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In some cases, this may result in taking the appropriate actions against those who, individually or as a practice, commit fraud, waste, abuse, mismanagement or misconduct , including but not limited to: Remedial education and/or training to attempt to eliminate the egregious action Increasingly stringent utilization review process Recoupment of previously paid monies from a provider/practice Termination of provider agreement or other contractual arrangements Civil and/or criminal prosecution Any other remedies available to rectify the issue identified The CountyCare SIU may also conduct prepayment reviews of provider claims as a result of suspected fraud, waste, abuse, mismanagement or misconduct, which may require the provider to submit additional records or documentation

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