Section He-M 504.10 - Fraud Detection and Investigation(a) In accordance with 42 CFR 455.14, the department's program integrity unit shall address complaints of medicaid fraud, waste, or abuse from any source or the identification of any questionable practices after analysis of paid claim history by conducting a preliminary investigation.(b) Cases where potential fraud has been detected as a result of a preliminary investigation pursuant to (a) above, shall be referred for a full investigation to the appropriate agency, in accordance with 42 CFR 455.15.(c) A full investigation and resolution shall be conducted in accordance with 42 CFR 455.16.(d) The department shall recoup state and federal medicaid payments as permitted by 42 CFR 455, 42 CFR 447, and 42 CFR 456 for a provider agency's failure to maintain supporting records in accordance He-W 520 and He-M 504.N.H. Admin. Code § He-M 504.10
Derived from Number 28, Filed July 13, 2023, Proposed by #13679, EMERGENCY RULE, Effective 6/28/2023, Expires 12/25/2023.Amended by Number 50, Filed December 14, 2023, Proposed by #13807, Effective 11/17/2023, Expires 11/17/2033.