CMS Pub. 100-08, ch. 4, § 4.11.7

The following information, if available, shall be included as part of the CMP case

package and made available upon request by CMS:

1. Background information:

a. All known identification numbers (NPI, Provider Transaction

Access Number (PTAN), etc.);

b. Provider's first and last name or entity name (if subject is an entity,

also include the full name of the principal operator);

c. Provider/supplier's address (street, city, state, and zip code). If

violator is an entity, identify address where principal operator

personally receives his/her mail;

2. Copies of any interviews, reports, or statements obtained regarding the

violation;

3. Copies of documentation supporting a confirmation of the violation;

4. Copies of all applicable correspondence between beneficiary and provider;

5. Copies of all applicable correspondence (including telephone contacts)

between the MAC and provider;

6. Copies of provider's applicable bills to beneficiaries and/or MACs, and

associated payment histories;

7. Copies of any complaints regarding provider and disposition of the

complaint;

8. Copies of all publications (e.g., bulletins, newsletters) sent to provider by

the UPIC, SMRCs or MAC who discuss the type of violation being addressed

in the CMP case;

9. Copies of any monitoring reports regarding the provider; and

10. Name and telephone number of UPIC contact.