NY Fraud, Waste & Abuse Compliance Information

NY Fraud, Waste & Abuse Compliance Information

Click here to read the latest Compliance Alert (#7) from the OMIG which includes:

2011 - 07: Effectiveness Review Process
Document #1 Announced Visit Template
Document #2 Announced Visit Doc Request
Document #3 Focused Review Form For Announced Reviews
Document #4 Service Bureau Survey
Document #5 Announced Visit Confirmation Letter
Document #6 ER Documentation Review
Document #7 Feedback from ER


REMINDER: You must certify with the OMIG on or before December 31 ANNUALLY.

MANDATORY:
FWA Manual Info:
To order your Fraud, Waste & Abuse Manual, click here for the order form or call the PSSNY Office at 800-632-8822.

• NEW 12/28/2010: Medicaid Home Delivery Policy - insert in your Policies & Procedures
  NEW 10/27/2010: Employee Code of Conduct & Conflict of Interest Statement
• Changes as of 12/02/09:
  New Instructions Page
  New Pages: 102-109 - print out and replace in your manual if you
  have already printed it

PSSNY RECOMMENDATION: keep your Manual in a binder in the pharmacy AND in SEPARATE binders/folders for EACH employee keep their signed statements so that there would be one folder per employee with their signed paperwork. In an audit situation they may ask for only one employee's signed statements and you can provide this quickly.

MANDATORY:
Fraud, Waste & Abuse Training Course - Mandatory for all people working with prescriptions - Not just Pharmacists
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.

MANDATORY:
Certify with the OMIG after you have completed the FWA training program and have the Manual in place. This is an online form only. Click here for more Provider Compliance information from the OMIG Website. You must certify with the OMIG on or before December 31 ANNUALLY.