42 CFR § 455.13
Methods for identification, investigation, and referral
June 11, 2020
The Medicaid agency must have—
(a) Methods and criteria for identifying suspected fraud cases;
(b) Methods for investigating these cases that—
(1) Do not infringe on the legal rights of persons involved; and
(2) Afford due process of law; and
(c) Procedures, developed in cooperation with State legal authorities, for referring suspected fraud cases to law enforcement officials.
[43 FR 45262, Sept. 29, 1978, as amended at 48 FR 3755, Jan. 27, 1983]