Medicaid program; withholding of Medicaid payments for fraud or willful misrepresentation--HHS. Final rule.
This final rule specifically encourages State Medicaid agencies to whithhold program payments to providers without first granting administrative review where the State agency has reliable evidence of fraudulent activity by the provider. These changes serve both to reinforce and strengthen existing State Medicaid agency responsibilities in the withholding of program funds, and to bring Medicaid program regulations in line with existing Medicare policy in this area.
D003415:Crime; D005607:Fraud; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000331:legislation & jurisprudence*; D014481:United States; D014483:United States Dept. of Health and Human Services