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FEDERAL · 42 CFR

Part 455 — Program Integrity: Medicaid

60 sections · Title 42: Public Health

§ 455.1Basis and scope.
§ 455.2Definitions.
§ 455.3Other applicable regulations.
§ 455.12State plan requirement.
§ 455.13Methods for identification, investigation, and referral.
§ 455.14Preliminary investigation.
§ 455.15Full investigation.
§ 455.16Resolution of full investigation.
§ 455.17Reporting requirements.
§ 455.18Provider's statements on claims forms.
§ 455.19Provider's statement on check.
§ 455.20Beneficiary verification procedure.
§ 455.21Cooperation with State Medicaid fraud control units.
§ 455.23Suspension of payments in cases of fraud.
§ 455.100Purpose.
§ 455.101Definitions.
§ 455.102Determination of ownership or control percentages.
§ 455.103State plan requirement.
§ 455.104Disclosure by Medicaid providers and fiscal agents: Information on ownership and control.
§ 455.105Disclosure by providers: Information related to business transactions.
§ 455.106Disclosure by providers: Information on persons convicted of crimes.
§ 455.107Disclosure of affiliations.
§ 455.200Basis and scope.
§ 455.202Limitation on contractor liability.
§ 455.230Eligibility requirements.
§ 455.232Medicaid integrity audit program contractor functions.
§ 455.234Awarding of a contract.
§ 455.236Renewal of a contract.
§ 455.238Conflict of interest.
§ 455.240Conflict of interest resolution.
§ 455.300Purpose.
§ 455.301Definitions.
§ 455.304Condition for Federal financial participation (FFP).
§ 455.400Purpose.
§ 455.405State plan requirements.
§ 455.410Enrollment and screening of providers.
§ 455.412Verification of provider licenses.
§ 455.414Revalidation of enrollment.
§ 455.416Termination or denial of enrollment.
§ 455.417Termination periods and termination database periods.
§ 455.420Reactivation of provider enrollment.
§ 455.422Appeal rights.
§ 455.432Site visits.
§ 455.434Criminal background checks.
§ 455.436Federal database checks.
§ 455.440National Provider Identifier.
§ 455.450Screening levels for Medicaid providers.
§ 455.452Other State screening methods.
§ 455.460Application fee.
§ 455.470Temporary moratoria.
§ 455.500Purpose.
§ 455.502Establishment of program.
§ 455.504Definitions.
§ 455.506Activities to be conducted by Medicaid RACs and States.
§ 455.508Eligibility requirements for Medicaid RACs.
§ 455.510Payments to RACs.
§ 455.512Medicaid RAC provider appeals.
§ 455.514Federal share of State expense of the Medicaid RAC program.
§ 455.516Exceptions from Medicaid RAC programs.
§ 455.518Applicability to the territories.