• Hypertrophic Cardiomyopathy (HCM)
  • Vaccines: 2023 Year in Review
  • Eyecare
  • Urothelial Carcinoma
  • Women's Health
  • Hemophilia
  • Heart Failure
  • Vaccines
  • Neonatal Care
  • NSCLC
  • Type II Inflammation
  • Substance Use Disorder
  • Gene Therapy
  • Lung Cancer
  • Spinal Muscular Atrophy
  • HIV
  • Post-Acute Care
  • Liver Disease
  • Biologics
  • Asthma
  • Atrial Fibrillation
  • RSV
  • COVID-19
  • Cardiovascular Diseases
  • Prescription Digital Therapeutics
  • Reproductive Health
  • The Improving Patient Access Podcast
  • Blood Cancer
  • Ulcerative Colitis
  • Respiratory Conditions
  • Multiple Sclerosis
  • Digital Health
  • Population Health
  • Sleep Disorders
  • Biosimilars
  • Plaque Psoriasis
  • Leukemia and Lymphoma
  • Oncology
  • Pediatrics
  • Urology
  • Obstetrics-Gynecology & Women's Health
  • Opioids
  • Solid Tumors
  • Autoimmune Diseases
  • Dermatology
  • Diabetes
  • Mental Health

Prepare for Part D audits

Article

The impact and magnitude of expenditures should have made Part D an immediate enforcement priority for the Centers for Medicare and Medicaid Services

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established the Medicare Part D outpatient prescription drug benefit, which took effect on January 1, 2006. The impact and magnitude of expenditures should have made this an immediate enforcement priority for the Centers for Medicare and Medicaid Services (CMS) to ensure that the Part D program operates efficiently and is protected from fraud and abuse.

While CMS is responsible for oversight and implementation of safeguards to protect the integrity of the Part D benefit, oversight of Part D programs continued to evolve slowly-until now. An effective compliance plan helps sponsors protect the integrity of Medicare funds by preventing fraud, waste and abuse.

Since 2005, federal regulations have required sponsors to have compliance programs in place. Chapter 9 of CMS's Prescription Drug Benefit Manual ("Part D Program to Control Fraud, Waste and Abuse," available online), provides guidance on the elements outlined in regulatory requirements along with additional requirements and recommendations. It will be updated by CMS soon, making requirements more stringent.

Related Videos
Related Content
© 2024 MJH Life Sciences

All rights reserved.