Fraud and Abuse Training

The Federal Rule, "Revisions to the Medicare Advantage and Part D Prescription Drug Contract Determinations, Appeals, and Intermediate Sanctions Processes,” FR Doc. 07-5946 (72 FR 68700 through 68741), published December 5, 2007, updated the compliance plan requirements for Medicare Advantage (MA) organizations and Part D Sponsors.

Specifically, the compliance regulation states that a compliance plan, which must include measures to detect, correct, and prevent fraud, waste and abuse, must consist of training, education, and effective lines of communication between the compliance officer and the organization’s employees, managers, and directors. These training and communication requirements also apply to all first tier, downstream, and related entities partnering with MA and Part D programs. Training must be conducted on an annual basis.

In accordance to the above Federal requirement, Gateway Health Plan^® (Gateway) must seek to assure that fraud, waste and abuse training is applied to its first tier, downstream and related entities. In order to accomplish this, Gateway has established a training website for providers and/or delegated entities to either access our training program or to report that training was completed through another MA organization or Part D Sponsor.

Providers or delegated entities must either report that training has been completed or access Gateway’ fraud and abuse training by logging into www.gatewayhealthplan.com and clicking on the fraud and abuse link on the bottom of the page. Gateway is requesting that once you fill out the form on the website, that you only provide one Gateway provider ID number if you are completing for a practice or group.

If you have any questions please email fwatraining@gatewayhealthplan.com