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June 24 — Despite several Centers for Medicare & Medicaid Services memorandums describing best practices and other agency offerings aimed at improving the audit performance of Medicare Advantage and Part D prescription drug plans, the agency is “not seeing the fruit of that labor,” an official said June 24.
Jerry Mulcahy, director of the CMS's Medicare Parts C & D Oversight and Enforcement Group (MOEG), told an agency conference that plans are still “inappropriately denying” enrollees access to drugs and services.
“We're not seeing the results we had hoped,” Mulcahy told attendees at the Medicare Advantage & Prescription Drug Oversight & Enforcement conference and webcast. The conference was intended to provide insight into preparing for a CMS performance audit, best practices of high performing organizations and common audit findings.
Mulcahy said that although the CMS has improved its process of informing plans about what they are doing wrong and showing them methods to achieve high performance, there are still problems and some sponsors have had to be terminated.
Overall, PDPs received better average audit scores than MA plans, Kathleen Flannery, deputy director of MOEG's Division of Analysis, Policy, and Strategy, said. Nonprofit groups had better scores on average than for-profits, she said
The CMS's audit policy has evolved from one that scored plans based on a pass/fail numeric threshold to one that considers not just the number of violations examined during an audit but their severity, she said.
Results of the 2013 audits will be posted on CMS's website this summer.
Lorelei Piantedosi of CMS's Division of Analysis, Policy, and Strategy offered details on sponsors audited during 2013:
Unfortunately, she said, many of the issues in the findings had been included in the past three best practice/common findings memos.
In the meantime, best practices found during 2013 audits included:
Piantedosi said that the fourth CMS memo on best practices will be out shortly.
To contact the reporter on this story: Mindy Yochelson in Washington at firstname.lastname@example.org
To contact the editor responsible for this story: Ward Pimley at email@example.com
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