[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: 42CFR455.1]



[Page 332]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 455_PROGRAM INTEGRITY: MEDICAID--Table of Contents

 

Sec.  455.1  Basis and scope.



    This part sets forth requirements for a State fraud detection and 

investigation program, and for disclosure of information on ownership 

and control.

    (a) Under the authority of sections 1902(a)(4), 1903(i)(2), and 1909 

of the Social Security Act, Subpart A provides State plan requirements 

for the identification, investigation, and referral of suspected fraud 

and abuse cases. In addition, the subpart requires that the State--

    (1) Report fraud and abuse information to the Department; and

    (2) Have a method to verify whether services reimbursed by Medicaid 

were actually furnished to recipients.

    (b) Subpart B implements sections 1124, 1126, 1902(a)(36), 

1903(i)(2), and 1903(n) of the Act. It requires that providers and 

fiscal agents must agree to disclose ownership and control information 

to the Medicaid State agency.



[51 FR 34787, Sept. 30, 1986]