AMA and MSV urge CMS to end physician fraud training requirements

22 December 2009
From the AMA

On December 8, medical societies representing 50 states and 35 physician groups and specialties joined the AMA in a comment letter to the Centers for Medicare and Medicaid Services (CMS) urging the agency to finalize its proposal to exempt physicians from requirements that Medicare Advantage (MA) plans provide fraud, waste and abuse compliance training to their "downstream entities." The AMA has heard complaints from state medical societies about MA plans indicating that physicians must complete an online compliance training program by the end of this year. Each plan seems to have its own training program and some even charge physicians to access it. Especially for physicians who contract with multiple MA plans, the training demands have generated a substantial amount of confusion and increased administrative burdens. In a proposed rule, CMS indicated it would deem any physician who had enrolled in the Medicare program as in compliance with the training requirement. The AMA’s coalition letter urged CMS to finalize this proposal, and to take immediate action to clarify that physicians who have enrolled in the Medicare program need not comply with the plans’ 2009 compliance training deadlines.

The comment letter also addressed MA plan audits of physician practices. Physicians have noted that MA plans, or their agents, demand far more patient charts than justified by CMS validation requirements, without offering compensation for the staff time involved in pulling, copying and re-filing them. The joint comment letter urged that methods be employed to ensure that physicians can identify the entity that is requesting information and the reasons for the request, and that the same practices are not required either to comply with repeated audit demands from one plan or with demands from multiple plans within the same timeframe.