42 CFR 422.224
§ 422.224 Payment to individuals and entities excluded by the OIG or included on the preclusion list.
United States · 42 CFR — Public Health · Status: effective
Cite this
- Citation
- 42 CFR 422.224, § 422.224 Payment to individuals and entities excluded by the OIG or included on the preclusion list, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/204564
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Full text
(a) An MA organization may not pay, directly or indirectly, on any basis, for items or services furnished to a Medicare enrollee by any individual or entity that is excluded by the Office of the Inspector General (OIG) or is included on the preclusion list, defined in § 422.2.
(b) If an MA organization receives a request for payment by, or on behalf of, an individual or entity that is excluded by the OIG or an individual or entity that is included on the preclusion list, defined in § 422.2, the MA organization must notify the enrollee and the excluded individual or entity or the individual or entity included on the preclusion list in writing, as directed by contract or other direction provided by CMS, that payments will not be made. Payment may not be made to, or on behalf of, an individual or entity that is excluded by the OIG or is included on the preclusion list.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.