General Compliance and Fraud, Waste and Abuse

  

General Information

Medicare Advantage (MA) Preferred Provider Organization (PPO) Network Sharing  — This document describes how MA PPO members can get in-network benefits when traveling or living in another Plan's service area.             

Fraud and Compliance Awareness

The Centers for Medicare & Medicaid Services (CMS) developed two training modules for (1) compliance and (2) fraud, waste and abuse (FWA).  These training modules are for use by health plans and the entities they partner (contract) with to provide services. This was done to reduce the burden on providers being asked to complete and attest to multiple compliance and FWA trainings from several insurers. 

Our providers who participate in the BlueCross MA network can fulfill this training requirement by choosing one of these methods:

All MA plans and prescription drug plans (PDP) must accept certificates of completion of this CMS Compliance and FWA training (located on the Medicare Learning Network) from network providers. You must complete the CMS FWA and compliance training by April 1 each year.

BlueCross acknowledges that some MA providers may have completed an internal CMS-approval compliance training course with their staff.

After you complete the compliance training, a certificate of completion will generate. You should print and retain this certification to validate that annual training has occurred for all staff.