AHIP TRAINING MEDICARE FRAUD, WASTE,
AND ABUSE TRAINING EXAMS WITH
CORRECT SOLUTIONS /PRACTICE EXAMS
1. FWA Training: A compliance program component - -ANS☑☑-**ALL Medicare
plans are required to have robust programs to assure compliance by plan
employees an subcontractors with all applicable laws, regulations and program
guidance.
**One required component of a compliance program is a FWA program to
identify and address issues of compliance with FWA.
**It is important to remember that ALL Medicare plan sponsor employees and
subcontractors are responsible for complying with all relevant Medicare
requirements, even if lack of compliance may not be viewed as FWA,
2. Medicare plan means - -ANS☑☑-A MA plan, MA-PD plan or PDP
3. Subcontractor means - -ANS☑☑-**An individual or entity that provides services
on behalf of a Medicare plan sponsor. This includes individuals and organizations
with DIRECT relationship with the plan sponsor or individuals or organizations
with INDIRECT relationship, such as an agent who has a contract with an agency
or filed marketing organization that contract with a Medicare plan.
4. FWA: Why participate in the training - -ANS☑☑-**Fraud, waste and abuse
impacts everyone who receives or relies on healthcare in the US.
5. **The purpose of this training is to help you detect, correct and prevent FWA and
your help is needed. You are part of the solution!
6. **As a subcontractor to or an employee of a Medicare plan, you are required to
participate in FWA training.
7. FWA: Combating: A federal priority - -ANS☑☑-**Important priority for the
Federal Government.
, 8. **CMS, the Federal agency responsible for administering these programs, takes its
role in leading anti-fraud efforts very seriously and has issued strict requirements
for those involved in providing MA and Medicare Part D coverage.
9. **The office of Inspector General, a sister agency to CMS within the US
Department of Health and Human Services , is also actively involved in anti-fraud
efforts.
10. Steps by Medicare plans to Combat FWA - -ANS☑☑---The establishment and
operation of special investigation units (SIU) or other existing departments that
perform an internal investigation function
11. --The analysis of claims data
12. --Collaboration with law enforcement agencies
13. --Adherence to rules set forth by CMS regarding efforts to identify and prevent
fraud, waste and abuse.
14. CMS Anti-FWA requirements for Medicare plans - -ANS☑☑---Actively seek to
prevent fraud, waste and abuse
15. --Detect and investigate suspected FWA
16. --Implement corrective action when instances of FWA are uncovered
17. --Have a system in place 24 hrs per day for employees and subcontractors to
voluntarily, and confidentially report suspected FWA or misconduct related to the
MA and Part D programs
18. CMS FWA training requirements for a Sponsor's Employees - -ANS☑☑-**CMS
requires Medicare plan sponsors to provide training in FWA to their employees
involved in Medicare plan work.
19. **This training must occur within 90 days of hire and annually thereafter.
20.CMS FWA training requirements: Agents, Brokers and other Subcontractors - -
ANS☑☑-**The FWA training must be received not only by Medicare plan
sponsor employees but also by subcontractors and their employees who are under
contract to provide health or administrative services. The EXCEPTIONS are limited
to:
21. ***accredited suppliers of DME, prosthetics, orthotics, and supplies (DMEPOS)
AND ABUSE TRAINING EXAMS WITH
CORRECT SOLUTIONS /PRACTICE EXAMS
1. FWA Training: A compliance program component - -ANS☑☑-**ALL Medicare
plans are required to have robust programs to assure compliance by plan
employees an subcontractors with all applicable laws, regulations and program
guidance.
**One required component of a compliance program is a FWA program to
identify and address issues of compliance with FWA.
**It is important to remember that ALL Medicare plan sponsor employees and
subcontractors are responsible for complying with all relevant Medicare
requirements, even if lack of compliance may not be viewed as FWA,
2. Medicare plan means - -ANS☑☑-A MA plan, MA-PD plan or PDP
3. Subcontractor means - -ANS☑☑-**An individual or entity that provides services
on behalf of a Medicare plan sponsor. This includes individuals and organizations
with DIRECT relationship with the plan sponsor or individuals or organizations
with INDIRECT relationship, such as an agent who has a contract with an agency
or filed marketing organization that contract with a Medicare plan.
4. FWA: Why participate in the training - -ANS☑☑-**Fraud, waste and abuse
impacts everyone who receives or relies on healthcare in the US.
5. **The purpose of this training is to help you detect, correct and prevent FWA and
your help is needed. You are part of the solution!
6. **As a subcontractor to or an employee of a Medicare plan, you are required to
participate in FWA training.
7. FWA: Combating: A federal priority - -ANS☑☑-**Important priority for the
Federal Government.
, 8. **CMS, the Federal agency responsible for administering these programs, takes its
role in leading anti-fraud efforts very seriously and has issued strict requirements
for those involved in providing MA and Medicare Part D coverage.
9. **The office of Inspector General, a sister agency to CMS within the US
Department of Health and Human Services , is also actively involved in anti-fraud
efforts.
10. Steps by Medicare plans to Combat FWA - -ANS☑☑---The establishment and
operation of special investigation units (SIU) or other existing departments that
perform an internal investigation function
11. --The analysis of claims data
12. --Collaboration with law enforcement agencies
13. --Adherence to rules set forth by CMS regarding efforts to identify and prevent
fraud, waste and abuse.
14. CMS Anti-FWA requirements for Medicare plans - -ANS☑☑---Actively seek to
prevent fraud, waste and abuse
15. --Detect and investigate suspected FWA
16. --Implement corrective action when instances of FWA are uncovered
17. --Have a system in place 24 hrs per day for employees and subcontractors to
voluntarily, and confidentially report suspected FWA or misconduct related to the
MA and Part D programs
18. CMS FWA training requirements for a Sponsor's Employees - -ANS☑☑-**CMS
requires Medicare plan sponsors to provide training in FWA to their employees
involved in Medicare plan work.
19. **This training must occur within 90 days of hire and annually thereafter.
20.CMS FWA training requirements: Agents, Brokers and other Subcontractors - -
ANS☑☑-**The FWA training must be received not only by Medicare plan
sponsor employees but also by subcontractors and their employees who are under
contract to provide health or administrative services. The EXCEPTIONS are limited
to:
21. ***accredited suppliers of DME, prosthetics, orthotics, and supplies (DMEPOS)
