Medicare Part D: CMS Oversight of Part D Sponsors' Fraud and Abuse Programs Has Been Limited, but CMS Plans Oversight Expansion

Medicare Part D, the voluntary, outpatient prescription drug benefit for eligible individuals 65 years and older and certain individuals with disabilities, is at risk for fraud, waste, and abuse. Part D is administered by the Centers for Medicare & Medicaid Services (CMS). All Part D sponsors--private companies that operate Part D benefit plans--are required to have programs to safeguard the Part D program from fraud, waste, and abuse. GAO refers to these programs as fraud and abuse programs. This statement discusses CMS's oversight of Part D sponsors' fraud and abuse programs, including its past efforts and planned oversight activities. It is primarily based on the GAO report, Medicare Part D: Some Plan Sponsors Have Not Completely Implemented Fraud and Abuse Programs, and CMS Oversight Has Been Limited (GAO-08-760). The five Part D sponsors GAO reviewed for that report had not completely implemented all of CMS's elements for Part D fraud and abuse programs at that time. CMS agreed with GAO's recommendation in the report that it conduct timely audits of Part D sponsors' fraud and abuse programs. For the 2008 report, GAO reviewed laws, regulation, and CMS documents, including fraud and abuse program guidance. GAO also interviewed CMS officials. For this statement, GAO updated selected information on CMS's oversight by interviewing CMS officials and reviewing agency documents.