42 CFR § 455.19 - Provider's statement on check.

---
identifier: "/us/cfr/t42/s455.19"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 455.19 - Provider's statement on check."
title_number: 42
title_name: "Public Health"
section_number: "455.19"
section_name: "Provider's statement on check."
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"
---


# 455.19 Provider's statement on check.

As an alternative to the statements required in § 455.18, the agency may print the following wording above the claimant's endorsement on the reverse of checks or warrants payable to each provider: “I understand in endorsing or depositing this check that payment will be from Federal and State funds and that any falsification, or concealment of a material fact, may be prosecuted under Federal and State laws.”