The OIG may perform a random prepayment review of claims submitted
by Medicaid providers for reimbursement to determine whether the claim
involves fraud, waste, or abuse. Suspect claims identified through
this process may result in:
(1) imposition of a recoupment of overpayments and/or
other pertinent administrative sanctions or actions;
(2) initiation of a full fraud, waste, or abuse investigation;
(3) referral for criminal or civil investigation and
prosecution;
(4) withholding payment of these claims for not more
than five working days without notice to the provider for which claims
were submitted.
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