Corporate Compliance

OIG releases 2006 report on CMS's prevention of fraud and abuse

Compliance Monitor, October 17, 2007

The OIG released CMS's Implementation of Safeguards During Fiscal Year 2006 To Prevent and Detect Fraud And Abuse In Medicare Prescription Drug Plans on October 11, 2007. The report examined CMS' efforts in 2006, and provided recommendations for the coming year.

The OIG found that:

  • CMS implemented safeguard activities throughout 2006, but further development and application of the activities is necessary
  • CMS largely relied on complaints to seek out potential fraud and abuse in the Medicare Part D program, but not all complaints were investigated in a timely manner
  • Limits to jurisdiction, legal authority, and CMS' ability to monitor enrollees switching plans complicated CMS' efforts to safeguard Medicare Part D Prescription Drug Plans

The OIG recommended the following:

  • CMS should develop a comprehensive safeguard strategy for Medicare Part D PDPs with target dates and specific activities.
  • CMS should ensure that all fraud complaints get appropriate attention
  • CMS should address legal concerns that might affect program integrity efforts.

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