[Code of Federal Regulations]
[Title 42, Volume 3, Parts 430 to end]
[Revised as of October 1, 2000]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR480.137]

[Page 400-401]
 
                         TITLE 42--PUBLIC HEALTH
 
                         CHAPTER IV--HEALTH CARE
                        FINANCING ADMINISTRATION,
                        DEPARTMENT OF HEALTH AND
                       HUMAN SERVICES--(Continued)
 
PART 480--ACQUISITION, PROTECTION, AND DISCLOSURE OF PEER REVIEW INFORMATION--Table of Contents
 
  Subpart B--Utilization and Quality Control Peer Review Organizations 
                                 (PROs)
 
Sec. 480.137  Disclosure to Federal and State enforcement agencies responsible for the investigation or identification of fraud or abuse of the Medicare or 
          Medicaid programs.

    (a) Required disclosure. Except as specified in Secs. 476.139(a) and 
476.140 relating to disclosure of PRO deliberations and quality review 
study information, the PRO must disclose confidential information 
relevant to an investigation of fraud or abuse of the Medicare or 
medicaid programs, including PRO medical necessity determinations and 
other information that includes patterns of the practice or performance 
of a practitioner or institution, when a written request is received 
from a State or Federal enforcement agency responsible for the 
investigation or identification of fraud or abuse of the Medicare or 
Medicaid programs that--
    (1) Identifies the name and title of the individual initiating the 
request,
    (2) Identifies the physician or institution about which information 
is requested, and
    (3) States affirmatively that the institution or practitioner is 
currently under investigation for fraud or abuse of the Medicare or 
Medicaid programs and that the information is needed in furtherance of 
that investigation.
    (b) Optional disclosure. The PRO may provide the information 
specified in paragraph (a) of this section to Federal or State fraud and 
abuse enforcement agencies responsible for the investigation or 
identification of fraud or abuse

[[Page 401]]

of the Medicare or Medicaid programs, without a request.

[50 FR 15358, Apr. 17, 1985, as amended at 52 FR 37458, Oct. 7, 1987. 
Redesignated at 64 FR 66279, Nov. 24, 1999]