Whenever, in the conduct of a review and verification into the eligibility of an applicant or the recertification of a participant, the evaluation of utilization review reports or participant profiles, there is evidence of program fraud or abuse by an applicant or participant, the contractor shall promptly refer the matter to the executive director for review.
N.Y. Comp. Codes R. & Regs. Tit. 9 § 9660.1