CMS Pub. 100-18, ch. 9, § 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.