[Federal Register Volume 59, Number 202 (Thursday, October 20, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-25942]


[[Page Unknown]]

[Federal Register: October 20, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Office of Inspector General; Health Care Financing 
Administration; Statement of Organization, Functions, and Delegations 
of Authority

    Notice is hereby given that under the authority vested in me by 
section 6 of Reorganization Plan No. 1 of 1953 and 5 U.S.C. 301, I have 
delegated to the Inspector General, with the authority to redelegate 
and to authorize further redelegation, my authority under sections 
1862(b)(3)(C) (financial incentives not to enroll in a group health 
plan), 1877(g)(3) (ownership restrictions for billing clinical lab 
services), 1877(g)(4) (circumventing ownership restriction governing 
clinical labs and referring physicians), 1882(d)(3)(B) (selling or 
issuing Medicare supplemental policy to beneficiary without obtaining a 
written statement from beneficiary with regard to Medicaid status), 
1927(b)(3)(B) (false information on drug manufacturer survey from 
manufacturer/wholesaler/seller), 1927(b)(3)(C) (provision of untimely 
or false information by drug manufacturer with rebate agreement), 
1929(i)(3) (notifying home and community-based care provider/settings 
of survey), and 1867(d)(1) (dumping by hospital/responsible physician 
of patients needing emergency medical care) of the Social Security Act, 
as amended (42 U.S.C. 1395y(b)(3)(C), 1395nn(g)(3), 1395nn(g)(4), 
1395ss(d)(3)(B), 1396r-7(b)(3)(B), 1396r-7(b)(3)(C)), 1396t(i)(3), and 
1395dd(d)(1)), relating to the imposition of administrative sanctions, 
including civil monetary penalties, assessments, and exclusions from 
program participation.
    Further, under the authority vested in me by section 6 of 
Reorganization Plan No. 1 of 1953 and 5 U.S.C. 301, I have delegated to 
the Administrator, Health Care Financing Administration with the 
authority to redelegate and to authorize further redelegation, my 
authority under sections 1833(h)(5)(D) (diagnostic clinical lab test 
assignment violations), 1833(i)(6) (charge limit bills for intraocular 
lenses with cataract surgery), 1833(1)(5)(B)(ii) (nurse anesthetist 
assignment violations), 1833(p) (nurse-midwife services assignment 
violations), 1834(a)(11)(A) (failure to supply rented DME without 
charge after payment limit), 1834(b)(5)(C) (nonparticipating physician 
radiology services limits), 1842(b)(12)(C) (physician assistant 
assignment violations), 1842(j)(1)(B) (nonparticipating physician 
charge limit violations--MAAC), 1842(j)(1)(D)(iv) (nonparticipating 
physician charge limit violations--overpriced procedures), 1842(k) 
(billing for assistants at cataract surgery), 1842(1)(3) 
(nonparticipating physician refund requirement for medically 
unnecessary services), 1842(m)(3) (nonparticipating physician violation 
of refund provision for elective surgery and non-disclosure of 
estimated charges), 1842(n)(3) (physician charge limit mark-up 
violation for certain purchased diagnostic procedures), 1842(p)(3)(A) 
(failing to provide diagnostic codes where billing on non-assigned 
basis), and 1842(p)(3)(B) (failing to provide diagnostic codes after 
notice by Secretary of obligations) of the Social Security Act, as 
amended, (42 U.S.C. 1395l(h)(5)(D), 1395l(i)(6), 1395l(1)(5)(B)(ii), 
1395l(p), 1395m(a)(11)(A), 1395m(b)(5)(C), 1395u(b)(12)(C), 
1395u(j)(1)(B), 1395u(j)(1)(D)(iv), 1395u(k), 1395u(1)(3), 1395u(m)(3), 
1395u(n)(3), 1395u(p)(3)(A), and 1395u(p)(3)(B)), relating to the 
imposition of civil monetary penalties, assessments, and exclusions 
from program participation.
    In addition, the Administrator of the Health Care Financing 
Administration and the Inspector General (or their delegatees) may 
determine that it would be in the interest of economy, efficiency, or 
effective coordination of activities to have the prosecutorial function 
for any civil monetary penalty, assessment, or exclusion authority 
delegated to the Administrator exercised by the Inspector General. In 
such case, the Inspector General and not the Administrator, shall have 
the delegated authority to exercise the prosecutional function with 
respect to those civil monetary penalty authorities. Such determination 
may be made on a case by case basis or with respect to all cases 
brought under a particular listed authority.
    Excluded from this delegation is the authority to conduct hearings, 
to review initial hearing decisions, and to issue regulations.
    The prior delegation of sections 1862(b)(3)(C), 1877(g)(3), 
1877(g)(4), 1882(d)(3)(B), 1927(b)(3)(B), 1927(b)(3)(C), 1929(i)(3) to 
the Administrator, Health Care Financing Administration (See Federal 
Register Notice of Secretary's Statement of Organization, Functions and 
Delegations of Authority, 49 FR 35247, September 6, 1984) is revoked.
    The previous delegation to the Inspector General of October 16, 
1987, covering sections 1842(k) and 1867 is revoked. With respect to 
sections 1833(l)(5)(B)(ii), 1842(b)(12)(C), 1842(j)(1)(B), 1842(l)(3), 
and 1842(m)(3), the previous delegation to the Inspector General of 
November 5, 1987, is revoked. With respect to sections 1833(h)(5)(D), 
1833(i)(6), 1833(p), 1834(a)(11)(A), 1834(b)(5)(C), 1842(j)(1)(D)(iv), 
1842(n)(3), 1842(p)(3)(A), and 1842(p)(3)(B), the previous delegation 
to the Inspector General of September 14, 1988, is revoked.
    This delegation is effective immediately.

    Dated: October 13, 1994.
Donna E. Shalala,
Secretary.
[FR Doc. 94-25942 Filed 10-19-94; 8:45 am]
BILLING CODE 4150-04-M