5 CFR 890.1049 - Claims for non-emergency items or services furnished by a debarred or suspended provider.

Status message

There is 1 rule appearing in the Federal Register for 5 CFR 890. View below or at eCFR (GPOAccess)
prev | next
§ 890.1049 Claims for non-emergency items or services furnished by a debarred or suspended provider.
(a) Covered individual unaware of debarment or suspension. FEHBP funds may be paid for items or services furnished by a debarred or suspended provider if, at the time the items or services were furnished, the covered individual did not know, and could not reasonably be expected to have known, that the provider was debarred or suspended. This provision is intended solely to protect the interests of FEHBP-covered persons who obtain services from a debarred or suspended provider in good faith and without knowledge that the provider has been sanctioned. It does not authorize debarred or suspended providers to submit claims for payment to FEHBP carriers.
(b) Notice sent by carrier. When paying a claim under the authority of paragraph (a) of this section, an FEHBP carrier must send a written notice to the covered individual, stating:
(1) That the provider is debarred or suspended and is prohibited from receiving payment of FEHBP funds for items or services furnished after the effective date of the debarment or suspension;
(2) That claims may not be paid for items or services furnished by the debarred or suspended provider after the covered individual is informed of the debarment or suspension;
(3) That the current claim is being paid as a legally-authorized exception to the effect of the debarment or suspension in order to protect covered individuals who obtain items or services without knowledge of their provider's debarment or suspension;
(4) That FEHBP carriers are required to deny payment of any claim for items or services rendered by a debarred or suspended provider 15 days or longer after the date of the notice described in paragraph (b) of this section, unless the covered individual had no knowledge of the provider's debarment or suspension when the items or services were rendered;
(5) The minimum period remaining in the provider's debarment or suspension; and
(6) That FEHBP funds cannot otherwise be paid to the provider until OPM terminates the debarment or suspension.
[69 FR 9920, Mar. 3, 2004]

Title 5 published on 2014-01-01

The following are only the Rules published in the Federal Register after the published date of Title 5.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2014-01-06; vol. 79 # 3 - Monday, January 6, 2014
    1. 79 FR 531 - Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance Program: Eligibility for Pathways Programs Participants
      GPO FDSys XML | Text
      OFFICE OF PERSONNEL MANAGEMENT
      Interim Final Rule with request for comments.
      This interim final rule is effective February 5, 2014. Comments are due on or before March 7, 2014.
      5 CFR Parts 890 and 894

This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.

This list is taken from the Parallel Table of Authorities and Rules provided by GPO [Government Printing Office].

It is not guaranteed to be accurate or up-to-date, though we do refresh the database weekly. More limitations on accuracy are described at the GPO site.


United States Code
U.S. Code: Title 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
U.S. Code: Title 22 - FOREIGN RELATIONS AND INTERCOURSE
U.S. Code: Title 50 - WAR AND NATIONAL DEFENSE
Statutes at Large

Title 5 published on 2014-01-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 5 CFR 890 after this date.

  • 2014-01-06; vol. 79 # 3 - Monday, January 6, 2014
    1. 79 FR 531 - Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance Program: Eligibility for Pathways Programs Participants
      GPO FDSys XML | Text
      OFFICE OF PERSONNEL MANAGEMENT
      Interim Final Rule with request for comments.
      This interim final rule is effective February 5, 2014. Comments are due on or before March 7, 2014.
      5 CFR Parts 890 and 894