No Managed Care Organization Should Allow a Gap between Compliance Officers
Medicare Parts C & D programs require managed care organizations (MCOs) to develop and implement effective compliance programs that include having a compliance officer…
New Changes Proposed for the Medicare Advantage and Prescription Drug Benefit Programs (CMS-4159-P)
The Part D Medicare prescription drug benefit was enacted as part of the Medicare Modernization Act of 2003 and provides extensive drug coverage…
The Tides are Shifting Once Again for Managed Care
The renewed focus on managed care underscores the importance for managed care organizations (MCOs) to focus on managing risks. Specifically, given…
CMS Issues a Final Rule Outlining Changes to Medicare Part C and D Programs.
The Centers for Medicare and Medicaid Services (CMS) recently issued a final rule implementing Patient Protection and Affordable Care Act…
Managed Care Executives at Risk under the OIG Responsible Corporate Officer Doctrine
Managed care organization plan executives are facing increased personal exposure to the OIG’s administrative sanctions under the “Responsible Corporate Officer Doctrine.” In light…
Taking Control of the CMS Managed Care Audit Process
The creation of the Medicare Parts C & D programs require managed care organizations to develop and implement effective compliance programs. There are…
Are You Prepared to Pass a CMS Managed Care Audit?
The creation of the Medicare Parts C & D programs carried with it requirements to develop and implement an effective compliance program[1].…
Medicare Part D Compliance: A Day of Reckoning Approaches
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) [1] established the Medicare Part D outpatient prescription drug benefit, which…
A Glimpse of the Future of Compliance Oversight by CMS: Part D Plans Case Study
Hospitals and other providers should take note of what the Centers for Medicare & Medicaid Services (CMS) is learning from…
Reassessing Protected Classes: The Impact on Part D Formularies
This article focuses on an interim rule issued by the Centers for Medicare & Medicaid Services (CMS) on the process…