CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS (parts 430 to 456) > PART 455—PROGRAM INTEGRITY: MEDICAID > SUBPART A—Medicaid Agency Fraud Detection and Investigation Program (§455.12 to §455.23) > 455.13—Methods for identification, investigation, and referral.

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]