42 CFR § 422.1086 - Effect of Departmental Appeals Board Decision.
(a) General rule. The Board's decision is binding unless -
(1) The affected party has a right to judicial review and timely files a civil action in a United States District Court or, in the case of a civil money penalty, in a United States Court of Appeals; or
(2) The Board reopens and revises its decision in accordance with 422.862.
(c) Special Rules: Civil Money Penalty - Finality of Board's decision. When CMS imposes a civil money penalty, notice of the Board's decision (or denial of review) is the final administrative action that initiates the 60-day period for seeking judicial review.