CMS Pub. 100-16, ch. 21, § 50.3.2

42 C.F.R. §§ 422.503(b)(4)(vi)(C), 423.504(b)(4)(vi)(C)

The sponsor’s employees (including temporary workers and volunteers), and governing

body members, as well as FDRs’ employees who have involvement in the administration

or delivery of Parts C and D benefits must, at a minimum, receive FWA training within

90 days of initial hiring (or contracting in the case of FDRs), and annually thereafter.

Additional, specialized or refresher training may be provided on issues posing FWA risks

based on the individual’s job function (e.g., pharmacist, statistician, customer service,

etc.). Training may be provided:

• upon appointment to a new job function;

• when requirements change;

• when employees are found to be noncompliant;

• as a corrective action to address a noncompliance issue; and

• when an employee works in an area implicated in past FWA.

Sponsors may choose to tailor the training in response to circumstances surrounding

potential FWA and specific functions performed by FDRs.

Sponsors must be able to demonstrate that their employees and FDRs have fulfilled these

training requirements as applicable. Examples of proof of training may include copies of

sign-in sheets, employee attestations and electronic certifications from the employees

taking and completing the training.

Sponsors must provide the FWA training directly to their FDRs or provide appropriate

FWA training materials to their FDRs.

To reduce the potential burden on FDRs, CMS has developed and provided a

standardized FWA training and education module. The module is available through the

CMS Medicare Learning Network (MLN) at http://www.cms.gov/MLNProducts. Using

CMS’ training module is optional and a sponsor may use another method. However, this

training meets CMS’ FWA training requirements so sponsors should accept FDRs’ use of

this FWA training option. For details on accessing the FWA training and education on

the MLN website, see the May 8, 2012, HPMS memo regarding Fraud, Waste and Abuse

Training and Education Guidance.

Topics that should be addressed in FWA training include, but are not limited to the

following:

• Laws and regulations related to MA and Part D FWA (i.e., False Claims Act,

Anti-Kickback statute, HIPAA/HITECH, etc.);

• Obligations of FDRs to have appropriate policies and procedures to address

FWA;

• Processes for sponsors and FDR employees to report suspected FWA to the

sponsor (or, as to FDR employees, either to the sponsor directly or to their

employers who then must report it to the sponsor);

• Protections for sponsor and FDR employees who report suspected FWA; and

• Types of FWA that can occur in the settings in which sponsor and FDR

employees work.

Sponsors are accountable for maintaining records for a period of 10 years of the time,

attendance, topic, certificates of completion (if applicable), and test scores of any tests

administered to their employees, and must require FDRs to maintain records of the

training of the FDRs’ employees.

FDRs who have met the FWA certification requirements through enrollment into Parts A

or B of the Medicare program or through accreditation as a supplier of DMEPOS are

deemed to have met the FWA training and education requirements. No additional

documentation beyond the documentation necessary for proper credentialing is required

to establish that an employee or FDR or employee of an FDR is deemed. In the case of

chains, such as chain pharmacies, each individual location must be enrolled into

Medicare Part A or B to be deemed. See examples of such entities in Pub. 100-16,

Medicare Managed Care Manual, chapter 6 §70.