[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: 42CFR455.21]



[Page 334-335]

 

                         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.  455.21  Cooperation with State Medicaid fraud control units.



    In a State with a Medicaid fraud control unit established and 

certified under subpart C of this part,

    (a) The agency must--

    (1) Refer all cases of suspected provider fraud to the unit;

    (2) If the unit determines that it may be useful in carrying out the 

unit's responsibilities, promptly comply with a request from the unit 

for--

    (i) Access to, and free copies of, any records or information kept 

by the agency or its contractors;

    (ii) Computerized data stored by the agency or its contractors. 

These data



[[Page 335]]



must be supplied without charge and in the form requested by the unit; 

and

    (iii) Access to any information kept by providers to which the 

agency is authorized access by section 1902(a)(27) of the Act and Sec.  

431.107 of this subchapter. In using this information, the unit must 

protect the privacy rights of recipients; and

    (3) On referral from the unit, initiate any available administrative 

or judicial action to recover improper payments to a provider.

    (b) The agency need not comply with specific requirements under this 

subpart that are the same as the responsibilities placed on the unit 

under subpart D of this part.