{"data":{"id":"us/42-cfr-455.16","jurisdiction":"us","citation":"42 CFR 455.16","heading":"Resolution of full investigation.","body":"A full investigation must continue until—\n(a) Appropriate legal action is initiated;\n(b) The case is closed or dropped because of insufficient evidence to support the allegations of fraud or abuse; or\n(c) The matter is resolved between the agency and the provider or beneficiary. This resolution may include but is not limited to—\n(1) Sending a warning letter to the provider or beneficiary, giving notice that continuation of the activity in question will result in further action;\n(2) Suspending or terminating the provider from participation in the Medicaid program;\n(3) Seeking recovery of payments made to the provider; or\n(4) Imposing other sanctions provided under the State plan.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS","PART 455—PROGRAM INTEGRITY: MEDICAID","Subpart A—Medicaid Agency Fraud Detection and Investigation Program"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"d5ca5e845d016a1a8c82f0816721ac8379263c78bc80a9c388c2ffc605c57a0c","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-455.15","next":"us/42-cfr-455.17"},"notice":"GroundRules: Original legal text. Not legal advice."}