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Title 42: Public Health
CHAPTER IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)
SUBCHAPTER C: MEDICAL ASSISTANCE PROGRAMS
PART 455: PROGRAM INTEGRITY: MEDICAID
Subpart A: Medicaid Agency Fraud Detection and Investigation Program
455.16 - Resolution of full investigation.
A full investigation must continue until?
(a) Appropriate legal action is initiated;
(b) The case is closed or dropped because of insufficient evidence to support the allegations of fraud or abuse; or
(c) The matter is resolved between the agency and the provider or recipient. This resolution may include but is not limited to?
(1) Sending a warning letter to the provider or recipient, giving notice that continuation of the activity in question will result in further action;
(2) Suspending or terminating the provider from participation in the Medicaid program;
(3) Seeking recovery of payments made to the provider; or
(4) Imposing other sanctions provided under the State plan.
[43 FR 45262, Sept. 29, 1978, as amended at 48 FR 3756, Jan. 27, 1983]
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