10a NCAC 22F .0105        DETECTION

(a)  The Division will accept, investigate and where good reason to do so exists, refer for prosecution, allegations or complaints of provider or recipient fraud, abuse, overutilization, error or aberrant practices.

(b)  The Division will conduct post‑payment reviews and audits of a statistically significant sampling of provider claims.

(c)  The Division will compare provider and recipient practices to establish statistical models of normal provider or recipient practices.


History Note:        Authority G.S. 108A‑25(b); 108A‑63; 108A‑64; 42 C.F.R. Part 455;

Eff. May 1, 1984.