(a) Pertaining to health care providers. Upon receipt of information
indicating that a physician or health care provider has engaged in
activities enumerated in subparagraphs (a) through (c) of Sec. 702.431,
the Director, through the Director's designees, may evaluate the
information (as described in Sec. 702.414) to ascertain whether
proceedings should be initiated against the physician or health care
provider to remove authorization to render medical care or service under
the Longshore and Harbor Workers' Compensation Act.
(b) Pertaining to health care providers and claims representatives.
If after appropriate investigation the Director determines that
proceedings should be initiated, written notice thereof sent certified
mail, return receipt requested, shall be provided to the physician,
health care provider or claims representative containing the following:
(1) A concise statement of the grounds upon which debarment will be
based;
(2) A summary of the information upon which the director has relied
in reaching an initial decision that debarment proceedings should be
initiated;
(3) An invitation to the physician, health care provider or claims
representative to: (i) Resign voluntarily from participation in the
program without admitting or denying the allegations presented in the
written notice; or (ii) request a decision on debarment to be based upon
the existing agency record and any other information the physician,
health care provider or claims representative may wish to provide;
(4) A notice of the physician's, health care provider's or claims
representative's right, in the event of an adverse ruling by the
Director, to request a formal hearing before an administrative law
judge;
(5) A notice that should the physician, health care provider or
claims representative fail to provide written answer to the written
notice described in this section within thirty (30) days of receipt, the
Director may deem the allegations made therein to be true and may order
exclusion of the physician, health care provider or claims
representative without conducting any further proceedings; and
(6) The name and address of the district director who shall be
responsible for receiving the answer from the physician, health care
provider or claims representative.
(c) Should the physician, health care provider or claims
representative fail to file a written answer to the notice described in
this section within thirty (30) days of receipt thereof, the Director
may deem the allegations made therein to be true and may order debarment
of the physician, health care provider or claims representative.
(d) The physician, health care provider or claims representative may
inspect or request copies of information in the agency records at any
time prior to the Director's decision.
(e) The Director shall issue a decision in writing, and shall send a
copy of the decision to the physician, health care provider or claims
representative by certified mail, return receipt requested. The decision
shall advise the physician, health care provider or claims
representative of the right to request, within thirty (30) days of the
date of an adverse decision, a formal hearing before an administrative
law judge under the procedures set forth herein. The filing of such a
request for hearing within the time specified shall operate to stay the
effectiveness of the decision to debar.
[50 FR 404, Jan. 3, 1985]
