The Department of Health & Human Services Office of Inspector General (OIG) has issued two reports examining the Medicare Part D prescription drug program. Under the program, private companies contract with the Centers for Medicare & Medicaid Services (CMS) as plan sponsors to provide Part D drug coverage to Medicare beneficiaries.
Plan sponsors are required to have a comprehensive program to identify fraud and abuse, and the first report looks at the extent to which sponsors have identified potential fraud and abuse. It finds that some plan sponsors did not identify any potential incidents, while some that did identify potential incidents did not initiate inquiries, corrective actions, or referrals to appropriate enforcement agencies. The report recommends that CMS review the plan sponsors to determine why some report high or low volumes of fraud and require sponsors to routinely report the results of their fraud and abuse programs.
The second report examines CMS’s oversight of sponsor compliance plans, which are required by federal regulation. It finds that although CMS had planned to begin routine compliance plan audits in January 2007, it had not completed any routine audits as of August 2008. It also finds that CMS had only information self-reported by plan sponsors to determine whether the sponsors are meeting federal requirements.
