[Code of Federal Regulations]
[Title 5, Volume 2]
[Revised as of January 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR890.1013]

[Page 489]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 890_FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
Subpart J_Administrative Sanctions Imposed Against Health Care Providers
 
Sec. 890.1013  Deciding 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.