FDR Compliance/FWA Training: CMS Contradicts Itself

By Julie Mason, Principal

As a best practice to document compliance with the latest Centers for Medicare and Medicaid (CMS) compliance program requirements, some Medicare Advantage organizations (MAOs) may make use of the CMS-issued Application XVlll Compliance Program crosswalk.

Comparing the requirements at 42 CFR §422.503, as detailed in the Final Rule issued on April 16, 2018, with the compliance program crosswalk in the 2020 MA application may lead some MA and/or PDP sponsors to question their responsibility to train and educate first-tier, downstream, and related entities (FDRs).  The compliance program crosswalk indicates that Medicare Advantage plans must provide compliance and FWA training to FDRs, while the April 16, 2018 Final Rule indicates that CMS deleted this requirement.

In the face of this contradiction, what are the MAOs’ responsibilities for training FDRs when it comes to general compliance and fraud, waste and abuse (FWA) training?

Last month, Medicare Compliance Solutions reached out directly to CMS for clarification. The initial response from the CMS Medicare Parts C and D Compliance Program Guidelines Team stated, “MAOs/PDPs are still responsible for providing training to their FDRs, but effective June 15, 2018 they are not required to use the CMS-developed compliance program training anymore.”

Given the clear contradiction between CMS’ response with the preamble and revised regulations in the April 16, 2018 Final Rule, MCS questioned that response from CMS  by providing excerpts from the preamble of the Final Rule which clearly stated that MAOs are no longer required to provide compliance and FWA training to their FDRs.  The CMS Compliance Program Guidelines Team then confirmed to MCS in writing the deletion of the FDR training requirement by stating, “MAOs are no longer required to provide general compliance and FWA training to their FDRs. MAOs are responsible and accountable for ensuring their FDRs comply with applicable regulations, standards, and requirements.”

The two take-aways here:

  1. Regardless of what the MA application Compliance Program Crosswalk states, MAOs are no longer required to train their FDRs on Medicare Parts C and D General Compliance Training and Combating Medicare Parts C and D Fraud, Waste, and Abuse.
  2. When CMS contradicts itself, it is best to go straight to the source and push until CMS clears up the contradiction.

Questions? Ask the Medicare Compliance Solutions team here.

Share this: