1. A. The BHSF director and PIU section chief shall suspend all Medicaid payments to a provider under investigation upon a determination there is a credible allegation of fraud. The department may waive the requirement to suspend payments if it determines there is good cause not to do so.

2. B. The requirements for the issuance of a withholding pursuant to LAC 50:I.4149 shall be applicable to a suspension of payments for a credible allegation of fraud, except:

   1. 1. At the written request of a law enforcement agency, notice of the suspension of payments may be delayed by 30 calendar days. The law enforcement agency may renew a 30-day delay request twice.
   2. 2. In no event may a delay of notice exceed 90 calendar days from the date of the initial payment suspension.
   3. 3. The notice must include a statement indicating payments are being suspended in accordance with 42 CFR 455.23.
3. C. In addition to the reasons provided in LAC 50:I.4417(B)(3), the BHSF director and the PIU section chief may rely on any of the good cause exceptions in 42 C.F.R. 405.371(b) to decide not to suspend payments. They may also adjust the scope of the payment suspension by either reducing a full suspension to a partial one or increasing partial suspension up to a full suspension.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and 46:437.1-46:440.3.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health, Bureau of Health Services Financing, LR 52:698 (May 2026).