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Code of Federal Regulations (Last Updated: July 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 434 - Contracts |
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Subpart E - XXX |
§ 434.53 - Periodic medical audits.
Latest version.
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(a) The agency must establish a system of periodic medical audits to insure that each contractor furnishes quality and accessible health care to enrolled recipients.
(b) The system of periodic medical audits must—
(1) Provide for audits conducted at least once a year for each contractor;
(2) Identify and collect management data for use by medical audit personnel; and
(3) Provide that the data includes—
(i) Reasons for enrollment and termination; and
(ii) Use of services.