Compliance Training

Medicare Advantage – Prescription Drug Compliance and Fraud, Waste and Abuse Training Attestation Form

Pursuant to 42 C.F.R. 422.503, all Medicare Advantage Organizations and Part D Plan Sponsors first tier, downstream and related entities are required to complete Compliance, Fraud, Waste and Abuse training on an annual basis.

Therefore, to meet these requirements, please complete the Attestation below.

*First Name
*Last Name
*Title
*Practice/Company Name
*Tax ID
*Phone
Email
*Address
Address 2
*City
*State
*ZIP

I attest that all employees who provide services on behalf of the contract with SummaCare as part of the Medicare Advantage plan have completed the Compliance and Fraud, Waste and Abuse training. Check one of the following:

I agree to the terms and to review the SummaCare Compliance and Fraud, Waste and Abuse Training presentation upon submitting this form.

Terms
I understand that CMS and/or Medicare Advantage Organizations or Part D Plan Sponsors may request additional information including training logs for staff to substantiate the statements made in this attestation.

Completed Compliance and Fraud, Waste and AbuseTraining, provided by: on