Notice of Administrative Sanction Action

4.10.2.4 - Notice of Administrative Sanction Action (Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21) When OIG receives the sanction recommendation, it is reviewed by medical and legal staff to determine whether the anticipated sanction action is supportable. OIG then develops a proposal and sends it to the provider, advising it of the recommended sanction period, the basis for the determination that excessive or poor- quality care has been provided, and its appeal rights. The provider is also furnished with a copy of all the material used to make the determination. This is the material that was previously forwarded to OIG with the initial sanction recommendation. The provider has 30 days from the date on the proposal letter to submit: • Documentary evidence and written argument against the proposed action, or • A written request to present evidence or argument orally to an OIG official OIG may extend the 30-day period. All additional information is reviewed by OIG, as well as by medical and/or legal personnel when necessary. In the event the provider requests an in-person review, it is conducted by OIG in Washington, D.C. When a final determination is made to exclude a provider, OIG sends a written notice to the provider at least 20 days prior to the effective date of the action (see 42 CFR §1001.2003 for exceptions to the 20 day notice). The notice includes: • The basis for the exclusion. • The duration of the exclusion and the factors considered in setting the duration. • The earliest date on which OIG accepts a request for reinstatement, and the requirements and procedures for reinstatement. • Appeal rights. • A statement that, should claims continue to be submitted during the period of sanction for which payments may not be made, the provider/supplier may be criminally prosecuted, subject to a CMP action and/or denied reinstatement.