CMS requires Qualified Health Plans (QHP) in the Federally-Facilitated Marketplaces (FFM) to ensure that general compliance and fraud, waste, and abuse training is communicated to their Delegated Entities who have involvement in the administration or delivery of federally governed health care programs. The CMS compliance program training is designed to ensure:
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Delegated Entities have at least a basic knowledge and understanding of compliance program requirements; and
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Delegated Entities are knowledgeable about compliance and FWA issues and how to appropriately address them.
You and any of your employees or contracted entities that provide health or administrative services to Piedmont’s enrollees must complete these trainings. There will be certain Delegated Entities where not every employee or contracted entity needs to take the training based on their duties. Please refer to the FAQs for more clarification.
CMS has created FWA and General Compliance Training Modules on the Medicare Learning Network (MLN). These models are intended to simplify compliance training and ensure that duplication of effort is avoided for Delegated Entities that hold contracts with multiple federal contracting organizations. You may have already completed this for another plan, in which case you need not do it again.
To complete both the Compliance and FWA trainings, CLICK HERE. Each individual will need to create an account. Once you are able to log in, select “Fraud and Abuse” under “Browse Categories” on the right side of the page. The courses to select are:
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Medicare Parts C and D General Compliance Training (January 2019) (Contact hours: 20 min.)
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Combating Medicare Parts C and D Fraud, Waste, and Abuse (January 2019) (Contact hours: 30 min.)
Successfully completing the course requires completing the entire lessons and scoring 70 percent or higher on the Post-Assessments. After successfully completing the Post-Assessment, you’ll get instructions to print your certificates. All government regulated health plan sponsors are required to accept these certificates as proof of completion of the required trainings.
Currently, CMS has 2 other options by which this training can be completed. Please see FAQs for more information on these options.
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