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U.S. Department of Health and Human Services

Inspections, Compliance, Enforcement, and Criminal Investigations

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10-9 - APPEAL PROCESS

10-9 - APPEAL PROCESS
      10-9-1 - Purpose
      10-9-2 - Who May Appeal
      10-9-3 - What May Be Appealed
      10-9-4 - When An Appeal Is Not Appropriate
      10-9-5 - Requests For Appeal
      10-9-6 - Review Of Appeals
      10-9-7 - Decision On Appeals

  10-9 - APPEAL PROCESS

  10-9-1 - Purpose

This section sets forth a procedure for the appeal of decisions regarding recommendations for legal or administrative actions.

  10-9-2 - Who May Appeal

Appeals may be originated by the RFDDs or the Center Directors for Compliance (or equivalent).

  10-9-3 - What May Be Appealed

Appropriate officials may appeal any decision disapproving a proposed action, administrative or legal, which is allegedly inconsistent, or where there is nonexistent enforcement policy. The directors of the involved offices must have attempted to resolve the disagreement prior to submitting an appeal.

  10-9-4 - When An Appeal Is Not Appropriate

An appeal is not appropriate when additional information that overcomes the basis for the original denial becomes available. In such cases, the recommendation should be updated to include the new or additional information and resubmitted to the reviewing office with an explanation for the resubmission and a request for reconsideration.

  10-9-5 - Requests For Appeal

District offices should submit appeals over the signature of the RFDD. Centers should submit appeals over the signature of the Center Director for Compliance. The appeal memorandum and two copies of relevant supporting material must be identified, indexed, and submitted to the Director, OE.

The appeal memorandum must identify the issues on which the appeal is based, and the reasons for disagreeing with the decision of the declining unit. Recommendations must include a summary of communications regarding attempts to resolve differences of opinion.

  10-9-6 - Review Of Appeals

OE/DCMO will review the appeal package to assure that it is complete, determine that an appeal is appropriate, and will determine whether the appeal deals with policy, regulations, or a statute. DCMO will initially attempt to gain a resolution of the disagreement by the parties to the appeal.

  10-9-7 - Decision On Appeals

If DCMO cannot get the parties to agree, an ad hoc committee meeting to be chaired by the Director, OE, will be scheduled, following the procedures outlined in section 10-6, ad hoc Committee.

The meeting will include the RFDD, the Center Director for Compliance, and the Deputy Chief Counsel for Litigation, if appropriate. If the principals are unable to attend, they will designate a senior compliance official to serve in their absence. Usually only one resource person must accompany the senior compliance official.

Resolution of appeals is by consensus of the ad hoc committee members. If the ad hoc committee can not reach a consensus, the matter will be forwarded to the ACRA for a final decision.

Decisions made by the ad hoc committee will be recorded and distributed to meeting participants. The decision may be limited to a decision on the merits of the case or it may include instructions to develop policy in a particular program area. The ACRA or OCC may review all committee decisions.