As stated in the October 20, 2008 Centers for Medicare and Medicaid Services (CMS) Memo entitled “Fraud, Waste, and Abuse Training Requirements, on December 5, 2007, CMS published the “Revisions to the Medicare Advantage and Part D Prescription Drug Contract Determinations, Appeals and Intermediate Sanctions Processes, “FR Doc. 07-5946 (72 FR 68700 through 68741), final rule. The regulations updated the existing compliance plan, including measure to detect, correct and prevent fraud, waste and abuse. The regulations clarified the requirements for Medicare Advantage organizations and Part D sponsors to include training, education, and effective lines of communication between the compliance officer and the organizations employees, managers, and directors as part of the compliance plan. The regulations also clarified that Medicare Advantage organizations and Part D Sponsors must apply the required compliance training to all first tier, downstream and related entities. For more information, please refer to section 42 C.F.R. 422.503 “Medicare Advantage Programs” and 42 C.F.R. 423.504 “Voluntary Medicare Prescription Drug Benefit”.
The change to the Fraud, Waste and Abuse training requirements was effective as of January 1, 2009 and required completion of training annually thereafter.
CMS recognizes the potential burden that many entities may experience due to their contractual relationship with numerous health plans. Therefore, one time training will satisfy the CMS requirements for all MA Organizations and Part D Sponsors with which they are affiliated.
Please note: First tier, downstream and related entities will need to provide attestations that the training has been completed for their respective organizations and be prepared to produce copies of training logs and other materials upon request.
- FWA Broker Memo
- FWA Provider Memo
- FWA Training Material
- FWA Attestation Form
- CMS Notices and Memos
- 42 C.F.R. 422.503 (b)(4)(vi)
- 42 C.F.R. 423.504 (b)(4)(vi)
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