CMS Program Audits
Guidance for increasing transparency related to the Medicare Advantage and Prescription Drug Plan program audits and other various types of audits to help drive the industry towards improvements in the delivery of health care services in the Medicare Advantage and Prescription Drug program. Information regarding the Program Audit Process and Protocols, Program Audit and Enforcement Reports, and HPMS Memo’s relating to the Program Audit process are located in the Downloads section below.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 14, 2020
The purpose of this web page is to increase transparency related to the Medicare Advantage and Prescription Drug Plan program audits and other various types of audits to help drive the industry towards improvements in the delivery of health care services in the Medicare Advantage and Prescription Drug program. Information regarding the Program Audit Process and Protocols, Program Audit and Enforcement Reports, and HPMS Memos relating to the Program Audit process are located in the Downloads section below. Please see the Related Links section to view Medicare Advantage and Prescription Drug manual chapters and Program Audit related training.
Please note, these protocols are not a substitute for a review of the applicable statutes or regulations. Rather, the data collection specifications and tools described in the program audit protocols, including the record layout instructions, are used for auditing and monitoring activities and by themselves should not be used to interpret policy.
NOTE: To access Program Audit Results data, please click on Program Audit Results in the left navigation pane.
Specific questions relating to Program Audits may be submitted at the following mailbox: part_c_part_d_audit@cms.hhs.gov
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.