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Code of Federal Regulations (Last Updated: April 5, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter C - Medical Assistance Programs |
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Part 455 - Program Integrity: Medicaid |
| § 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 - xxx |
| 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. |