It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Those who exploit federal healthcare programs cost taxpayers billions of dollars while putting beneficiaries’ health and welfare at risk. The impact of these losses and risks magnifies as Medicare continues to serve a growing number of beneficiaries.
Most physicians try to work ethically, provide high-quality patient medical care, and submit proper claims. Trust is core to the physician-patient relationship.
Fraud schemes range from solo ventures to widespread activities of an institution or group. Even organized crime groups infiltrate the Medicare Program and operate as Medicare providers and suppliers.
Combating Fraud, Waste, and Abuse (FWA) Training for Healthcare Providers is designed to educate healthcare providers (HCP) on how to prevent, detect, and report fraud, waste, and abuse in the healthcare setting.
What you’ll learn
- About fraud, waste, and abuse
- Fraud, waste, and abuse laws
- Physician relationships and reporting procedures
- Compliance programs and reporting fraud
Details
Course length: 1 hour and 30 minutes.
Languages: American English
Key features: Audio narration, learning activity, and post-assessment
Get Certified
American Medical Compliance (AMC) is a leader in the industry for compliance, Billing, and HR solutions. To become certified, please visit us at: American Medical Compliance (AMC).
Reach out for other courses by: AMC Course Library
ACCME Accreditation
American Medical Compliance is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education to physicians. Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve patient care outcomes. Through high-quality educational activities, we aim to address the identified educational gaps and to support the continuous professional development of our medical community. American Medical Compliance designates this activity for a maximum of 1.5 AMA PRA Category 1 Credits. Physicians should only claim this credit for their complete participation in this activity.
FWA Training
FWA training stands for fraud, waste, and abuse training. Every year, organizations that provide prescription drugs, health care, or administrative services to persons who have Medicare Advantage (MA) or Prescription Drug Plan (PDP) instead of a health plan must complete this training. The Centers for Medicare and Medicaid Services (CMS) require FWA training. In compliance with the FWA Training Certificate requirement, first-tier companies must ensure that their downstream entities undergo CMS FWA Training. Documentation of this distribution is required. Medicare Advantage and Part D sponsors have to provide FWA training.
The first tier entity is a party with a written agreement with an MA Organization or Part D Plan Sponsor to provide healthcare and administrative services to any eligible individual for Medicare under the MA or Part D programs. In contrast, the downstream entity is a party with a written agreement with persons or entities involved in the MA or Part D benefit. This is below the arrangement level between a MA Organization or Part D Plan Sponsor along with a first-tier entity. Such written arrangements continue down to the ultimate administrative and health services provider.
CMS requires Medicare Advantage and Part D Sponsors to develop a compliance plan to protect against potential fraud, waste, and abuse.
The Medicare Part D Sponsor refers to prescription drug insurance, which helps pay for prescription medications, some immunizations, and medical equipment, such as insulin needles and syringes. Prescription Drug Plans (PDP) provides such coverage.
CMS FWA Training 2023
The CMS requires both Part D plan sponsors and MA organizations to annually communicate certain compliance and FWA requirements to FDRs or first-tier, downstream, and related entities. FDRs include healthcare professionals, contracted physicians, ancillary providers, healthcare facility providers, and other related parties. CMS, along with other federal and state agencies, require your organization and employees to satisfy certain FWA and general compliance standards as a delegate that offers administrative or healthcare services. It is expected that FDRs will create an efficient compliance program that includes instruction and training on FWA and compliance.
FWA Training for Pharmacies
Pharmacy FWA training must include a variety of subjects. This list includes Medicare’s compliance with the rules and regulations governing prescription drug coverage. Anyone submitting medication claims under the Medicare Part D program must comply with this. Medicare Part D requires specific pharmaceutical standards for reporting potential fraud, waste, and abuse. Examples of fraudulent practices at pharmacies that breach such requirements include tools to help you better grasp Medicare Part D standards.
CMS requires Medicare Prescription Drug Plan sponsors to implement a training and education program as part of their compliance plan. Pharmacies that have been contracted to provide Medicare Part D services must participate in training to help detect, prevent, and correct medical fraud, waste, and abuse.
