Review of Sterling Life Insurance Company's Internal Controls to Guard Against Fraud, Waste and Abuse for the Medicare Part D Program

摘要

Title I of the Medicare Prescription Drug, Improvement, and the Modernization Act of 2003 (MMA) amended Title XVIII of the Social Security Act by establishing the Medicare Part D prescription drug benefit. Under the Part D program, which began January 1, 2006, individuals entitled to benefits under Part A or enrolled in Part B may obtain drug coverage. The Centers for Medicare & Medicaid Services (CMS), which administers Medicare, contracts with private prescription drug plans (Part D sponsors), which must apply to CMS to participate in the Part D program, to offer prescription drug benefits to Centers for Medicare & Medicaid Services Oversight Responsibilities CMS is responsible for safeguarding the Part D program from fraud, waste and abuse (FWA), including ensuring Part D sponsors compliance with applicable requirements. CMS contracts with Medicare Drug Integrity Contractors (MEDIC) to perform many Part D oversight activities. The MEDIC's responsibilities include analyzing claims and other data, investigating complaints, and reviewing the FWA components of Part D sponsors compliance plans.