42 CFR 455.13 : Public Health (Part 1 To Parts 1009-1099) — (§ 430.0 To Part 481) — Centers For Medicare & Medicaid Services, Department Of Health And Human Services (Continued) (§ 430.0 To Part 481) — Medical Assistance Programs (§ 430.0 To § 456.725) — Program Integrity: Medicaid (§ 455.1 To § 455.518) — Medicaid Agency Fraud Detection And Investigation Program (§ 455.12 To § 455.23) — Methods for identification, investigation, and referral.

4 Aug 2016

The Medicaid agency must have -

(a) Methods and criteria for identifying suspected fraud cases;

(b) Methods for investigating these cases that -

(1) Do not infringe on the legal rights of persons involved; and

(2) Afford due process of law; and

(c) Procedures, developed in cooperation with State legal authorities, for referring suspected fraud cases to law enforcement officials.

42 CFR 455.13

[43 FR 45262, Sept. 29, 1978, as amended at 48 FR 3755, Jan. 27, 1983]