LESS THAN HALF OF PART D SPONSORS VOLUNTARILY REPORTED DATA ON POTENTIAL FRAUD AND ABUSE

Department of Health and Human Services: 2/27

 

In 2011, total expenditures for the Medicare Part D prescription drug program were $67.1 billion. The Centers for Medicare & Medicaid Services (CMS) contracts with plan sponsors to provide Part D coverage to beneficiaries. The Office of Inspector General has recommended that CMS require sponsors to report data on potential fraud and abuse related to Part D to CMS. Rather than requiring these data, CMS encouraged sponsors to voluntarily report them beginning in 2010. This study provides information on the fraud and abuse data reported by sponsors and on whether CMS used these data to monitor or oversee the Part D program.

HOW WE DID THIS STUDY

We accessed CMS’s Healthcare Plan Management System to download data on potential fraud and abuse reported by Part D plan sponsors from 2010 through 2012. We also accessed CMS’s public files of Part D enrollment to determine the number of beneficiaries enrolled in Part D plans from 2010 through 2012. We reviewed the sponsors’ aggregate data to determine the number and percentage of sponsors that reported data on potential fraud and abuse each year. In addition, we surveyed CMS about its review and use of these reported data.  Read More