Fed Regist. 1980 Dec 1;45(232):79658-60.
This proposal would amend existing regulations to provide timely notice and administrative review when Medicare payments for services are withheld because there is evidence of fraud. This proposal would specify what constitutes evidence of fraud sufficient to support withholding: where a case is under criminal investigation, or a formal criminal charge has been issued, or a civil suit has been filed, or the procedures for exclusion from the Medicare program have been initiated because of fraud related to the Medicare program. The purpose of this proposal is to specify in regulations procedures to protect the interests of providers, practitioners, and suppliers of service without compromising pending actions or procedures or the ability of the Federal government to protect funds.
本提案将修订现有法规，以便在因存在欺诈证据而扣留医疗保险服务款项时提供及时通知和行政审查。本提案将明确足以支持扣留的欺诈证据的构成要件：即案件正在刑事调查中、已发布正式刑事指控、已提起民事诉讼，或者因与医疗保险计划相关的欺诈行为而启动了从医疗保险计划中排除的程序。本提案的目的是在法规中明确程序，以保护服务提供者、从业者和供应商的利益，同时不影响未决行动或程序，也不损害联邦政府保护资金的能力。
