Vendor Compliance FAQ

No, FDRs are required to use only CMS FWA training, CareSource FWA training or FWA training provided by another Medicare Advantage and Part D Sponsor.

Because of your contractual relationship with CareSource (or its subsidiaries) you are considered an FDR, therefore required to ensure that you, your employees, your Downstream and Related Entity employees complete this training.

The Centers for Medicare and Medicaid Services (CMS) requires Medicare Advantage Organizations and Part D sponsors to ensure that general compliance and fraud, waste, and abuse training and education is communicated to their First Tier, Downstream, and Related Entities (FDRs) who have involvement in the administration or delivery of Parts C and D benefits. Because of your contractual relationship with CareSource (or its subsidiaries), you are considered an FDR; therefore CMS requires that you, your employees, your Downstream and Related Entity employees complete this training.

CMS defines First Tier, Downstream and Related entities (FDR) as:

First Tier Entity – any party that enters into a written arrangement, acceptable to CMS, with a Medicare Advantage Organization (MAO) or Part D plan sponsor or applicant to provide administrative services or health care services to a Medicare-eligible individual under the Medicare Advantage program or Part D program.

Downstream Entity – any party that enters into a written agreement, acceptable to CMS, with persons or entities involved with the Medicare Advantage or Part D benefit, below the level of first tier entity. These arrangements continue down to the level of the ultimate provider of both health and administrative services.

Related Entity – any entity that is related to an MAO or Part D Sponsor by common ownership or control and performs some of the sponsor’s management functions under contract or delegation; furnishes services to Medicare enrollees under an oral or written agreement, or leases real property or sells materials to the MAO or Part D plan sponsor at a cost of more than $2500 during a contract period.

This training does not apply to you unless you are contracted with another entity that is contracted with CareSource to service CareSource’s Medicare products.

You, your employees, and any of your Downstream and/or Related Entity employees that are involved in the delivery of CareSource’s Medicare product administration or delivery of services must take this training. It is your responsibility to identify those parties that serve in this capacity for you and to ensure they complete the training. The only exception is if they are deemed, allowing them to be exempt from the Fraud, Waste, and Abuse (FWA) training.

FDR employees who perform work on behalf of CareSource’s Medicare products must satisfy CMS FWA Training requirements, unless the employees are deemed to have met the FWA training requirements.

Compliance Training is required by CMS of CareSource’s FDR employees but can be completed through the dissemination of a Code of Conduct to these employees; therefore, CareSource’s Compliance Training requirements are to distribute CareSource’s Code of Conduct or an equivalent code to your employees and Downstream and/or Related Entities.

This training must be completed initially and annually thereafter.

This training must be completed within 90 days of your and your employees’ initial hire date and at least annually thereafter. Your Downstream and/or Related Entity’s must also be trained within this same timeframe.

Evidence may be in the form of employee attestations, employee attendance/training logs, or other means determined by you to best represent fulfillment of your obligations. You should retain evidence of completion for at least 10 years. CareSource and/or CMS may request this evidence to ensure completion of these requirements. If you and/or your employees are deemed to have met the FWA training requirements, you should retain proof of the deemed status.

CareSource collects attestations to confirm completion of the training requirements. Depending on the type of First Tier that you are for CareSource, you may receive the request by email or in another manner.

You must also maintain evidence to document the completion of this training for all of your employees and Downstream and/or Related Entity employees. Evidence may be in the form of employee attestations, employee attendance/training logs, or other means determined by you to best represent fulfillment of your obligations. You should retain evidence of completion for at least ten years. CareSource and/or CMS may request this evidence to ensure completion of these requirements.

If you and/or your employees are deemed to have met the FWA training requirements, you should provide proof of the deemed status.

If areas of noncompliance are determined, enforcement actions may be taken to both cure the deficiency and prevent future occurrences. Enforcement actions, such as corrective action plans and/or contract termination, may vary depending upon the severity of the issue. CMS requirements dictate this training so completion of it is not an option.

As expressed within the Code of Conduct, it is expected that you ensure timely, consistent, and effective enforcement through well-publicized disciplinary standards (e.g., mandatory retraining, termination, etc.) that are taken with any personnel within your organization who demonstrate any non-compliant or fraudulent behavior. As a CareSource First Tier, you are expected to enforce completion of these requirements with your Downstream and/or Related Entities, as well. If you are aware of or suspect non-compliant, unethical or illegal behavior by others, including, but not limited to, failure to complete the required training and education, you are obligated to report it to CareSource immediately so that we can investigate and respond appropriately.