42 CFR § 455.13 - Methods for identification, investigation, and referral.

---
identifier: "/us/cfr/t42/s455.13"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 455.13 - Methods for identification, investigation, and referral."
title_number: 42
title_name: "Public Health"
section_number: "455.13"
section_name: "Methods for identification, investigation, and referral."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "C"
subchapter_name: "MEDICAL ASSISTANCE PROGRAMS"
part_number: "455"
part_name: "PROGRAM INTEGRITY: MEDICAID"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302."
regulatory_source: "43 FR 45262, Sept. 29, 1978, unless otherwise noted."
cfr_part: "455"
---


# 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.

[43 FR 45262, Sept. 29, 1978, as amended at 48 FR 3755, Jan. 27, 1983]