Sen. Carper Highlights Positive Findings of GAO Report on Medicare Part D Prescription Drug Program Oversight

WASHINGTON – Today, Sen. Tom Carper (D-Del.), Chairman of the Senate Subcommittee on Federal Financial Management, highlighted a report released by the Government Accountability Office (GAO) on Centers for Medicare and Medicaid Services’ (CMS) oversight of the Medicare Part D prescription drug program. The report details GAO’s assessment of CMS’s required reviews of Medicare Part D drug sponsors’ compliance plans, which are designed to safeguard Part D from waste, fraud and abuse. The report concluded that CMS, having conducted on-site audits of 33 sponsors and taken formal enforcement action against several sponsors accordingly, made substantial improvements to its oversight of the sponsors’ compliance plans. These steps taken by CMS helped to bolster the integrity of the Medicare Part D prescription drug program and ensure that taxpayer dollars were being spent appropriately.  

“These drug sponsor compliance plans are critical to protecting the integrity of the Medicare prescription drug program, working to prevent the misuse of medications as well as taxpayer funds,” said Sen. Carper. “The Government Accountability Office found that the Administration has taken deliberate steps to improve its oversight of these compliance plans since concerns about ineffectiveness were first raised during a hearing I held in March 2010 on Medicare prescription drug oversight. I commend the Administration on the progress it has made and look forward to continuing to work with them to protect taxpayer dollars and ensure the integrity of this and other life-saving Medicare programs.”  

Background:  

The Medicare Part D program provides a voluntary, outpatient prescription drug benefit for eligible individuals 65 years and older and eligible individuals with disabilities. CMS contracts with private companies–such as health insurance companies and companies that manage pharmacy benefits–to provide Part D prescription drug plans for Medicare beneficiaries. These companies are referred to as Part D sponsors.  

About 27 million individuals were enrolled in Medicare Part D as of December 2009, and estimated Medicare Part D spending was $51 billion in fiscal year 2009. Because of the size, nature and complexity of the Part D program, GAO and the Department of Health and Human Services’ (HHS) Inspector General have reported that the Part D program is at particularly high risk for waste, fraud and abuse.  

CMS regulations require Part D sponsors to have compliance plans that must include measures that detect, correct, and prevent fraud, waste, and abuse. CMS oversees Part D sponsors’ fraud and abuse programs and may conduct audits to ensure that sponsors are in compliance with program requirements.  

To read the full GAO report, please click HERE.  

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