Section 1004.80 - QIO report to the OIG(a)Manner of reporting. If the violation(s) identified by the QIO have not been resolved, it must submit a report and recommendation to the OIG at the field office with jurisdiction.(b)Content of report. The QIO report must include the following information-(1) Identification of the practitioner or other person and, when applicable, the name of the director, administrator or owner of the entity involved;(2) The type of health care services involved;(3) A description of each failure to comply with an obligation, including specific dates, places, circumstances and other relevant facts;(4) Pertinent documentary evidence;(5) Copies of written correspondence, including reports of conversations with the practitioner or other person regarding the violation and, if applicable, a copy of the verbatim transcript of the meeting with the practitioner or other person;(6) The QIO's finding that an obligation under section 1156(a) of the Act has been violated and that the violation is substantial and has occurred in a substantial number of cases or is gross and flagrant;(7) A case-by-case analysis and evaluation of any additional information provided by the practitioner or other person in response to the QIO's initial finding;(8) A copy of the CAP that was developed and documentation of the results of such plan;(9) The number of admissions by the practitioner or other person reviewed by the QIO during the period in which the violation(s) were identified;(10) The professional qualifications of the QIO's reviewers; and(11) The QIO's sanction recommendation.(c)QIO recommendation. The QIO must specify in its report-(1) The sanction recommended;(2) The amount of the monetary penalty recommended, if applicable;(3) The period of exclusion recommended, if applicable;(4) The availability of alternative sources of services in the community, with supporting information; and(5) The county or counties in which the practitioner or other person furnishes services.60 FR 63640, Dec. 12, 1995, as amended at 62 FR 23143, Apr. 29, 1997