Services - For Medicare Part D Plan Sponsors (FWA4PlanSponsors.Com)

FWA4PlanSponsors.Com provides a comprehensive array of auditing services for Medicare Part D Plan Sponsors including FWA Compliance audits, PBM audits and contract negotiation.  After two years, can your PBM reconcile your PDE’s to claim records?  Have you or your PBM audited pharmacies for compliance and to prevent Fraud, Waste and Abuse?

Chapter Nine of the CMS Guidelines stipulates that you cannot delegate your FWA program to your PBM because there is no PBM with the skills, objectivity and expertise to perform a FWA program.  Our program:

Focuses on Auditing to Reduce Plan Costs...

• Analyzes claims data for potential fraud, waste and abuse.  Our portfolio contains over 20 reports that target physicians, PBMs, pharmacies and patients who may be abusing the program, creating waste or perpetrating fraud.
• Performs desk audits of potential pharmacies, patients, physicians and your PBM who may be costing you money and reducing overall profit.
• Auditing Long Term Care, Specialty and Home Infusion pharmacies
• Performs onsite audits, working with SIU units, to further investigate and recover monies at the same time reducing potential fraud, waste and abuse.
• Audits your PBM for adherence to financial terms
• Audits your PBM for compliance with CMS requirements including processing straddle claims, LICS indicators and TrOOP accumulators.

Focuses on Contracting to Eliminate Plan Errors...

• PBM contracts that require for transparency and accountability
• PBM contracts that include all important Part D services like production of EOBs, PDEs and retrospective accounts receivable to ineligible patients
• PBM contract that have appropriate policies and procedures and Code of Ethics programs for First Tier and Downstream entities
• PBM contracts that detail financial terms for all network providers and administrative responsibilities.

There is no program as comprehensive as FWA4PlanSponsors in analyzing, investigating and recovering pharmacy dollars. Our programs have an approximately 3:1 return on investment and meet CMS requirements.

We specialize in services for Medicare Part D Plan Sponsors - FWA 4 Plan Sponsors.