Annual FDR Compliance Attestation

Annual FDR Compliance Attestation

Medicare program requirements apply to First Tier, Downstream, and Related entities (FDRs) to whom MediGold has delegated administrative or health care service functions relating to its Part C and D contracts. To ensure those requirements are met, MediGold has developed a Compliance attestation that must be completed and submitted annually by each FDR entity to confirm compliance.

I attest to the following:

I have reviewed MediGold's FDR Manual which includes MediGold's Standards of Conduct and Compliance Policies. My organization has received, understands, and has complied with the requirement to provide the following to our employees upon hire and annually thereafter by:



My organization maintains a confidential compliance & FWA reporting mechanism that has been distributed and is widely publicized for all employees and contractors within the organization. My organization encourages reporting potential compliance and FWA issues by:



I certify that I have authority to attest for the group or organization listed above. My organization understands and agrees to maintain supporting documentation for a period of ten years and will provide such documentation to MediGold or CMS upon request.

  (Adding your name on this line will serve as your electronic signature)