PI4
CMS-Required Outcome
CMS-required outcome
System can suspend Medicaid payments in whole or in part to providers for whom the agency has determined there is a credible allegation of fraud and is conducting an investigation and other activities, including provide notice of suspension; referrals to MFCU; and documentation and record retention.
Default metrics
- Track number of PI FWA detection and actionable cases sent ending in payment suspension/All cases initiated
Regulatory sources
- None cited