State Operations Manual (Pub. 100-07), Ch. 5 § 5230
Special CMS location Processing
5230 - Special CMS location Processing
(Rev. 243; Issued: 06-12-26; Effective: 06-12-26; Implementation: 06-12-26)
The following types of allegations are subject to special CMS location handling:
1. Over-Utilization or Inappropriate Utilization of Services- The CMS location
refers to the local QIO for investigation, and documents the provider’s files as for
other allegations. The CMS location acts, as necessary, on any findings returned
by the QIO;
2. Civil Rights Violations- The CMS location refers to the regional OCR for
investigation. The CMS location documents the provider’s files as for other
allegations. The CMS location acts as necessary on any findings returned by
OCR; and
3. Medicare/Medicaid/CLIA fraud- The CMS location refers to the CMS location of
the Inspector General/DHHS for investigation. The CMS location documents the
provider’s files as for other allegations.
In each of the above instances, the CMS location ensures that the complainant and SA are
notified of any findings.