---
kind: "section"
citation: "42 C.F.R. § 455.21"
title: "42"
number: "455.21"
heading: "Cooperation with State Medicaid fraud control units."
url: "https://uscodex.org/cfr/42/455.21"
---

# §455.21. Cooperation with State Medicaid fraud control units.


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](/cfr/42/431.107.md) of this subchapter. In using this information, the unit must protect the privacy rights of beneficiaries; 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.
- (c) The agency must enter into a written agreement with the unit under which:
  - (1) The agency will agree to comply with all requirements of [§ 455.21(a)](#a);
  - (2) The unit will agree to comply with the requirements of [§ 1007.11(c)](/cfr/42/1007.11.md?p=c) of this title; and
  - (3) The agency and the unit will agree to—
    - (i) Establish a practice of regular meetings or communication between the two entities;
    - (ii) Establish procedures for how they will coordinate their efforts;
    - (iii) Establish procedures for [§§ 1007.9(e) through 1007.9(h)](/cfr/42/1007.9.md?p=e..h) of this title;
    - (iv) Establish procedures by which the unit will receive referrals of potential fraud from managed care organizations, if applicable, either directly or through the agency, as required at [§ 438.608(a)(7)](/cfr/42/438.608.md?p=a-7) of this title; and
    - (v) Review and, as necessary, update the agreement no less frequently than every five (5) years to ensure that the agreement reflects current law and practice.

## Notes

### Amendments

[43 FR 45262, Sept. 29, 1978, as amended at 84 FR 10713, Mar. 22, 2019]

### Authority

Authority: 42 U.S.C. 1302.

### Source

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

### Amendments

[43 FR 45262, Sept. 29, 1978, as amended at 84 FR 10713, Mar. 22, 2019]