The federal government is currently only able to audit 10 percent (about 30 of 300) of Medicare private health plan sponsors each year. Recent audits uncovered noncompliance among most plan sponsors on multiple measures related to beneficiary grievances and appeals. These audits are critical to judging plan performance, assessing customer service, and ensuring beneficiary access to needed care. Both Congress and the federal government should prioritize avenues to mandate more regular and consistent auditing of MA and Part D plan sponsors.
Enhance audit capacity and increase transparency on Medicare Advantage (MA) and Part D sanctionsMedicare Rights Center