[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR1007.7]



[Page 1207]

 

                         TITLE 42--PUBLIC HEALTH

 

      GENERAL--HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

PART 1007_STATE MEDICAID FRAUD CONTROL UNITS--Table of Contents

 

Sec.  1007.7  Organization and location requirements.



    Any of the following three alternatives is acceptable:

    (a) The unit is located in the office of the State Attorney General 

or another department of State government which has Statewide authority 

to prosecute individuals for violations of criminal laws with respect to 

fraud in the provision or administration of medical assistance under a 

State plan implementing title XIX of the Act;

    (b) If there is no State agency with Statewide authority and 

capability for criminal fraud prosecutions, the unit has established 

formal procedures that assure that the unit refers suspected cases of 

criminal fraud in the State Medicaid program to the appropriate State 

prosecuting authority or authorities, and provides assistance and 

coordination to such authority or authorities in the prosecution of such 

cases; or

    (c) The unit has a formal working relationship with the office of 

the State Attorney General and has formal procedures for referring to 

the Attorney General suspected criminal violations occurring in the 

State Medicaid program and for effective coordination of the activities 

of both entities relating to the detection, investigation and 

prosecution of those violations. Under this requirement, the office of 

the State Attorney General must agree to assume responsibility for 

prosecuting alleged criminal violations referred to it by the unit. 

However, if the Attorney General finds that another prosecuting 

authority has the demonstrated capacity, experience and willingness to 

prosecute an alleged violation, he or she may refer a case to that 

prosecuting authority, as long as the Attorney General's Office 

maintains oversight responsibility for the prosecution and for 

coordination between the unit and the prosecuting authority.