Lexology July 22, 2025
WHAT YOU NEED TO KNOW:
- On July 15, 2025, CMS released an Audit and Enforcement Report summarizing its annual Medicare Advantage and Prescription Drug program audits and enforcement actions in 2024.
- The report underscores CMS’s focus on particular federal requirements for the Part C and Part D programs—including utilization management, coverage determinations, and effective compliance programs—and summarizes the agency’s imposition of sanctions for non-compliance.
- Insurers that offer Medicare Advantage, prescription drug, and Medicare Medicaid plans should continue to maintain effective internal auditing, monitoring, and compliance systems.
On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released an Audit and Enforcement Report summarizing its annual Medicare Advantage (Part C) and Prescription Drug (Part D) program audits...
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