Written Notification to Practitioner or Other Person

9025.2 – Written Notification to Practitioner or Other Person (Rev. 24, Issued: 02-12-16, Effective: 03-14-16, Implementation: 03-14-16) Under 42 CFR §1004.40, the QIO must send the practitioner or other person written notice of the initial finding and other information. The QIO Sanction Panel should issue this notice within two (2) business days of making the initial finding and notifying the COR. (See Appendices 9.2, 9-5, and 9.8 for Initial Notification Model Letters.) The written notification must include at least: • Obligation(s) involved; • Situation, circumstances, or activity that resulted in the violation; • Authority and responsibility of the QIO to report violations of any obligation under §1156(a) of the Act; • Suggested method for correcting the situation and a time period for corrective action, if appropriate; • Sanction the QIO could recommend to OIG (see 42 CFR §1004.40); • Right of the practitioner or other person to submit to the QIO within 30 days of receiving the notice additional information and/or a written request for a meeting with the QIO to review and discuss the finding (the date of receipt is 5 days after the date on the notice, unless there is reasonable showing to the contrary); and • Copy of the material the QIO used in arriving at its findings, except for the QIO deliberations, as set forth in 42 CFR §480.139. NOTE: Any time the QIO activates the sanction process against a Medicare Health Plan, the QIO must notify the COR, the respective Regional Office’s (RO) Division for Medicare Health Plan Operations, and Providers and include with that notice a copy of the initial notice to the Health Plan.