Medicare FWA Training
CMS fraud, waste, and abuse training can be provided to both individuals and organizations. The corresponding certificates will be issued upon completion.
Fraud is defined as an intentional act of deception or misrepresentation that a person commits with the knowledge that it may result in an unauthorized benefit to themself or another person. Furthermore, waste refers to the excessive use of procedures and services that results in unnecessary expenses. It also refers to wasteful behavior, such as spending money without obtaining sufficient returns. Abuse refers to provider practices that are inconsistent with sound business, medical, and fiscal practices. Abuses create a variety of issues, including:
- Wasteful Medicaid and Medicare program expenses.
- Compensation for services that are not medically essential.
- Services that fail to meet professionally acknowledged standards for healthcare services.
Anyone who wants to obtain the Fraud Waste and Abuse certification can complete the individual training, which complies with CMS requirements. Consequently, this certification will provide any employer or organization with proof of training.
The FWA Training Certification defines critical standards for compliance, transparency, disclosure, and quality of service.
Individuals who work with Medicare or Medicaid beneficiaries or who get paid by these systems are eligible for this training.
Any organization must develop compliance procedures and training to tackle fraud, waste, and abuse inside the Medicare/Medicaid system.
FWA Compliance Training
Knowing various examples of FWA is part of FWA compliance training. Examples include but are not limited to:
- falsifying data to support coverage
- billing for services and supplies never delivered, including missed patient appointments
- proposing or accepting bribes, kickbacks, or rebates
Additionally, double billing or falsely billed treatments that result in an inaccurate record of the patient’s care are also examples.
FWA Training Course
Solutions include conducting regular internal audits, checking claims and billings for correctness, and ensuring that coding appropriately reflects the services provided. Other ways to address FWA include communication with coworkers, double-checking information, keeping an eye out for any suspicious behavior, and acting once an issue is identified. It is critical to report any suspicious conduct or suspected FWA to human resources, your supervisor, or the compliance officer.
FWA Certification
To acquire an FWA certification, the Centers for Medicare & Medicaid Services (CMS) requires first-tier, downstream, and related entities (FDR) to complete two trainings. These include the Medicare Parts C and D General Compliance Training and Combatting Medicare Parts C and D Fraud, Waste, and Abuse (FWA) Training.
After being hired, contracted, or appointed, you have 90 days to finish this training. It must be completed annually after that, between January 1 and December 31 of each contract year.
FWA Training Certificate
An FWA training attestation is then provided after an individual or organization completed the FWA training. Individuals acting as FDRs must certify that they have completed general compliance and FWA training. They also certify that they have completed specialized compliance training on issues that present unique compliance risks to their functions.
A submitter attesting on behalf of the FDR must certify that all individuals in the organization who provide MAPD plan-related services have completed both general compliance and FWA training. They must also attest to specialized compliance training on compliance risks specific to their functions.
CMS FWA Training Requirements
Why is FWA training essential? Due to FWA, billions of dollars are improperly spent each year. This affects everyone, including you. This instruction helps in identifying, fixing, and preventing FWA. Furthermore, it is everyone’s responsibility to fight off FWA. As an individual providing health or administrative services for Medicare enrollees, every action taken is likely to affect the Medicare program, Medicare enrollees, and the Medicare Trust Fund.
Individuals who work with Medicare Parts C and D must receive training. Employees of Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs), collectively known as sponsors, must receive training in detecting, preventing, and correcting FWA.
Medicare FWA Training Requirements
After completing all of the CMS FWA Training 3.0 requirements, you must be able to recognize FWA in the Medicare Program and name the key legal provisions that deal with FWA. Following completion, the trainee should be able to recognize the potential consequences and penalties associated with violations. The trainee must also be able to identify FWA prevention methods, and how to report and correct FWA.
FDRs are regarded to have completed the fraud, waste, and abuse training if they have already met the requirements for FWA training and education certification through membership in Medicare Parts A or B or accreditation as a supplier of durable medical equipment. Prosthetics, orthotics, and supplies are among the durable medical equipment mentioned (DMEPOS). However, they are not exempt from taking the general compliance training requirement.
