42 CFR §455.16
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
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.