The CMS needs to step up its activities to protect the Medicare Part D program from fraud and abuse, according to a report from HHS inspector generals office.
In analyzing the safeguards the agency took during fiscal 2006, the inspector generals office found that the CMS relied largely on complaints to identify potential fraud and abuse in the Part D program. However, not all of these complaints were investigated in a timely manner. In particular, the office identified several weaknesses to the effective oversight of the program. The CMS, for example, has limited authority over insurance brokers, some of the most frequent subjects of fraud complaints. In addition, coordination of information between plans about beneficiaries suspected of inappropriate usage hasnt taken place because plan sponsors are worried about violating patient privacy laws.
The CMS should address legal concerns that may impede program integrity efforts and ensure that all fraud complaints receive proper attention, according to the report. In addition, the agency should develop a comprehensive strategy for Medicare Part D prescription drug plans and ensure that all activities are progressing in a timely manner. The agency responded that many of its activities already satisfy the recommendations. The CMS went on to say that the report also didnt fully explain the workload involved with developing and administering the benefit in its first year, and that processes have improved with time since then. -- by Jennifer Lubell
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