Medicare Managed Care Manual (Pub. 100-16), Ch. 11 § 120
Compliance with Other Laws and Regulations
120 - Compliance with Other Laws and Regulations
(Rev. 79, Issued 02-17-06, Effective Date 02-17-06)
MA organizations are obligated to comply with other laws, specifically Federal laws and
regulations designed to prevent or ameliorate fraud, waste, and abuse including, but not
limited to:
• Applicable provisions of Federal criminal law;
• The False Claims Act (31 U.S.C. 3729 et seq.);
• The Anti-kickback statute (Section 1128B(b) of the Act); and
• HIPAA administrative simplification rules at 45 CFR Part 160, 162, and 164.
MA organizations receiving Federal payments under MA contracts, and related entities,
contractors, and subcontractors paid by an MA organization to fulfill its obligations under
its MA contract are subject to certain laws that are applicable to individuals and entities
receiving Federal funds. MA organizations must inform all related entities, contractors
and subcontractors, first tier and downstream entities that payments they receive are, in
whole or in part, from Federal funds.
MA organizations offering a Part D prescription drug benefit must follow additional
requirements relating to fraud, waste, and abuse. Please see 42 CFR 423.504(b)(4)(vi)(H)
for these requirements.