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Medicare first-tier, downstream and related entities

Providence Health Assurance (PHA) is contracted with The Centers for Medicare & Medicaid Services (CMS) to provide health care and prescription drug coverage to our Medicare beneficiaries. These beneficiaries are PHA’s valued members. As a condition of our contract with CMS, PHA is required to provide and oversee the below training and educational presentations that are given to our contracted providers, vendors and related entities that provide service to our members. These providers, vendors and related entities are PHA’s first-tier, downstream and related entities, also known as FDRs.

Thank you for your service to our members. We appreciate your partnership with Providence Health Assurance. If you have a compliance question, please email us at PHAMedicareCompliance@providence.org.

CMS requires that FDR’s receive general compliance and fraud, waste and abuse training upon hire and annually thereafter.

In order to successfully meet our training obligation (42 CFR §422.503 (b)(4)(vi)(C)(3) and §423.504 (b)(4)(vi)(C)(3)) with CMS, please complete one the following steps.

You will be asked to attest during your annual FDR Attestation.

Please review the required documents. Once you have completed the MA Compliance and Fraud, Waste and Abuse training and pass the post-test you will receive an email confirmation. Please download your certificate and keep for your records. If you have any additional questions regarding this required training please contact your PHA provider representative.

Medicare Compliance

Providence Medicare Advantage Plans is committed to a “culture” of compliance. As part of our contract with The Centers for Medicare & Medicaid Services (CMS), we have developed and adopted an effective compliance program. Our compliance program reinforces our commitment to ethical standards and conduct, and establishes our expectation that all Providence Medicare Advantage Plan employees, governing board, first tier, downstream, related entities and members conduct themselves in an ethical and lawful manner, and comply with all federal, state and local laws and regulations.

How to Report Potential Non-Compliance Concerns

1. Please fill out the potential non-compliance external referral form (PDF)

  • Send by fax to: 503-574-6543
OR
  • Send by mail to:
    Attention: Medicare Compliance Manager
    3601 SW Murray Blvd, Suite 10
    Beaverton, Oregon 97005

2. Contact the Providence Health Assurance Chief Compliance and Risk Officer at 503-574-7430 

or the Medicare Compliance Officer at 503-574-6437. 

3. Call the confidential Providence Integrity Hotline at 888-294-8455, 24 hours a day, seven days a week.

Conflict of interest

Providence Health Assurance’s expectation of all FDRs is that they should have a conflict of interest process in place for all employees that work with the PHA line of business.

Policy and procedures