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UNOFFICIAL 1704-3 prosecution of fraud, the cases shall be referred to the medicaid fraud control unit. [Eff 08/01/94 ] (Auth: HRS §346-14; 42 C.F.R. §§431.10, 455.14) (Imp: 42 C.F.R. §§455.13, 455.14)

§17-1704-6 Resolution of investigation. A full investigation shall continue until: (1) Appropriate criminal or civil legal action is initiated; (2) The matter is resolved between the department and the provider through any one or appropriate combination of the following actions: (A) A monitoring program of provider's medicaid practice is established to ensure corrective measures have been introduced; (B) A demand letter is sent to the provider requiring repayment of overpayments to the provider made by the medical assistance program and warning the provider that payment on that provider's pending claims may be withheld in part or in whole to be applied to overpayments previously made to the provider by the medical assistance program; (C) All claims of a provider are placed on

review prior to payment; (D) In the event that the department is

unable to determine whether the actions

of a provider constitute improper medical practice, the department requests an

opinion of the Hawaii Medical Association peer review committee; and (E) The provider is suspended or terminated

from participation in the medical

assistance program as described in sections 17-1736-17 and 17-1736-18. [Eff 08/01/94 ] (Auth: HRS §346- 14; 42 C.F.R. §431.10) (Imp: 42 C.F.R. §§455.13, 455.14, 455.15, 455.16)