• Fraud, waste and abuse training: What do they want now?

    The messages insurers send to physicians regarding government requirements that they complete fraud, waste and abuse training (also referred to as FWA training) are about as clear as mud. Referencing terms such as "downstream, first tier, and related entities," these requests make even a seasoned reader of the Federal Register say "Huh?" If you don't have any dealings with Medicare Advantage plans, you can skip to the last paragraph. For everyone else, here's a translation:

    When Congress put forth the Part D prescription benefit program, some changes to the Medicare Advantage (Part C) program were included. Among these were requirements for Part D and Medicare Advantage contractors to develop compliance programs that incorporate measures to detect, prevent, and correct fraud, waste, and abuse.

    The Centers for Medicare & Medicaid Services (CMS) then published rules that defined what these compliance programs must include and who must complete them. This is where the "downstream, first tier, and related entities" come in. The Medicare Advantage contractors were instructed to apply their training and education and effective lines of communication requirements to their first tier, downstream, and related entities. Without going into Medicare language, if you contract with a Medicare Advantage plan or provide administrative or health care services to a group that has a contract with a Medicare Advantage plan, you meet one of the definitions, and your practice must complete a FWA training program.

    Here's why this is no big deal:
    You should already have a compliance program in your practice that includes fraud, waste, and abuse training but even if you don't, there are relatively pain-free versions available for free from Medicare Advantage contractors and the Medicare Learning Network (see the web-based training section). Once you and your staff have completed one FWA training program, you can just complete attestation statements for any Medicare Advantage plan that asks you to complete a program.

    The hassle of attestation may soon go away. CMS has recently proposed to modify the fraud training requirement to state that physicians and other providers who have met this requirement through enrollment into the Medicare program are deemed to have met it for Medicare Advantage purposes. The AAFP and multiple other organizations have signed onto a letter supporting this proposal.

    Even if you are not participating in Medicare Advantage plans, you still should have a compliance document that outlines expectations and provide training for everyone on your staff (clinicians and administrative staff). A simple first step might be to adopt a Code of Conduct that each person must read and sign upon employment and periodically thereafter. Your practice can be held responsible for what you know or should have known; demonstrating that you are aware of the rules and have attempted to comply may go a long way toward defending your practice if you find yourself in hot water. One word of caution: Don't adopt a compliance document and then not follow it. That could be construed as showing intent to act wrongfully.

    Posted on Mar 05, 2010 by Cindy Hughes

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