State Medicaid agencies are required to suspend payments for healthcare items and services when there is a credible allegation of fraud against the provider, unless "good cause" exists not to suspend payment.
Using payment suspensions, when appropriate, is important to protect Medicaid funds. Payment suspensions, based on credible allegations of fraud, can swiftly stop the flow of Medicaid dollars to providers defrauding Medicaid. A payment suspension can remain in place throughout the law enforcement investigation, and potential prosecution of the healthcare fraud case.