Medicare Part D Fraud Prevention Certification: Requirements & Compliance

As of 2010, Medicare Part D requires all of its sponsors and partners seeking reimbursement for prescription drug benefits to provide proof that they have provided training in the control of fraud, waste and abuse to acquire certification.

Certification

• All pharmacies seeking to receive payment on behalf of Medicare Part D must enter a contract with the Center for Medicare and Medicaid Services (CMS) that provides for training to control fraud, waste and abuse as mandated by Chapter 9 of the Prescription Drug Benefit Manual (v.04.25.06).

Training

• Training for those seeking to become certified for Medicare Part D must include training on CMS requirements concerning benefit administration, standard benefits, requirements for coverage, accurate governmental reporting and how to identify and report suspected fraud, waste and abuse of Medicare Part D to the government. Training may be presented in person or through several available online courses.

Proof of Training

• Pharmacies must keep accurate attendance logs detailing the time and date that all individuals were provided the Medicare Part D training to prevent fraud.