US · guidance
CMS Pub. 100-08, ch. 4, § 4.9
Referrals
The UPIC shall refer investigations to law enforcement when it has substantiated
allegations of fraud including, but not limited to, documented allegations that a provider,
beneficiary, supplier, or other subject: (a) engaged in a pattern of improper billing, (b)
submitted improper claims with suspected knowledge of their falsity, or (c) submitted
improper claims with reckless disregard or deliberate ignorance of their truth or falsity.
Prior to making such referrals, the UPIC shall follow the direction as outlined in § 4.9.2
Referral of Cases to the OIG/OI, unless otherwise instructed by CMS.
History
(Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
d70cbdd8a4a76de6225b308d47275ca45563870804fb72da60b7cc1a3ac237d6
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