[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: 42CFR455.13]



[Page 333]

 

                         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

 

   Subpart A_Medicaid Agency Fraud Detection and Investigation Program

 

Sec.  455.13  Methods for identification, investigation, and referral.



    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.



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