FAQ: Do I have to complete Medicare Advantage fraud, waste and abuse training?

August 27, 2019
Area(s) of Interest: Practice Management Public Payors 

Over the past few years, the California Medical Association (CMA) has received sporadic calls from physician practices participating in a Medicare Advantage (MA) plan asking whether they need to comply with the Centers for Medicare & Medicaid Services (CMS) requirement to complete fraud, waste and abuse, and compliance training.

Most of these practices report they were notified by an MA plan that, as a participating provider, CMS requires that they complete the training on an annual basis.

On June 7, 2010, CMS issued a clarification via final rule 42 CFR 422.503(b)(4)(vi)(C)(2), which states that physicians who are enrolled in the Medicare program are deemed to have met the Medicare Advantage training and educational requirements for fraud, waste and abuse. If requested to take the fraud and abuse training by a Medicare Advantage plan, physicians should refer the payor to this final rule.

While this requirement eliminates the need for further fraud or abuse training, it does not remove the requirement that physicians complete compliance training and education if requested to by their contracted Medicare Advantage plan.

To help monitor adherence to applicable statutes, regulations, and program requirements, the Office of Inspector General has developed a series guidance documents regarding voluntary compliance training programs. The guidance for individual and small group physician practices can be found here.

Contact: CMA reimbursement helpline, (888) 401-5911 or economicservices@cmadocs.org.


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