42 CFR Part 455
PART 455—PROGRAM INTEGRITY: MEDICAID
- PART 455—PROGRAM INTEGRITY: MEDICAID
- Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services › Subchapter C—Medical Assistance Programs
- § 455.1 Basis and scope.
- § 455.2 Definitions.
- § 455.3 Other applicable regulations.
- 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
- § 455.300 Purpose.
- § 455.301 Definitions.
- § 455.304 Condition for Federal financial participation (FFP).
- 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.
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