Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.2.2
Take Administrative Action on Cases Referred to and
4.9.2.2 - Take Administrative Action on Cases Referred to and
Declined/Returned by OIG/OI
(Rev. 11962; Issued: 04-21-23; Effective: 05-22-23; Implementation: 05-22-23)
The UPICs take immediate action to implement appropriate administrative remedies,
including the suspension or denial of payments, and the recovery of overpayments (see
PIM, chapter 3). Because the case has been rejected by LE, UPICs shall consult with the
BFL or Suspension SME concerning the imposition of suspension. They pursue
administrative and/or civil sanctions by OIG where LE has declined a case.