The Medicare Advantage & Part D Compliance Training – Recognizing and Reporting Fraud, Waste and Abuse

Fraud, Waste and Abuse for Providers

Due to the pending deadline and high call volumes a most frequently asked questions Q&A is detailed below. Utilize the bulk purchase process to expedite your organization’s registration and enrollment in the training.

Click here to purchase the training program with Attestation Form which must be completed by your authorized training representative. This is the person within your organization that documents employee participation in required training.

Click here to purchase the general training for all other personnel. If you need to train 10 or more employees just follow these bulk purchase instructions and send your request to bulkpurchase@learnsomething.com to receive quantity discounts.

Who needs to take the training?

All employees, board members, officers, contracted personnel, contracted providers/practitioners, contractors, sub-contractors and vendors that the employees, contractors, and officers affiliated with my organization who have direct or indirect contact with your Medicare business.

I heard about an Attestation Form. What is that?

CMS requires that all plans keep records of annual training utilizing an Attestation Form. An authorized training representative is required to sign off on this form. Additional information is required to be kept on file for this individual. When we set up your account we will collect this additional information. You will need to provide your EIN or NPI number if you have one. This is the key element that will be utilized by plans when they research the national database for proof of training.

Why do I need to use this program?

This course was developed by the National Health Care and Antifraud Association and has been presented to most of the healthcare plans for feedback and approval as being a program that meets the CMS guidelines for training. Because all the plans you contract with have this CMS requirement you could find that you need to train your employees multiple times. Completion records for this national program are available to all plans so the occurrence of needing to train your employees multiple times is minimized. If you do have a plan unfamiliar with this training program NHCAA will make every attempt to gain their approval.

Why is there a cost associated with this program when I have seen other programs available for free?

The fee you are paying is not so much for access to the training but for the filing of the completion in the national report database.

How long will it take to get my organization set up for training?

Once we receive your order we will contact you if you sent it in by fax or e-mail to verify the authorized training representative information. You will need a credit card to process your order and once completed we will send a follow up e-mail with specific directions as to how your employees need to enroll and redeem the pre-paid voucher for the course enrollment. If you need to train 5 people or less you would enroll employees and the authorized training representative using the e-commerce functionality available on the portal.

Why the program was developed

Detecting and preventing fraud, waste and abuse (FWA) is the responsibility of everyone, including employees, members, physicians, vendors, subcontractors, hospitals, brokers, agents and other persons who may be subject to federal or state laws relating to FWA. The Centers for Medicare and Medicaid Services (CMS) requires that all employees who work or contract with Part C Medicare Advantage Programs (MA) and or Part D Medicare Prescription Drug Programs (PDP) meet annual compliance and education training requirements with respect to FWA.

The National Health Care Anti-Fraud Association with the input of the Blue Cross and Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield Plans has developed a computer based training titled “The Medicare Advantage & Part D Compliance Training – Recognizing and Reporting Fraud, Waste and Abuse”. It is intended to be offered to Plan’s first tier, downstream and related entities including physicians, vendors, subcontractors and hospitals. The training will help promote understanding of general FWA by reviewing key concepts and laws affecting Compliance and FWA, increasing awareness of FWA and reviewing existing FWA and compliance oversight processes and resources. The Blue Cross and Blue Shield Plans are independent licensees of the Blue Cross and Blue Shield Association.

Group Purchases Available

The negotiated list price is $14.95. If you need to train 10 or more employees just follow these bulk purchase instructions and send your request to bulkpurchase@learnsomething.com to receive quantity discounts. You can also use the bulk purchase form to purchase by check.

If you wish to report fraud, waste or abuse you can call the WellCare Compliance Hotline at 866-678-8355.

You may also contact the HHS-OIG Hotline by calling 800-HHS-TIPS (447-8477).