Part 455 — Program Integrity: Medicaid
Subpart A — Medicaid Agency Fraud Detection and Investigation Program
- § 455.12— State plan requirement.
- § 455.13— Methods for identification, investigation, and referral.
- § 455.14— Preliminary investigation.
- § 455.15— Full investigation.
- § 455.16— Resolution of full investigation.
- § 455.17— Reporting requirements.
- § 455.18— Provider's statements on claims forms.
- § 455.19— Provider's statement on check.
- § 455.20— Beneficiary verification procedure.
- § 455.21— Cooperation with State Medicaid fraud control units.
- § 455.23— Suspension of payments in cases of fraud.
Subpart B — Disclosure of Information by Providers and Fiscal Agents
- § 455.100— Purpose.
- § 455.101— Definitions.
- § 455.102— Determination of ownership or control percentages.
- § 455.103— State plan requirement.
- § 455.104— Disclosure by Medicaid providers and fiscal agents: Information on ownership and control.
- § 455.105— Disclosure by providers: Information related to business transactions.
- § 455.106— Disclosure by providers: Information on persons convicted of crimes.
- § 455.107— Disclosure of affiliations.
Subpart C — Medicaid Integrity Program
- § 455.200— Basis and scope.
- § 455.202— Limitation on contractor liability.
- § 455.230— Eligibility requirements.
- § 455.232— Medicaid integrity audit program contractor functions.
- § 455.234— Awarding of a contract.
- § 455.236— Renewal of a contract.
- § 455.238— Conflict of interest.
- § 455.240— Conflict of interest resolution.
Subpart D — Independent Certified Audit of State Disproportionate Share Hospital Payment Adjustments
Subpart E — Provider Screening and Enrollment
- § 455.400— Purpose.
- § 455.405— State plan requirements.
- § 455.410— Enrollment and screening of providers.
- § 455.412— Verification of provider licenses.
- § 455.414— Revalidation of enrollment.
- § 455.416— Termination or denial of enrollment.
- § 455.417— Termination periods and termination database periods.
- § 455.420— Reactivation of provider enrollment.
- § 455.422— Appeal rights.
- § 455.432— Site visits.
- § 455.434— Criminal background checks.
- § 455.436— Federal database checks.
- § 455.440— National Provider Identifier.
- § 455.450— Screening levels for Medicaid providers.
- § 455.452— Other State screening methods.
- § 455.460— Application fee.
- § 455.470— Temporary moratoria.
Subpart F — Medicaid Recovery Audit Contractors Program
- § 455.500— Purpose.
- § 455.502— Establishment of program.
- § 455.504— Definitions.
- § 455.506— Activities to be conducted by Medicaid RACs and States.
- § 455.508— Eligibility requirements for Medicaid RACs.
- § 455.510— Payments to RACs.
- § 455.512— Medicaid RAC provider appeals.
- § 455.514— Federal share of State expense of the Medicaid RAC program.
- § 455.516— Exceptions from Medicaid RAC programs.
- § 455.518— Applicability to the territories.