Annual Network Provider Anti-Fraud, Waste & Abuse

Training Acknowledgement & Attestation

Fraud, Waste and Abuse Prevention Training

Instructions: Please watch the full video before filling out the form below. If you need additional reading time, you can pause and play the video at any time.

Please fill out the form

Instructions: After watching the video above, please sign the form attesting to have received the annually required Network Provider Anti-Fraud, Waste & Abuse Training and resources for the Medi-Cal/Medicaid program. * Please fill out all required fields

An Authorized Person can complete the training attestation on behalf of your practice for each provider

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Annual Network Provider Anti-Fraud, Waste & Abuse

Training Acknowledgement & Attestation


Health Plan of San Joaquin, as a licensed health care services plan regulated by the Department of Managed Health Care (DMHC) and contracted with the Department of Health Care Services (DHCS), is committed to protecting members, our network of providers, and public interests by preventing, detecting, investigating, correcting, and reporting Fraud, Waste, and Abuse (FWA).


Under legal requirements overseen by the federal Centers for Medicare & Medicaid Services (CMS), 42 C.F.R. §422.503 and 42 C.F.R. §423.504, providers are required to either complete the FWA training offered on the HPSJ website and send HPSJ a signed attestation or attest that you have completed another, acceptable FWA training.


An Authorized Person can complete the training attestation on behalf of your practice
for each provider listed on page 2.



Please select the training option you have completed


, attest to having received the annually required Network Provider Anti-Fraud, Waste & Abuse Training and resources for the Medi-Cal/Medicaid program.

.

Note: Please make sure you write a visible signature using your mouse or finger in the signature area. 



Provider/Authorized Signature
(Please Sign Here)
Clear Signature

Please list all providers name & individual NPI# below”

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Posted on July 5th, 2019 and last modified on April 26th, 2022.

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