Excluded Provider Attestation

CMS requires all Medicare Advantage Plans to obtain certifications from all first-tier, downstream and related entities that these entities will review the excluded provider lists U.S. Office of Inspector General and System for Award Management (SAM) upon initially hiring and annually thereafter to ensure that any employee or manager responsible for administering or delivering Part D benefits is not excluded from federal health care programs.

In addition, CMS requires Medicare Advantage Plans to obtain certifications that if an employee of the first-tier, downstream or related entity responsible for the administration of delivery of any Part D benefits is on such lists, that employee will immediately be removed from any work related directly or indirectly to all federal health care programs and the entity will take appropriate corrective actions.

If you have any employees or providers that are on one of the excluded lists, please notify us via email at PHPMedicareCompliance@providence.org.

The attestation for this section is included in the form following your attestation or post-test.