{"data":{"id":"us/42-cfr-455.21","jurisdiction":"us","citation":"42 CFR 455.21","heading":"Cooperation with State Medicaid fraud control units.","body":"In a State with a Medicaid fraud control unit established and certified under subpart C of this part,\n(a) The agency must—\n(1) Refer all cases of suspected provider fraud to the unit;\n(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—\n(i) Access to, and free copies of, any records or information kept by the agency or its contractors;\n(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\n(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\n(3) On referral from the unit, initiate any available administrative or judicial action to recover improper payments to a provider.\n(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.\n(c) The agency must enter into a written agreement with the unit under which:\n(1) The agency will agree to comply with all requirements of § 455.21(a);\n(2) The unit will agree to comply with the requirements of § 1007.11(c) of this title; and\n(3) The agency and the unit will agree to—\n(i) Establish a practice of regular meetings or communication between the two entities;\n(ii) Establish procedures for how they will coordinate their efforts;\n(iii) Establish procedures for §§ 1007.9(e) through 1007.9(h) of this title;\n(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\n(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.","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":"7d0e5682db6ba6c87416c70a78c6fec4738a250a528d2e66392469d858d46848","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-455.20","next":"us/42-cfr-455.23"},"notice":"GroundRules: Original legal text. Not legal advice."}