Some of the laws governing Medicare Parts C and D Fraud, Waste, and Abuse (FWA) include HIPAA; the False Claims Act; the Anti-Kickback Statute; LEIE; and the Health Care Fraud Statute.

• A. True
• B. False
• C. Not specified
• D. Partially true

Answer: (A)

At the heart of Medicare Part C and Part D fraud, waste, and abuse controls is a set of federal laws that create accountability and deter improper billing and referrals. HIPAA contributes to program integrity by providing privacy and security protections for health information and by imposing criminal penalties for misuse, which supports detecting and preventing FWA activities. The False Claims Act gives a powerful civil remedy for submitting false or fraudulent claims to the government, including those tied to federal health programs, often with treble damages and penalties. The Anti-Kickback Statute forbids knowing and willful remunerations intended to induce referrals or to generate federal health care program business, preventing incentive schemes that drive FWA in Part C and Part D. The List of Excluded Individuals/Entities (LEIE) identifies who cannot participate in federal health care programs, helping to remove high-risk actors from Part C and Part D networks. The Health Care Fraud Statute criminalizes schemes to defraud health care programs and is used to prosecute fraud involving Medicare and related programs. Together, these laws provide a comprehensive enforcement framework for Part C and Part D FWA, which is why the statement is true.