42 CFR § 457.915 - Fraud detection and investigation.

---
identifier: "/us/cfr/t42/s457.915"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 457.915 - Fraud detection and investigation."
title_number: 42
title_name: "Public Health"
section_number: "457.915"
section_name: "Fraud detection and investigation."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "D"
subchapter_name: "STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs)"
part_number: "457"
part_name: "ALLOTMENTS AND GRANTS TO STATES"
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: "65 FR 33622, May 24, 2000, unless otherwise noted."
cfr_part: "457"
---


# 457.915 Fraud detection and investigation.

(a) *State program requirements.* The State must establish procedures for ensuring program integrity and detecting fraudulent or abusive activity. These procedures must include the following:

(1) Methods and criteria for identifying suspected fraud and abuse cases.

(2) Methods for investigating fraud and abuse cases that—

(i) Do not infringe on legal rights of persons involved; and

(ii) Afford due process of law.

(b) *State program integrity unit.* The State may establish an administrative agency responsible for monitoring and maintaining the integrity of the separate child health program.

(c) *Program coordination.* The State must develop and implement procedures for referring suspected fraud and abuse cases to the State program integrity unit (if such a unit is established) and to appropriate law enforcement officials. Law enforcement officials include the—

(1) U.S. Department of Health and Human Services Office of Inspector General (OIG);

(2) U.S. Attorney's Office, Department of Justice (DOJ);

(3) Federal Bureau of Investigation (FBI); and

(4) State Attorney General's office.