Incidents or practices that are inconsistent with sound fiscal, business, or medical practices that could result in an unnecessary cost to Alliance, the State or Federal government, or another organization. It could also result in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program. (42 CFR 455.2)



Page last modified: October 15, 2015
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