Fraud Waste and Abuse Training Requirements Eliminated for Providers

A final rule published in the April 15, 2010 Federal Register makes clear that enrolling in Medicare is considered enough proof that providers know about fraud, waste and abuse issues, and that Medicare Advantage (“MA”) plans do not need to require additional compliance training.

In the 2007 MA regulations, CMS stated that it would hold MA plans and Part D sponsors responsible for fraud and abuse training of first-tier and downstream entities that participate in their plans. This would have included providers who contract with many health plans, which means providers would have had to establish many different training programs.

CMS appeared to back away from the requirement in a proposed regulation posted in October 2009.  This latest final rule, which takes effect June 7, 2010, puts the issue to rest.

CMS listened to providers’ complaints about the burden triggered by training requirements from different MA plans, which essentially amounted to CMS being a tad too extreme in its fraud-fighting efforts. CMS wanted to make sure that plans had good compliance programs and that their downstream contractors, such as providers, had them as well.  But pushing the responsibilities onto providers went a little too far.

To comply with all the idiosyncrasies of each plan’s compliance program would have been a logistical nightmare. Now, with the final rule, an unnecessary and basically impossible standard has been made reasonable and providers will not have to deal with the additional training requirements.

© 2010 Parsonage Vandenack Williams LLC

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