GAO says CMS should audit Part D sponsors due to fraud and abuse
Summary:
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit, known as Medicare Part D. The Centers for Medicare & Medicaid Services (CMS) contracts with private companies to serve as Part D sponsors and administer the Part D prescription drug benefit plans. To protect beneficiaries and the fiscal integrity of the program, the MMA requires Part D sponsors to implement programs to control for fraud and abuse in Part D. Subsequent regulations and guidance from CMS contain requirements and recommended measures for these programs.
This report examines (1) the extent to which certain Part D sponsors have implemented programs to control fraud, waste, and abuse and (2) the extent of CMS’s oversight of Part D sponsors’ programs to control fraud, waste, and abuse. GAO conducted on-site reviews of five of the largest Part D sponsors’ fraud and abuse programs. GAO also interviewed officials from CMS and reviewed CMS documents.
What GAO Recommends
To help safeguard the Medicare Part D program from fraud, waste, and abuse, GAO recommends that CMS conduct timely audits of Part D sponsors’ fraud and abuse programs. CMS disagreed that its oversight has been limited, but GAO found that CMS has not audited sponsors’ fraud and abuse programs. CMS concurred with GAO’s recommendation.