---
kind: "section"
citation: "42 C.F.R. § 457.915"
title: "42"
number: "457.915"
heading: "Fraud detection and investigation."
url: "https://uscodex.org/cfr/42/457.915"
---

# §457.915. Fraud detection and investigation.

- (a) **State program requirements.** The State must establish procedures for ensuring program integrity and detecting fraudulent or abusive activity. These procedures must include the following:
  - (1) **Methods and criteria for identifying suspected fraud and abuse cases.**
  - (2) **Methods for investigating fraud and abuse cases that—**
    - (i) Do not infringe on legal rights of persons involved; and
    - (ii) **Afford due process of law.**
- (b) **State program integrity unit.** The State may establish an administrative agency responsible for monitoring and maintaining the integrity of the separate child health program.
- (c) **Program coordination.** The State must develop and implement procedures for referring suspected fraud and abuse cases to the State program integrity unit (if such a unit is established) and to appropriate law enforcement officials. Law enforcement officials include the—
  - (1) U.S. Department of Health and Human Services Office of Inspector General (OIG);
  - (2) U.S. Attorney's Office, Department of Justice (DOJ);
  - (3) Federal Bureau of Investigation (FBI); and
  - (4) **State Attorney General's office.**

## Notes

### Source

Source: 66 FR 2685, Jan. 11, 2001, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 65 FR 33622, May 24, 2000, unless otherwise noted.