OIG Report on Medicare Part D Prescription Drug Event Reconciliation Process
The OIG released a report entitled "Medicare Part D - Prescription Drug Event Reconciliation Process." The OIG contracted with a certified public accounting firm to audit CMS's Medicare Part D PDE reconciliation process. Under this process, CMS compares estimated subsidy payments made to plan sponsors throughout the year with the cost data submitted by plan sponsors through PDE records and direct or indirect remuneration (DIR) data to determine any residual payments required by CMS to plan sponsors or plan sponsors to CMS. The audit recommended that CMS (1) strengthen controls over the bid review and audit process, (2) improve controls over the accuracy and completeness of PDE and true out-of-pocket accumulation, (3) strengthen controls to ensure completeness and accuracy of DIR data before reconciliation, and (4) conduct more plan sponsor audit procedures throughout the benefit year. CMS generally agreed with the recommendations.
