Medicare Part D: Some Plan Sponsors Have Not Completely Implemented Fraud and Abuse Programs, and CMS Oversight Has Been Limited.GAO-08-760 July 21, 2008The Medicare Prescription Drug, Improvement, and Modernization Act The Medicare Prescription Drug, Improvement, and Modernization Act (Pub.L. 108-173, 117 Stat. 2066, also called Medicare Modernization Act or MMA) is a law of the United States which was enacted in 2003. of 2003 (MMA (Microcomputer Managers Association, Inc.) A membership organization with chapters throughout the U.S. that was devoted to educating personnel responsible for personal computers. It disbanded in 1996. Mma - A fast Mathematica-like system, in Allegro CL by R. Fateman, 1991. ) established a voluntary outpatient prescription drug prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, benefit, known as Medicare Part D. The Centers for Medicare & Medicaid Services (CMS (1) See content management system and color management system. (2) (Conversational Monitor System) Software that provides interactive communications for IBM's VM operating system. ) 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. The five Part D sponsors in GAO's review had not completely implemented all of CMS's required compliance plan elements and selected recommended measures for Part D fraud and abuse programs. All Part D sponsors had completely implemented the requirements and selected recommendations for three of the seven required compliance plan elements. However, Part D sponsors varied in their implementation of the remaining required elements and selected recommended measures. CMS oversight of Part D sponsors' fraud and abuse programs has been limited. 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. For example, CMS officials reported that they worked with sponsors to help them develop fraud and abuse program plans that met the agency's compliance plan requirements and recommendations specific to fraud and abuse. However, CMS has not conducted oversight to assess Part D sponsors' implementation of fraud and abuse programs. Officials from CMS stated that the agency had not audited sponsors' implementation of fraud and abuse programs in 2007, and as of April 2008, no audits of these programs had been conducted. Categories: Health, Fraud, Health care fraud, Health care planning, Health care policies, Health care programs, Health care reform, Internal controls, Managed health care, Medicare, Noncompliance, Prescription drugs, Program abuses, Program evaluation Program evaluation is a formalized approach to studying and assessing projects, policies and program and determining if they 'work'. Program evaluation is used in government and the private sector and it's taught in numerous universities. , Program management, Requirements definition, Standards, Strategic planning, Voluntary compliance, GAO High Risk Series, Medicare Part D |
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