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Corporate Compliance / Fraud, Waste and Abuse Training

Occasionally, questions arise about annual compliance training requirements, specifically whether Fraud, Waste and Abuse training needs to occur annually if at all. For those organizations billing Medicare, the following applies.

Under 42 C.F.R. §§422.503 a MA (Medicare Advantage) organization should "adopt and implement an effective compliance program, which must include measures that prevent, detect and correct non-compliance with CMS' program requirements as well as measures that prevent, detect, and correct fraud, waste, and abuse." Further, "each MA organization must establish and implement effective training and education between the compliance officer and organization employees, the MA organization's chief executive or other senior administrator, managers and governing body members, and the MA organization's first tier, downstream, and related entities. Such training and education must occur at a minimum annually and must be made a part of the orientation for a new employee, new first tier, downstream and related entities, and new appointment to a chief executive, manager, or governing body member."

Under 42 C.F.R. §§423.504, any entity seeking to contract as a Part D plan sponsor must "Adopt and implement an effective compliance program, which must include measures that prevent, detect, and correct noncompliance with CMS' program requirements as well as measures that prevent, detect, and correct fraud, waste, and abuse." Further "each Part D plan sponsor must establish, implement and provide effective training and education for its employees including, the chief executive and senior administrators or managers; governing body members; and first tier, downstream, and related entities." The training and education "must occur at a least annually and be a part of the orientation for new employees including, the chief executive and senior administrators or managers; governing body members; and first tier, downstream, and related entities."

There is one exception: Regulations effective June 7, 2010 implemented a "deeming" exception which exempts first tier, downstream, and related entities (FDRs) who are enrolled in Medicare Parts A or B from annual FWA training and education. FDRs who have met the fraud, waste, and abuse certification requirements through enrollment into the Medicare program or accreditation as a supplier of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, are deemed to have met the training and educational requirements for fraud, waste, and abuse. However, if you are exempt/deemed from the fraud, waste and abuse training, you must still complete the General Compliance training requirement.

Conclusion

Initial training and education on Corporate Compliance and fraud, waste and abuse training should be completed during the orientation process for new employees. All employees should complete annual General Corporate Compliance refresher training thereafter.  The "deeming" exception of enrollment/participation in Medicare Parts A or B of the Medicare program, or accreditation as a supplier of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies applies to fraud, waste and abuse training requirements. Unless this exception applies to your organization, fraud, waste and abuse training should be completed annually. In addition to training requirements, all entities contracted to perform work related to Medicare programs are required to have appropriate policies and procedures to address fraud, waste, and abuse.

We highly recommend organizations taking advantage of customizing their Corporate Compliance and fraud, waste and abuse programs and providing employee training on these programs.

If you have any additional questions about our Corporate Compliance or Fraud, Waste and Abuse, training, please do not hesitate to contact one of our professional consultants.

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