42 CFR 455.506 - Activities to be conducted by Medicaid RACs and States.

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There are 2 Updates appearing in the Federal Register for 42 CFR Part 455. View below or at eCFR (GPOAccess)
§ 455.506 Activities to be conducted by Medicaid RACs and States.

(a)Medicaid RACs will review claims submitted by providers of items and services or other individuals furnishingitems and services for which payment has been made under section 1902(a) of the Act or under any waiver of the State Plan to identify underpayments and overpayments and recoup overpayments for the States.

(1) States may exclude Medicaidmanaged care claims from review by Medicaid RACs.

(b) States may coordinate with Medicaid RACs regarding the recoupment of overpayments.

(c) States must coordinate the recovery audit efforts of their RACs with other auditing entities.

(d) States must make referrals of suspected fraud and/or abuse, as defined in 42 CFR 455.2, to the MFCU or other appropriate law enforcement agency.

(e) States must set limits on the number and frequency of medical records to be reviewed by the RACs, subject to requests for exception from RACs to States.

This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.

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United States Code

Title 42 published on 2015-11-28

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR Part 455 after this date.

  • 2016-09-20; vol. 81 # 182 - Tuesday, September 20, 2016
    1. 81 FR 64383 - Medicaid; Revisions to State Medicaid Fraud Control Unit Rules
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      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, Office of Inspector General
      Proposed rule.
      To ensure consideration, comments must be delivered to the address provided below by no later than 5 p.m. Eastern Standard Time on November 21, 2016.
      42 CFR Part 455
The section you are viewing is cited by the following CFR sections.

Title 42 published on 2015-11-28.

The following are only the Rules published in the Federal Register after the published date of Title 42.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2016-08-03; vol. 81 # 149 - Wednesday, August 3, 2016
    1. 81 FR 51116 - Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Provider Enrollment Moratoria Access Waiver Demonstration of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Moratoria-Designated Geographic Locations
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      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services
      Implementation of the waiver demonstration.
      Effective July 29, 2016.
      42 CFR Parts 405, 424, and 455