CMS’ enforcement of all Medicare Part D prescription drug benefit plans and the effective compliance programs they are required to have in place is ramping up. During 2010, CMS conducted MEDIC (Medicare Drug Integrity Contractor) audits of 30 Part D plans, focused on Compliance & Enforcement and Benefit Integrity. These audits resulted in sanctions including the suspension of marketing and enrollment of new members for several large health plans.

For 2011 and beyond, CMS has stated that its intent is to audit one-third of Medicare Part D plans each year on a three-year rotation. This increased scrutiny harbors significant risk for Part D programs, especially those that cannot proactively demonstrate the effectiveness of their regulatory compliance programs and controls to thwart fraud, waste and abuse. 

Join us for this webinar focused on preparing for these audits and minimizing the risk of potential sanctions. Our expert presenter, Jim Cottos, a senior vice president with Strategic Management Services, LLC, has unique hands-on experience as a MEDIC Compliance Team Leader for several of the 2010 CMS Plan audits. His presentation will include:

• Overview of the new compliance program regulations and requirements
• Explanation of the initial document request and recommendations for preparing for audits based on short notices – MEDIC audits are conducted on an aggressive timeframe that starts when CMS sends a letter to the managed care plan ten days to one week prior to an on-site visit
• Understanding the key steps and areas of focus in the MEDIC audit process and recommendations for managing the on-site portion of the audit
• Recommendations for updates to policies, procedures, controls, measures and training

To hightlight the recommendations, the presentation will include observed best-practice and worst-practice examples.

Who Should Attend

• Chief Compliance Officer
• Legal/Regulatory Counsel
• Director of Regulatory Affairs
• Director of Internal Audit
• Chief Risk Officer
• CEO/CFO

About the Presenter

Jim Cottos is a recognized expert in corporate compliance, risk management, health care fraud and abuse, and litigation support. Mr. Cottos specializes in providing compliance advisory services to health care organizations in the areas of corporate compliance program development, evaluation of compliance program effectiveness, compliance education and training, as well as conducting compliance investigations and issue resolution. Most recently, he worked as a MEDIC Compliance Team Leader for several of the 2010 CMS Plan audits. He is a former HHS OIG Chief Inspector and Regional Inspector General for Investigations.