Scheme Nickname: 
Administrative sanctions - FEHB providers

Adjudication scheme for imposition of administrative sanctions (e.g., debarment, suspension, civil monetary penalties, and other monetary assessments) by OPM against FEHB providers pursuant to its authority under the FEHB program (5 CFR Parts 890, Subpart J).

For FEHB cases, by statute, there are two classes of debarment: mandatory debarment (based on certain criminal convictions such as fraud, abuse of patients, and distribution of controlled substances) and permissive debarment (based on license revocation or pending disciplinary proceedings concerning provider's professional competence). Statutory minimum for mandatory debarments is 3 years. Permissive debarments are (with certain exceptions) indefinite based on licensure status.

Types of Adjudication: 
Type B
Distinctive Features: 
While there is no "discovery" permitted in these proceedings in the traditional sense, in FEHB cases involving permissive debarment or civil penalties, OPM regulations impose an affirmative (mandatory) disclosure obligation on providers to disclose specified background information related to (a) existing, proposed, or prior debarment/suspension proceedings by a federal, state, or local government; and (b) criminal or civil proceedings arising from the same facts serving as the basis for the current suspension/debarment action. (5 CFR 890.1023(c), 890.1069(b)).
Other Comments: 
The Federal Employees Health Care Protection Act of 1998 specifically provides that hearings held under the Act are not APA-style hearings: "Such hearing [related to suspension/debarment of FEHB providers] shall be conducted without regard to [5 USC 551-559]." (5 USC 8902a(h)(1)).
Verified by Agency: 
Not verified
Is this a Major Adjudication: