Statutes, codes, and regulations
Wyoming Administrative Code
Agency 048 - Health, Department ofSubagency 0037 - Medicaid
Chapter 16 - PROGRAM INTEGRITY
Section 16-5 - Investigation of Suspected Fraud, Theft, or Abuse of Services by Clients

048-16 Wyo. Code R. § 16-5

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Current through April 27, 2019
Section 16-5 - Investigation of Suspected Fraud, Theft, or Abuse of Services by Clients

(a) The Department is authorized to identify and investigate, or to refer to appropriate agencies for investigation, suspected fraud, theft, or abuse of services by clients identified pursuant to this section. An investigation shall be for the purpose of determining if:

  • (i) Fraud, theft, or abuse of services occurred or is occurring and can be documented;
  • (ii) Sufficient evidence can be developed to support restricting client participation pursuant to Section 10 of this Chapter; or
  • (iii) Sufficient evidence can be developed to support recovery of overpayments.

(b) The Department may, at any time, refer suspected client fraud, theft, or abuse of services, to PRICE or any other appropriate law enforcement agency.

(c) Sources of information. For purposes of its duties under this Chapter, the Department may use information from sources including, but not limited to, those specified in Section 4 of this Chapter.

(d) Post-investigation actions. After the completion of or during an investigation, the Department shall take one or more of the following actions:

  • (i) Determine that no further action is warranted; or
  • (ii) Take action pursuant to this Chapter.

048-16 Wyo. Code R. § 16-5