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| CMS’s Part D Audit Findings: A Roadmap for Plan Sponsors |
As CMS continues to move from routine audits to more targeted, data-driven or risk-based audits of Medicare Part D plans, there are lessons to be learned from the mistakes of other plans.
CMS’s Part D Audit Findings: A Roadmap for Plan Sponsors will help Part D plans avoid becoming agency targets. This collection of summaries of CMS’s recent audit reports details what CMS and Medicare Drug Integrity Contractors have focused on in the past year — and will likely continue to focus on — during audits.
Industry trends point to these top five audit hot spots:
- Enrollment eligibility/disenrollment
- Marketing
- Complaints, appeals and grievances
- Delegation oversight
- Compliance programs
CMS’s Part D Audit Findings: A Roadmap for Plan Sponsors highlights these and other audit areas, and includes a comprehensive table summarizing the status of more than 100 Part D and MA-PD sponsors’ audits. Order your copy today, and start developing sound strategies to avoid becoming a high-risk plan on CMS's audit radar.
Table
of Contents
Recent CMS Audit Reports
- Fox Insurance Co.
- Health Care Service Corp.
- Priority Health (Spectrum Health System)
- Medical Card System, Inc.
- SilverScript Insurance Company and Accendo Insurance Company (CVS Caremark Corp.)
- First Medical Health Plan, Inc.
- Windsor Health Group
- Aveta, LLC
- Independent Living for Seniors, Inc. (Rochester General Hospital)
- Mountain Empire Older Citizens, Inc.
- SilverScript Insurance Company (CVS Caremark Corp.)
- Florida PACE Centers, Inc.
- Bienvivir Senior Health Services
- AmeriHealth HMO, Inc.
- UnitedHealth Group
- AMERIGROUP Corp.
- Group Health Cooperative
- Medica Health Plans
- Health Net, Inc.
- Universal American Corp.
- Health Plan of the Upper Ohio Valley
- ODS Companies, Inc.
- Blue MedicareRx
- CVS Caremark Corp. Subsidiary RxAmerica LLC
- Aetna Inc.
- Coventry Health Care, Inc.
- WellPoint, Inc.
- Neighbor Health Providers, Inc.
- Presbyterian Healthcare Services
- SDM Healthcare Management, Inc.
Table: Status of Sample of Part D and MA-PD Sponsors’ Audits
Written
By
This
book was written by the editorial staff of AIS.
Written
For
- Health plan sponsors
- PBMs
- Pharmaceutical companies
- Pharmacy chains
- Consultants and attorneys
- Hospital pharmacy managers and compliance officers
- Other health care organizations with a major stake in Part D
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Related
Publications
Medicare Part D News
Medicare Advantage News
Drug Benefit News
Health Plan Week
Medicare Part D: A Comprehensive Analysis of CMS Rules
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