N.H. Code Admin. R. He-W 520.05
Fraud Detection and Investigation
Effective Oct 22, 2025(See Revision Note at chapter heading He-W 500); ss by #6574, eff 9-12-97; ss by #6925, eff 1-1-99; ss by #8781, eff 1-1-07, EXPIRED: 1-1-15 New. #10776, INTERIM, eff 1-31-15, EXPIRES: 7-30-15; ss by #10887, eff 7-17-15; ss by 14415, eff 10-22-25, EXPIRES 10-22-35Former Division of Human Services
- (a) In accordance with 42 CFR 455.14, if the department or MCO receives a complaint of medicaid fraud or abuse from any source or identifies any questionable practices, they shall conduct a preliminary investigation.
- (b) Cases where potential fraud has been detected as a result of a preliminary investigation pursuant to (a) above, shall be referred for a full investigation to the appropriate agency, in accordance with 42 CFR 455.15.
- (c) A full investigation and resolution shall be conducted in accordance with 42 CFR 455.15 and 42 CFR 455.16.
Source. (See Revision Note at chapter heading He-W 500); ss by #6574, eff 9-12-97; ss by #6925, eff 1-1-99; ss by #8781, eff 1-1-07, EXPIRED: 1-1-15 New. #10776, INTERIM, eff 1-31-15, EXPIRES: 7-30-15; ss by #10887, eff 7-17-15; ss by 14415, eff 10-22-25, EXPIRES 10-22-35