On November 22, 2013, members of the Good Neighbor Pharmacy Provider Network received an e-mail notification regarding the mandatory 2013 Medicare Part D Fraud, Waste and Abuse (FWA) Compliance Program Provider Attestation. Caremark and Express Scripts each have separate attestations also due by year-end.

The Attestation requires that by December 31, 2013, providers verify that they have in place policies and procedures that are detailed, specific and describe the operation of their compliance program in regard to:

  • FWA Training
  • Standards of Conduct
  • Conflict of Interest
  • Policies and Procedures
  • Monitoring Risks
  • Suspected FWA Reporting and Tracking Mechanisms
  • Excluded Party Review
  • Record Retention and Access
  • Audits

To have a qualified, effective compliance program which meets the Attestation requirements and as required by The Social Security Act and Centers for Medicare and Medicaid Services (CMS) regulations, Part C and Part D, providers must have a compliance program that includes measures to prevent, detect and correct Medicare non-compliance as well as measures to prevent, detect and correct fraud, waste and abuse. In order to maintain billing status, companies must have a qualified compliance program implemented and complete Fraud, Waste and Abuse Training and General Compliance Training by December 31, 2013. In addition, providers must sign and submit a Fraud, Waste and Abuse Compliance Program 2013 Provider Attestation verifying training and verifying they have a fully implemented compliance program. 

The attorneys at Roetzel are experienced in providing the required FWA training and in implementing compliance programs that meet the criteria required by government agencies under the Social Security Act, the Anti-Kickback statute, Safe Harbor regulations, Stark Law, False Claims Act and HIPAA.