42 C.F.R. § 455.16 Resolution of full investigation.
Title 42 - Public Health
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]
Title 42: Public Health
PART 455—PROGRAM INTEGRITY: MEDICAID
Subpart A—Medicaid Agency Fraud Detection and Investigation Program
§ 455.16 Resolution of full investigation.
