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Life Health > Health Insurance > Life Insurance Strategies

Stark Slams Lack Of Part D Audits

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House Ways and Means Health Subcommittee Chairman Pete Stark has attacked the regulators in charge of overseeing the Medicare Part D drug plan program.

The lawmaker is “extremely disturbed” by reports from the U.S. Department of Heath and Human Services Office of the Inspector General about shortcomings in Part D program oversight by the Centers for Medicare and Medicaid Services, Stark, D-Calif., writes in a letter to Acting CMS Administrator Kerry Weems.

An OIG report released earlier this month describes “rampant abuse by plan sponsors and an inexcusable lack of oversight or accountability” by CMS, Stark writes.

Stark points to an OIG finding that, as of April 2008, only 4% of 2006 audits of Part D plan bids had begun, despite a legal requirement for an audit of one third of plan sponsors.

OIG found that one-fourth of the audits that were completed uncovered a material problem, Stark writes.

“Despite this high rate of noncompliance, CMS takes no action whatsoever to sanction any plans that submit incorrect bids, such as adjusting bid amounts, beneficiary premiums or payments to plan sponsors,” Stark writes.

The new OIG report triggers an “overwhelming sense of d?j? vu,” because the findings are “almost verbatim restatements” of the findings described in a July 2007 U.S. Government Accountability Office report, Stark writes.

“Not only was the language the same, but the excuses offered by CMS were identical to those of over a year ago,” Stark writes.

Stark notes that Weems has agreed that the CMS should consider taking enforcement actions.

“Given the consistency of your agency’s inaction, however, I can only surmise that your actual consideration is to run out the clock on this administration without ever complying with the minimal oversight requirements Congress put in place to check private plans,” Stark writes.

Stark expressed concerns about how the plans handle specialty drugs and penalize beneficiaries who use name brand drugs rather than generic equivalents.

“I remain very concerned about the increase in cost sharing under Part D for drugs and whether plans are truly getting the best deal for taxpayers,” Stark writes.

Jeff Nelligan, a spokesman for CMS, says the agency has just received the letter.

“We are closely reviewing it,” Nelligan says.


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