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Medicare SummaCare Annual Vendor Requirements Attestation

SummaCare Annual Vendor Requirements Attestation (Medicare)

SummaCare Medicare Vendors must attest (prior to contracting and annually thereafter) in writing to the following:

  1. Compliance with SummaCare’s Code of Ethical Conduct and all other applicable Compliance policies and procedures.
  2. The completion of Exclusion Checks prior to contracting/hiring and monthly thereafter.
  3. The publication of disciplinary standards as well as methods for reporting Medicare program noncompliance and FWA to employees. (Disciplinary standards must include a non-retaliation policy for good faith reporting.)
  4. A comprehensive review of any applicable downstream and related entities that have involvement in the administration or delivery of SummaCare’s Parts C and D benefits to ensure Medicare compliance.
  5. A completed attestation form (if applicable) with information about any offshore subcontractors.

How to Download & Submit the SummaCare FDR Requirements Attestation Form

Download the 2022 SummaCare Medicare First Tier, Downstream & Related Entity (FDR) Requirements Attestation form, which should be completed by an authorized representative of your organization. Once the form has been completed it should be submitted to