Section 455.21 - Cooperation with State Medicaid fraud control unitsIn 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