In connection with this authority, the OIG is authorized to access any documents necessary to validate claims, including medical records and any other “records necessary for evaluation of the economy, efficiency, and effectiveness of” federal health care programs. The PPACA also expands the government’s subpoena power by allowing for physical access by DOJ to any institution, and its books and records, where the institution “is the subject of an investigation under [the Civil Rights of Institutionalized Persons Act (42 U.S.C. § 1997 et seq.)] to determine whether there are conditions which deprive persons residing in or confined to the institution of any rights, privileges, or immunities secured or protected by the Constitution or laws of the United States.” 340B Integrity Amendments The PPACA adds a new subsection (d) to section 340B of the Public Health Service Act (42 U.S.C. § 256b).

The court adopted the following instruction: "Reasonable doubt . . .is a doubt based upon reason - -a doubt for which you have a reason based upon the evidence or lack of evidence in the case. If, after careful, honest, and impartial consideration of all the evidence, you cannot say that you are firmly convinced of the defendant's guilt, then you have a reasonable doubt...."Brown v. Toombs UNLESS THE RECORD demonstrates that the requirements of the Prison Litigation Reform Act of 1995, or PLRA, 42 U.S.C. 1997, have been satisfied, an appeal should be dismissed without prejudice for failing to satisfy the exhaustion of available state remedies, the 6th U.S. Circuit Court of Appeals ruled March 27. Brown v. Toombs, 97-1333.