Fraud, Waste and Abuse Training Attestation

Provider/Organization Name*

Provider/Organization NPI*

Provider/Organization Mail Contact (Name)*

Provider/Organization Mail Contact (Email)*

We have received a copy of CareOregon’s Code of Conduct and Compliance and Fraud, Waste, and Abuse Training Materials. On an annual basis and at CareOregon’s request, we will provide an attestation that Compliance and Fraud, Waste, and Abuse training has been conducted in accordance with 42 CFR § 422.503(b)(4)(vi)(c) and 42 CFR § 423.504(b)(4)(vi)(c).

FWA Training Completed*

Training Completion Date*

Attestation Completed by (Name)*

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