42 CFR 455.13 - Methods for identification, investigation, and referral.
The Medicaid agency must have -
(a) Methods and criteria for identifying suspected fraud cases;
(b) Methods for investigating these cases that -
(1) Do not infringe on the legal rights of persons involved; and
(2) Afford due process of law; and
(c) Procedures, developed in cooperation with State legal authorities, for referring suspected fraud cases to law enforcement officials.