Module 1 Workbook — Auditor Legality (Print / PDF)

How to use this workbook

Assign primary and backup contacts for each auditor type before a letter or survey arrives.
Train staff on the rights checklist — check each item when covered in inservice.
Use the record-production log for every ADR, RAC request, UPIC/OIG subpoena, or survey record pull.
Calendar appeal deadlines (42 CFR § 405.900) and survey dispute windows (42 CFR § 488.334).
Keep completed logs with compliance files — counsel may need production history.

Facility: _________________________________	CCN: _________________
Compliance officer: _________________________________	Outside counsel: _________________
Healthcare counsel (UPIC/OIG/DOJ): _________________________________

Auditor type	Primary (name / role / phone)	Backup	Statute ref (quick)

Check when policy/training completed:

Log minimum necessary production per 45 CFR § 164.514. Duplicate this page for each request or add rows below.

#	Date received	Requestor / agency	Request type	Scope (claims, residents, dates)	What we produced	Sent by / date	Deadline

Request type codes: SA = state survey · MAC/ADR · RAC · UPIC · OIG · DOJ · MFCU · Other

Determination / citation	Date received	Appeal level (405.900 / 488.334)	Deadline	Filed date	Outcome

Designated facility spokesperson (OIG/DOJ): _________________________

Last staff inservice date: __________ Next: __________

Upon receipt of UPIC, OIG, DOJ, or MFCU contact — no deletion or alteration of records (42 U.S.C. § 1320a-7b; 18 U.S.C. § 1001).

Hold issued by: _________________________ Date: __________

IT / email admin notified: _________________________

Administrator signature: _________________________ Date: __________