Closing Investigations

4.7.7 – Closing Investigations (Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21) An investigation shall be closed if it is referred to LE (i.e., it is referred to OIG, DOJ, FBI, or AUSA) and there are no pending administrative actions. In addition, an investigation may be closed due to the following circumstances: • When no further action is warranted by the UPIC and the matter is referred back to the MAC or to another CMS contractor for further review; • If it is closed with administrative action(s); • If the potential fraud is not substantiated; and/or • If CMS declined a requested administrative action.