42 CFR § 455.16 - Resolution of full investigation.

---
identifier: "/us/cfr/t42/s455.16"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 455.16 - Resolution of full investigation."
title_number: 42
title_name: "Public Health"
section_number: "455.16"
section_name: "Resolution of full investigation."
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: "2026-03-24"
last_updated: "2026-03-24"
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"
---


# 455.16 Resolution of full investigation.

A full investigation must continue until—

(a) Appropriate legal action is initiated;

(b) The case is closed or dropped because of insufficient evidence to support the allegations of fraud or abuse; or

(c) The matter is resolved between the agency and the provider or beneficiary. This resolution may include but is not limited to—

(1) Sending a warning letter to the provider or beneficiary, giving notice that continuation of the activity in question will result in further action;

(2) Suspending or terminating the provider from participation in the Medicaid program;

(3) Seeking recovery of payments made to the provider; or

(4) Imposing other sanctions provided under the State plan.

[43 FR 45262, Sept. 29, 1978, as amended at 48 FR 3756, Jan. 27, 1983]