Description

As part of the Medicare Part D – Prescription Drug Benefit, CMS released final guidance in April 2006 for compliance guidance to all Medicare Part D Sponsors titled “CMS Prescription Drug Benefit Manual, Chapter 9 – Part D Program to Control Fraud, Waste and Abuse”. Section 50.2.3 of the Manual recommends that Part D plans ensure that network pharmacists and other pharmacy workforce members engaged in delivering any Medicare services should receive general and specialized training to prevent fraud, waste and abuse. In addition, in 2007 CMS issued a final rule, which required Part D plans to ensure that members of each network pharmacy’s workforce receive “effective training and education” on fraud and abuse compliance. However, in 2010 CMS revised the rule to provide that training is not mandatory for pharmacies that are enrolled as Medicare Part B suppliers or are DMEPOS accredited. See 42 C.F.R. §§ 422.503(b)(4)(vi)(C), 423.504(b)(4)(vi)(C).

Learning Objectives

At the completion of this program, you should be able to:

• Describe the federal regulations related to fraud, waste and abuse
• Explain how government regulations aimed towards fraud, waste and abuse affect daily work in the pharmacy
• Identify and report suspected activities in pharmacies
• Describe the range of penalties for fraud, waste and abuse violations
• Identify the components of a fraud, waste and abuse compliance program
• Specify the responsibilities workforce members have under their company's policies and procedures
• State workforce protections when reporting suspected fraud, waste and abuse

Authors

• Don L. Bell: General Counsel and Senior Vice President, Legal Affairs; National Association of Chain Drug Stores
• Mary Ellen Kleiman: Associate General Counsel and Vice President, Legal Affairs; National Association of Chain Drug Stores

System Requirements