42 C.F.R. § 431.302
Purposes directly related to State plan administration
Purposes directly related to plan administration include—
(a) Establishing eligibility;
(b) Determining the amount of medical assistance;
(c) Providing services for beneficiaries; and
(d) Conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the administration of the plan.
Notes of Decisions
Cited in 7
cases, 1982–2019 · leading case: Prot. & Advocacy Sys., Inc. v. Freudenthal, 412 F. Supp. 2d 1211 (D. Wyo. 2006).
Prot. & Advocacy Sys., Inc. v. Freudenthal, 412 F. Supp. 2d 1211 (D. Wyo. 2006). “Records may be released pursuant to 42 C.F.R. § 431.302 for purposes which are directly related to State plan administration, including: (a) Establishing eligibility; (b) Determining the amount of medical assistance; (c) Providing services for recipients; and (d) Conducting or…”
State v. Chalice Renee Zeitner, 436 P.3d 484 (Ariz. 2019). “301 , those purposes include "[c]onducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the administration of the plan," 42 C.F.R. § 431.302 (d). ¶11 Federal law also requires state Medicaid agencies to support independent prosecutorial…”
In Re Grand Jury Investigation, 441 A.2d 525 (R.I. 1982). “” 42 C.F.R. § 431.302 . Regarding criminal investigations, federal law provides for the creation of a state Medicaid fraud control unit to protect the program from fraudulent practices.”
Stornanti v. Commonwealth, 451 N.E.2d 707 (Mass. 1983). “” 42 C.F.R. § 431.302 (1982). A State Medicaid fraud control unit is designed to protect the program from fraudulent practices, 42 U.”
People v. Ekong, 582 N.E.2d 233 (Ill. App. Ct. 1991). “” 42 C.F.R. §431.302 (1991). Regarding criminal investigations, Federal law provides for the creation of a State medicaid fraud-control unit to protect the program from fraudulent practices.”
John J. Dominguez, M.D. v. Don A. Gilbert, Comm'r, & Sharon Thompson, Dir., Medicaid Fraud Unit, Texas Health & Human Servs. Comm'n (Tex. App. 2001). “42 C.F.R. § 431.302 (2000). At a minimum, safeguarded information must include names, addresses, medical services provided, social and economic circumstances, agency evaluations of personal information, medical data, income eligibility, and the amount of medical assistance…”
Clifton Springs Hosp. & Clinic v. McCrossen, 8 Misc. 3d 919 (N.Y. Sup. Ct. 2005). “Taken together these two components provide a basis for the hospital’s entitlement to obtain the subject records (see, 42 CFR 431.302). Specifically, the focus of the instant action is on the defendant County’s alleged error in its assessment of Mrs.”
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