42 C.F.R. § 455.17
Reporting requirements
The agency must report the following fraud or abuse information to the appropriate Department officials at intervals prescribed in instructions.
(a) The number of complaints of fraud and abuse made to the agency that warrant preliminary investigation.
(b) For each case of suspected provider fraud and abuse that warrants a full investigation—
(1) The provider's name and number;
(2) The source of the complaint;
(3) The type of provider;
(4) The nature of the complaint;
(5) The approximate range of dollars involved; and
(6) The legal and administrative disposition of the case, including actions taken by law enforcement officials to whom the case has been referred.
Notes of Decisions
Cited in 5
cases (1 in the last 5 years), 1984–2025 · leading case: United States ex rel. Wisconsin v. Dean, 729 F.2d 1100 (7th Cir. 1984).
United States ex rel. Wisconsin v. Dean, 729 F.2d 1100 (7th Cir. 1984). “Many of those reports were required from the State under 42 C.F.R. § 455.17 (1980). Second, the state criminal proceedings were reported extensively in two Milwaukee newspapers.”
United States ex rel. Woodard v. Country View Care Ctr., Inc., 797 F.2d 888 (10th Cir. 1986). “Yet another statutory provision pertaining to medicaid fraud reporting requirements and tangentially relevant to this appeal is 42 C.F.R. § 455.17 (1980). In order to comply with the notification provisions of section 232(C), the relator served a copy of the complaint upon the…”
Patrick M. Hays v. Luverne Hoffman, 325 F.3d 982 (8th Cir. 2003). “And it must report the findings of those investigations to HHS, 42 C.F.R. § 455.17 (b), setting the stage for either federal or state criminal or civil enforcement actions.”
Sam Jones Co., LLC v. Biotronik, Inc. (9th Cir. 2025). “See 42 C.F.R. § 455.17 (1980). Interpreting the 1943 amendment, the Seventh Circuit held that the government knowledge bar deprived the court of jurisdiction because the federal government technically knew about the fraud before Wisconsin filed suit.”
Ramanadhan v. Wing, 174 Misc. 2d 11 (N.Y. Sup. Ct. 1997). “(42 USC § 1396r-2 [a] [1], [2]; 42 CFR 455.17.) When Medicaid initiates the exclusion of a doctor, it is required to notify other State agencies, the State medical licensing board, the public, beneficiaries, and everyone entitled to notice of an exclusion from Medicaid pursuant…”
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