2019 Part D Misclassifications, Formulary Issues Fueled CMPs
Of the 13 Medicare Advantage and Part D organizations that were subject to 2019 program audits, nearly half received a civil monetary penalty (CMP), with noncompliance in the audit area of Part D formulary and benefit administration (FA) driving fines.
CMS via the Health Plan Management System released the audit scores of the 13 organizations that underwent 2019 Medicare Parts C and D program audits, with scores ranging from 0 to 1.74 (the lower the score, the better the performance). The results included Health Care Service Corp. (HCSC), which was audited in 2018 and 2019 but received a CMP only for 2018.
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