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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

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Annual Medicare Advantage

PW_B130908
Fraud, Waste and Abuse (FWA) Training for First Tier, Downstream and Related Entities  
Background 
The Centers for Medicare & Medicaid Services (CMS) has made policy changes to 42 C.F.R § 422.503 (b) (4) (vi) and 42 C.F.R § 423.504 (b) (4) (vi) that became effective January 1, 2009. The regulation revision clarifies that Medicare Advantage Organizations (MAO) and Prescription Drug Plans (PDP) sponsors must apply FWA training to all entities that are not eligible to provide services under traditional Medicare they are partnering with to provide benefits or services in the Part C and Part D programs. 
In accordance with these CMS stipulations, Blue Cross and Blue Shield of Georgia (BCBSGA) and its subsidiaries requires providers that are not eligible to provide services under traditional Medicare or do not have a Medicare identification number to train employees on Fraud, Waste and Abuse on an annual basis. The attestation is also included in the training and must be submitted to the plan. If you are a provider who is Medicare eligible and have a Medicare number you have already fulfilled the Fraud, Waste and Abuse requirement and do not need to attest to an MAO on an annual basis. If you would like to stay current on your FWA training, you are welcome to continue using BCBSGA’s free online FWA training. The training also has an attestation form that we would welcome you to fill out to keep for your records. 
BCBSGA offers a free Fraud, Waste and Abuse training. Our training meets CMS requirements and includes an attestation statement. To access our free Fraud, Waste and Abuse training, Click here  
Additional Information 
Please be sure to check our website and provider newsletters for updates to this CMS required Fraud, Waste and Abuse training.  
 
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.