Foreword from report issued July 18, 2023 by CMS’ Medicare Parts C and D Oversight and Enforcement Group:

Read full report here

The Medicare Parts C and D Oversight and Enforcement Group (MOEG) in the Centers for Medicare & Medicaid Services (CMS) has historically released an annual report summarizing information from its annual Part C and Part D program audits and enforcement actions to encourage improvement in industry performance. These data and analyses provided year-to-year comparisons of audit scores for Medicare Advantage Organizations (MAOs), prescription drug plans (PDPs), and Medicare-Medicaid plans (MMPs), collectively referred to as “sponsors.” We encouraged sponsors to review this information with their compliance staff, compliance committee, and other pertinent staff with the intent of ensuring:

  • Enrollees have appropriate access to health care services and medications
  • Sponsors are in compliance with selected federal requirements
  • Sponsors understood our audit process and had a means to provide us feedback

We also used this report to solicit feedback from our stakeholders about the types of information we could include in the report to further drive improvement. The feedback we received helped us realize that the information we were sharing wasn’t as helpful as it could be, and sponsors want us to provide more specifics about the types of noncompliance we see and the reasons for it. We listened to your feedback and revised the report accordingly. In this report, you will gain greater insight into the noncompliance we cited in 2022 and the enforcement actions that resulted from these oversight activities.

Note that information included in this report should not be used to draw broad conclusions about the significance of deficiencies or performance across the MA, Part D, or MMP programs. This report is not intended to reflect overall industry performance and should not be interpreted to mean that there are pervasive issues throughout the industry related to the noncompliance we identified.

Lastly, we continue to welcome sponsor feedback on the changes made to this report. Please submit comments to our Parts C and D audit mailbox: (include “Comments on the Part C and Part D Program Audit and Enforcement Report” in the subject line).