42 CFR 455.23 - Suspension of payments in cases of fraud
| Cite as | 42 CFR 455.23 |
-
- This document is available in original version only for vLex customers
View this document and try vLex for 7 days - TRY VLEX
- This document is available in original version only for vLex customers
73 practice notes
-
San Lazaro Ass'n, Inc. v. Connell, No. 00-55065
...requirement; and (3) the Controller's audit could not constitute "reliable evidence" sufficient to justify withholding payments under 42 C.F.R. § 455.23. The district court also awarded Plaintiffs attorney's fees under 42 U.S.C. § Because there have been significant developments regarding t......
-
Malloy v. State, No. S13A0188.
...42 USC § 1302; 42 CFR § 456.22. The agency is also required to have methods and criteria for identifying suspected fraud cases. 42 CFR § 455. 1, et seq. Chapter 403 of DCH's 2010 provider manual sets forth the responsibilities of the Program Integrity (PI) Section of the Office of the Inspe......
-
Rcj Medical Services, Inc. v. Bonta', No. B143160.
...evidence of potential fraud or willful misrepresentation during an investigation' (Scope of Work, paragraph 10). Federal regulations at 42 CFR 455.23 authorize such withholds by the State Medicaid agency. The IA stipulates that the [Controller] will not make independent fraud referrals to l......
-
Bader v. Wernert, CAUSE NO.: 1:15-CV-375-TLS
...in late-2013, the Providers' interactions with FSSA changed. On October 28, 2013, FSSA issued a letter stating that, in accordance with 42 C.F.R. § 455.23, NIGCC had been placed on a payment suspension, which applied to “any and all Medicaid claims submitted by” NIGCC. (Pls.' Hr'g Ex. 1, at......
Request a trial to view additional results
59 cases
-
San Lazaro Ass'n, Inc. v. Connell, No. 00-55065
...and (3) the Controller's audit could not constitute "reliable evidence" sufficient to justify withholding payments under 42 C.F.R. § 455.23. The district court also awarded Plaintiffs attorney's fees under 42 U.S.C. § Because there have been significant developments regarding the ......
-
Malloy v. State, No. S13A0188.
...42 USC § 1302; 42 CFR § 456.22. The agency is also required to have methods and criteria for identifying suspected fraud cases. 42 CFR § 455. 1, et seq. Chapter 403 of DCH's 2010 provider manual sets forth the responsibilities of the Program Integrity (PI) Section of the Office of the Inspe......
-
Rcj Medical Services, Inc. v. Bonta', No. B143160.
...evidence of potential fraud or willful misrepresentation during an investigation' (Scope of Work, paragraph 10). Federal regulations at 42 CFR 455.23 authorize such withholds by the State Medicaid agency. The IA stipulates that the [Controller] will not make independent fraud referrals to l......
-
Bader v. Wernert, CAUSE NO.: 1:15-CV-375-TLS
...in late-2013, the Providers' interactions with FSSA changed. On October 28, 2013, FSSA issued a letter stating that, in accordance with 42 C.F.R. § 455.23, NIGCC had been placed on a payment suspension, which applied to “any and all Medicaid claims submitted by” NIGCC. (Pls.' Hr'g Ex. 1, at......
Request a trial to view additional results
11 firm's commentaries
-
CMS Issues Proposed Rule Addressing Enhanced Program Integrity Requirements
...at 42 U.S.C. § 1395y(o)4 42 C.F.R. § 405.371(a)5 75 Fed. Reg. at 58,2396 Id.7 Id.8 75 Fed. Reg. at 58,2229 75 Fed. Reg. at 58,23910 42 C.F.R. § 455.23(a)11 75 Fed. Reg. at 58,2431275 Fed. Reg. at 58,24313 75 Fed. Reg. at 58,22414 75 Fed. Reg. at 58,24415 75 Fed. Reg. at 58,24416 Pub. L. 111......
-
“Credible Allegations of Fraud”: Immediate Medicare Payment Suspension!
...employee. Yes, that is sarcasm. 42 CFR § 405.372 is the regulation outlining the requirements for suspending Medicare payments. 42 CFR § 455.23 is the regulation mandating suspension of Medicaid payments upon credible allegations of fraud. Pursuant to Medicare regulations, CMS must suspend ......
-
CMS Finalizes Regulations Intended to Strengthen Program Integrity
...Medicaid Current state Medicaid regulations that permit the suspension of Medicaid payments are based on the authority established by 42 C.F.R. § 455.23, which authorizes state Medicaid agencies to temporarily withhold Medicaid payments upon receipt of ‘‘reliable evidence’’ of fraud or will......
-
Medicaid managed care proposed rule expands program integrity obligations
...PIHPs, and PAHPs to suspend payments to a network provider that is the subject of a credible allegation of fraud in accordance with 42 C.F.R. § 455.23. CMS had previously discussed the applicability of suspension of payment requirements to Medicaid managed care plans,1 and believes the same......
Request a trial to view additional results
1 provisions
-
HB 166 – Creates FY 2020-2021 operating budget
...complete. (E) After suspending a provider agreement under division (B) of this section, the department shall, as specified in 42 C.F.R. 455.23(b), send notice of the suspension to the affected medicaid provider or, if the provider is a noninstitutional provider, the owner in accordance with......