Centers for Medicare & Medicaid Services Finalizes Fraud, Waste and Abuse Training Regulations; Program Participants To Be Deemed Compliant Beginning June 7, 2010
May 24, 2010
The Centers for Medicare & Medicaid Services (“CMS”) has finalized regulations concerning fraud, waste and abuse training for Providers and Suppliers, including physician and non-physician practitioners, institutional providers and suppliers who participate in Medicare Advantage and Part D programs. Effective June 7, 2010, these Providers and Suppliers will be “deemed” to be in compliance with fraud, waste and abuse training requirements as a result of their participation in the Medicare program.
Since publication of a final Rule issued on December 5, 2007, CMS had required that all such Providers and Suppliers receive annual training in the prevention of fraud, waste and abuse. This training may have been redundant of the certification made when these entities submit enrollment applications to become Medicare Providers and Suppliers. It also may have presented an unnecessary burden to Provider and Suppliers, leading many to request that CMS consider the elimination of this requirement.
The new Rules modify this training requirement to state that providers who have met the requirement through enrollment into the Medicare program are “deemed” to have met the training and education requirement. Specifically, CMS has amended 42 C.F.R. § 422.503(b)(4)(vi)(C)(2), to specify that Medicare Advantage organizations whose first tier, downstream, and related entities have met the fraud, waste and abuse certification requirements are deemed to have met the training and educational requirements for fraud, waste and abuse. A similar regulation for the Medicare Part D program was added as Section 423.504(b)(4)(vi)(C)(3). These Rules were finalized on April 15, 2010.
The regulations state that these provisions are effective on June 7, 2010, but further provide that because Medicare Part C and D programs operate under contracts with CMS on a calendar year basis, the provisions will not be applicable prior to January 1, 2011 unless otherwise noted.
On April 30, 2010, CMS issued a memorandum to provide guidance concerning the implementation date of these Rules and certain other recently published requirements to the Medicare Part C and D program operations. This notice stated that, “the fraud, waste, and abuse training and education deeming provisions (422.503(b)(4)(vi)(C)(2) and 423.504(b)(4)(vi)(C)(3)) finalized in 4085-F and described in Section II.B.5. are applicable beginning June 7, 2010. These provisions will reduce burden on providers, and ultimately sponsors, who have already met fraud, waste, and abuse training requirements through enrollment into the Medicare program or accreditation as a Durable Medical Equipment, Prosthetics, Orthotics and Supplies supplier.”
For further details about this issue on the CMS Web site, go to: www.cms.gov/PRIT/PRITIA/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=4&sortOrder=ascending&itemID=CMS1231443&intNumPerPage=10
The April 30, 2010 Notice issued by CMS regarding the effective date of final Medicare Part C and D policy and technical changes regulation is available by clicking here: www.cms.gov/PrescriptionDrugCovContra/Downloads/EffectiveDate2010Reg043010.pdf
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