C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 447—PAYMENTS FOR SERVICES › Subpart B—Payment Methods: General Provisions

42 C.F.R. § 447.202

Audits

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The Medicaid agency must assure appropriate audit of records if payment is based on costs of services or on a fee plus cost of materials.

Notes of Decisions
Cited in 6 cases, 1992–2010 · leading case: Hidden Heights Assisted Living, Inc. v. State, Department of Health & Social Services, Division of Health Care Services
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Hidden Heights Assisted Living, Inc. v. State, Department of Health & Social Services, Division of Health Care Services (2009) alaska “§ 1396a(a)(42); see also 42 CFR. § 447.202 ('The Medicaid agency must assure appropriate audit of records if payment is based on costs of services or on a fee plus cost of materials.”
Fulkerson v. Commissioner, Maine Department of Human Services (1992) med “To be sure, the regulations at 42 C.F.R. §§ 447.202 -.203 require the Medicaid agency to assure appropriate audit of records (if payment is based on costs of services or on a fee plus cost of materials), maintain documentation of payment rates and record certain estimates…”
San Lazaro Ass'n v. Connell (2002) ca9 “necessary to insure that proper payments are made under the plan”); 42 C.F.R. § 447.202 (“The Medicaid agency must assure appropriate audit of records if payment is based on costs of services or on a fee plus costs of materials.”
San Lazaro Ass'n v. Connell (2002) ca9 “necessary to insure that proper payments are made under the plan”); 42 C.F.R. § 447.202 (“The Medicaid agency must assure appropriate audit of records if payment is based on costs of services or on a fee plus costs of materials”).”
Smart v. State (2010) alaska “"Audit" is defined by regulation as "the process of obtaining competent evidentiary material about a provider through inspection, observation, inquiry, and confirmation sufficient to support a reasonable basis for determining the provider's compliance with the legal requirements…”
Patrick M. Hays v. Luverne Hoffman (2003) ca8 “42 C.F.R. § 447.202 . And it must adopt a Fraud Detection and Investigation Program meeting strict federal standards.”
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