---
kind: "section"
citation: "42 C.F.R. § 455.15"
title: "42"
number: "455.15"
heading: "Full investigation."
url: "https://uscodex.org/cfr/42/455.15"
---

# §455.15. Full investigation.


If the findings of a preliminary investigation give the agency reason to believe that an incident of fraud or abuse has occurred in the Medicaid program, the agency must take the following action, as appropriate:

- (a) If a provider is suspected of fraud or abuse, the agency must—
  - (1) In States with a State Medicaid fraud control unit certified under [subpart C of part 1002 of this title](/cfr/42/part1002-subpartC.md), refer the case to the unit under the terms of its agreement with the unit entered into under [§ 1002.309](/cfr/42/1002.309.md) of this title; or
  - (2) In States with no certified Medicaid fraud control unit, or in cases where no referral to the State Medicaid fraud control unit is required under [paragraph (a)(1)](#a-1) of this section, conduct a full investigation or refer the case to the appropriate law enforcement agency.
- (b) If there is reason to believe that a beneficiary has defrauded the Medicaid program, the agency must refer the case to an appropriate law enforcement agency.
- (c) If there is reason to believe that a beneficiary has abused the Medicaid program, the agency must conduct a full investigation of the abuse.

## Notes

### Amendments

[48 FR 3756, Jan. 27, 1983, as amended at 51 FR 34788, Sept. 30, 1986]

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 43 FR 45262, Sept. 29, 1978, unless otherwise noted.

### Amendments

[48 FR 3756, Jan. 27, 1983, as amended at 51 FR 34788, Sept. 30, 1986]