CMS Relaxes Fraud, Waste, and Abuse (FWA) Training Requirements for Medicare Advantage Contractors

On Friday, October 9, 2009, CMS circulated a proposed rule (Proposed Rule) that would significantly ease the compliance burden associated with fraud, waste, and abuse (FWA) education required for hospitals, skilled nursing facilities, home health agencies, and other providers and suppliers doing business with Medicare Advantage (MA) plans. When finalized, the Proposed Rule will change the existing regulations governing FWA education published on December 5, 2007, clarified by CMS on August 21, 2009.

Sponsors participating in Medicare Parts C and D are required by CMS to monitor participation compliance by certain entities with which the sponsors contract. Many plans designed online FWA-training vehicles, slides, and materials and sought proof that all employees of contracting providers and suppliers had gone through the FWA training by the end of 2009. Naturally, many providers and suppliers do business with a number of MA plans and prescription drug plans (PDPs). Providers faced the possibility and potential burden of having to provide duplicative FWA training to thousands of employees. A number of providers and trade associations brought these issues to CMS’ attention and worked with the plans to mitigate the administrative burden while satisfying the plans’ obligations.

The Proposed Rule recognizes that providers and suppliers already have provider agreements in place with CMS that permit them to provide services under Medicare. Providers and suppliers make various certifications of compliance in connection with their provider enrollment, which cover the FWA obligations. Thus, CMS has proposed that providers and suppliers be “deemed to have met [the FWA] training and education requirement” by virtue of their enrollment certifications.

Providers and suppliers are, of course, free to participate in any plan-sponsored education or training programs made available, but the new Proposed Rule clarifies that the MA plans and PDPs should not require any such training for Medicare-certified providers and suppliers. 

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