Cooperation with State Medicaid fraud control units.

In a State with a Medicaid fraud control unit established and certified under subpart C of this part, (a) The agency must— (1) Refer all cases of suspected provider fraud to the unit; (2) If the unit determines that it may be useful in carrying out the unit's responsibilities, promptly comply with a request from the unit for— (i) Access to, and free copies of, any records or information kept by the agency or its contractors; (ii) Computerized data stored by the agency or its contractors. These data must be supplied without charge and in the form requested by the unit; and (iii) Access to any information kept by providers to which the agency is authorized access by section 1902(a)(27) of the Act and § 431.107 of this subchapter. In using this information, the unit must protect the privacy rights of beneficiaries; and (3) On referral from the unit, initiate any available administrative or judicial action to recover improper payments to a provider. (b) The agency need not comply with specific requirements under this subpart that are the same as the responsibilities placed on the unit under subpart D of this part. (c) The agency must enter into a written agreement with the unit under which: (1) The agency will agree to comply with all requirements of § 455.21(a); (2) The unit will agree to comply with the requirements of § 1007.11(c) of this title; and (3) The agency and the unit will agree to— (i) Establish a practice of regular meetings or communication between the two entities; (ii) Establish procedures for how they will coordinate their efforts; (iii) Establish procedures for §§ 1007.9(e) through 1007.9(h) of this title; (iv) Establish procedures by which the unit will receive referrals of potential fraud from managed care organizations, if applicable, either directly or through the agency, as required at § 438.608(a)(7) of this title; and (v) Review and, as necessary, update the agreement no less frequently than every five (5) years to ensure that the agreement reflects current law and practice. [43 FR 45262, Sept. 29, 1978, as amended at 84 FR 10713, Mar. 22, 2019]