[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: 5CFR890.1070]

[Page 504-505]
 
                    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. 890.1070  Deciding contests of proposed penalties and assessments.

    (a) Debarring official reviews entire administrative record. After 
the provider submits the information and evidence authorized or required 
by Sec. 890.1069, the debarring official shall review the entire 
official record to determine if the contest can be decided without 
additional administrative proceedings, or if an evidentiary hearing is 
required to resolve disputed material facts.
    (b) Previously determined facts. Any facts relating to the basis for 
the proposed penalties and assessments that were determined in prior due 
process proceedings are binding on the debarring official in deciding 
the contest. ``Prior due process proceedings'' are those set forth in 
Sec. 890.1025(a)(1) through (4).
    (c) Deciding the contest without further proceedings. To decide the 
contest without further administrative proceedings, the debarring 
official must determine that:
    (1) The preponderance of the evidence in the administrative record 
as a whole demonstrates that the provider committed a sanctionable 
violation described in Sec. 890.1061; and
    (2) The evidentiary record contains no bona fide dispute of any fact 
material to the proposed financial sanction. A ``material fact'' is a 
fact essential to determining whether a provider committed a 
sanctionable violation for

[[Page 505]]

which penalties and assessments may be imposed.
    (d) Final decision without further proceedings. If the debarring 
official determines that paragraphs (c)(1) and (c)(2) of this section 
both apply, a final decision may be issued, imposing financial sanctions 
in amounts not exceeding those proposed in the notice to the provider 
described in Sec. 890.1066.
    (e) Insufficient evidence. If the debarring official determines that 
a preponderance of the evidence does not demonstrate that the provider 
committed a sanctionable violation described in Sec. 890.1061, the 
notice of proposed sanctions described in Sec. 890.1066 must be 
withdrawn.
    (f) Disputed material facts. If the debarring official determines 
that the administrative record contains a bona fide dispute about any 
fact material to the proposed sanction, he must refer the case for a 
fact-finding hearing to resolve the disputed fact or facts. The 
provisions of Sec. 890.1027(b) and (c), 890.1028, and 890.1029(a) and 
(b) will govern such a hearing.
    (g) Final decision after fact-finding hearing. After receiving the 
report of the fact-finding hearing, the debarring official must apply 
the provisions of paragraphs (c), (d), and (e) of this section to reach 
a final decision on the provider's contest.