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) > 455.16—Resolution of full investigation.

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
(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]