C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 417—HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS › Subpart L—Medicare Contract Requirements

42 C.F.R. § 417.500

Intermediate sanctions for and civil monetary penalties against HMOs and CMPs

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(a) Except as provided in paragraph (c) of this section, the rights, procedures, and requirements related to intermediate sanctions and civil money penalties set forth in part 422 subparts O and T of this chapter also apply to Medicare contracts with HMOs or CMPs under sections 1876 of the Act.

(b) In applying paragraph (a) of this section, references to part 422 of this chapter must be read as references to this part and references to MA organizations must be read as references to HMOs or CMPs.

(c) In applying paragraph (a) of this section, the amounts of civil money penalties that can be imposed are governed by section 1876(i)(6)(B) and (C) of the Act, not by the provisions in part 422 of this chapter.

[75 FR 19803, Apr. 15, 2010]
Notes of Decisions
Cited in 2 cases, 2001–2001 · leading case: McCall v. PacifiCare of California, Inc., 21 P.3d 1189 (Cal. 2001).
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McCall v. PacifiCare of California, Inc., 21 P.3d 1189 (Cal. 2001). · cites it 6× “(See also 42 C.F.R. § 417.500 (2000).) Integral to the Medicare scheme is a thorough administrative review process for an individual "dissatisfied with a determination regarding his or her Medicare benefits.”
In re Managed Care Litig., 135 F. Supp. 2d 1253 (S.D. Fla. 2001). · cites it 2× “FEDERAL PROMPT-PAY REQUIREMENTS The Plaintiffs assert an implied claim for relief pursuant to the Omnibus Budget Reconciliation Act of 1986, § 9312(d), which they submit is “codified” at 42 CFR § 417.500 (a)(6). Amended Complaint, ¶ 304.”
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