The Government Accountability Office (GAO) has found that the five Part D sponsors reviewed by GAO have not completely implemented all of the compliance plan elements and selected recommended measures for Medicare Part D fraud and abuse programs required by the Centers for Medicare and Medicaid Services (CMS).
In a review of the extent to which certain Part D sponsors have implemented programs to control fraud, waste, and abuse, and the extent of CMS’s oversight of those programs, GAO learned that all Part D sponsors had completely implemented the requirements and selected recommendations for three of the seven required compliance plan elements--written policies, procedures, and standards of conduct; effective lines of communication; and enforcement of standards through disciplinary guidelines. However, the sponsors varied in their implementation of the remaining required elements--compliance officer and compliance committee, effective training and education, internal monitoring and auditing, and prompt responses to detected offenses.
Also, GAO found that, to date, CMS’s activities have been limited to the review and approval of sponsors’ fraud and abuse program plans submitted as part of the initial Part D applications, but has not conducted oversight to assess Part D sponsors’ implementation of fraud and abuse programs. Download the report.
