§ 890.1013Deciding whether to propose a permissive debarment.
(a)Review factors. The factors OPM shall consider in deciding whether to propose a provider's debarment under a permissive debarment authority are:
(1) The nature of any claims involved in the basis for the proposed debarment and the circumstances under which they were presented to FEHBP carriers;
(2) The improper conduct involved in the basis for the proposed debarment, and the provider's degree of culpability and history of prior offenses;
(3) The extent to which the provider poses or may pose a risk to the health and safety of FEHBP-covered individuals or to the integrity of FEHBP transactions; and
(4) Other factors specifically relevant to the provider's debarment that shall be considered in the interests of fairness.
(b)Absence of a factor. The absence of a factor shall be considered neutral, and shall have no effect on OPM's decision.
(c)Specialized review in certain cases. In determining whether to propose debarment under 5 U.S.C 8902a(c)(4) for providing items or services substantially in excess of the needs of a covered individual or for providing items or services that fail to meet professionally-recognized quality standards, OPM shall obtain the input of trained reviewers, based on written medical protocols developed by physicians. If OPM cannot reach a decision on this basis, it shall consult with a physician in an appropriate specialty area.
Title 5 published on 2014-01-01
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