made available to the practitioner or other person promptly.