§455.16. Resolution of full investigation.

42 C.F.R. § 455.16

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 beneficiary. This resolution may include but is not limited to—

(1)

Sending a warning letter to the provider or beneficiary, 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.

Notes, amendments, and revision history

[43 FR 45262, Sept. 29, 1978, as amended at 48 FR 3756, Jan. 27, 1983]

Authority: 42 U.S.C. 1302.

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

[43 FR 45262, Sept. 29, 1978, as amended at 48 FR 3756, Jan. 27, 1983]