final adverse action
Defined in 2 places of the United States Code.
Subject to subparagraph (B), the term “final adverse action” includes—
(i) civil judgments against a health care provider, supplier, or practitioner in State court related to the delivery of a health care item or service;
(ii) State criminal convictions related to the delivery of a health care item or service;
(iii) exclusion from participation in State health care programs (as defined in section 1320a–7(h) of this title);
(iv) any licensing or certification action described in subsection (a)(1)(A) taken against a supplier by a State licensing or certification agency; and
(v) any other adjudicated actions or decisions that the Secretary shall establish by regulation.
Source
- 2010–present42 U.S.C. § 1396RThe Public Health and Welfare · Information concerning sanctions taken by State licensing authorities against health care practitioners and providers · for purposes of this section
The term “final adverse action” includes:
(i) Civil judgments against a health care provider, supplier, or practitioner in Federal or State court related to the delivery of a health care item or service.
(ii) Federal or State criminal convictions related to the delivery of a health care item or service.
(iii) Actions by Federal agencies responsible for the licensing and certification of health care providers, suppliers, and licensed health care practitioners, including—
(I) formal or official actions, such as revocation or suspension of a license (and the length of any such suspension), reprimand, censure or probation,
(II) any dismissal or closure of the proceedings by reason of the provider, supplier, or practitioner surrendering their license or leaving the State or jurisdiction 1
(III) any other loss of license or the right to apply for, or renew, a license of the provider, supplier, or practitioner, whether by operation of law, voluntary surrender, non-renewability, or otherwise, or
(IV) any other negative action or finding by such Federal agency that is publicly available information.
(iv) Exclusion from participation in a Federal health care program (as defined in section 1320a–7b(f) of this title).
(v) Any other adjudicated actions or decisions that the Secretary shall establish by regulation.
Source
- 2010–present42 U.S.C. § 1320AThe Public Health and Welfare · Health care fraud and abuse data collection program · for purposes of this section
The term “final adverse action” includes:
(i) Civil judgments against a health care provider, supplier, or practitioner in Federal or State court related to the delivery of a health care item or service.
(ii) Federal or State criminal convictions related to the delivery of a health care item or service.
(iii) Actions by Federal or State agencies responsible for the licensing and certification of health care providers, suppliers, and licensed health care practitioners, including—
(I) formal or official actions, such as revocation or suspension of a license (and the length of any such suspension), reprimand, censure or probation,
(II) any other loss of license or the right to apply for, or renew, a license of the provider, supplier, or practitioner, whether by operation of law, voluntary surrender, non-renewability, or otherwise, or
(III) any other negative action or finding by such Federal or State agency that is publicly available information.
(iv) Exclusion from participation in Federal or State health care programs (as defined in sections 1320a–7b(f) and 1320a–7(h) of this title, respectively).
(v) Any other adjudicated actions or decisions that the Secretary shall establish by regulation.
Source
- 1996–201042 U.S.C. § 1320AThe Public Health and Welfare · Health care fraud and abuse data collection program · for purposes of this section