CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER B—MEDICARE PROGRAM (parts 405 to 426) > PART 420—PROGRAM INTEGRITY: MEDICARE > SUBPART D—Access to Books, Documents, and Records of Subcontractors (§420.300 to §420.304) > 420.303—HHS criteria for requesting books, documents, and records.

420.303—HHS criteria for requesting books, documents, and records.

HHS will generally request books, documents, and records from a subcontractor only if one of the following situations exists and the question cannot satisfactorily and efficiently be resolved without access to the books, documents, and records:
(a) HHS has reason to believe that the costs claimed for services of the subcontractor are excessive or inappropriate.
(b) There is insufficient information to judge the appropriateness of the costs.
(c) There is a written accusation with suitable evidence against the provider or subcontractor of kickbacks, bribes, rebates, or other illegal activities.
(d) There is evidence of a possible nondisclosure of the existence of a related organization.