[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: 42CFR455.16]



[Page 333-334]

 

                         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.  455.16  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



[[Page 334]]



    (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]