42 C.F.R. § 455.21 Cooperation with State Medicaid fraud control units.
Title 42 - Public Health
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 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 §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.
Title 42: Public Health
PART 455—PROGRAM INTEGRITY: MEDICAID
Subpart A—Medicaid Agency Fraud Detection and Investigation Program
§ 455.21 Cooperation with State Medicaid fraud control units.
