CMS Issues Final Part D Guidance on Controlling Fraud, Waste, and Abuse

On April 25, 2006, the Centers for Medicare and Medicaid Services (CMS) issued its final guidance (Final Guidance) for sponsors of Medicare Part D prescription drug plans (Sponsors) on detecting, correcting, and preventing fraud, waste, and abuse (FWA). The Final Guidance is available at http://www.cms.hhs.gov. Even though CMS has heralded the Final Guidance as taking a flexible approach, it nevertheless imposes considerable obligations on Sponsors and other parties involved in the delivery and administration of the Part D benefit. Some of the requirements bear striking similarity to the often onerous Corporate Integrity Agreement provisions with which health care entities accused of violating federal fraud and abuse laws must comply. Further, enforcement authorities, including the Office of Inspector General (OIG) for the Department of Health and Human Services, have made clear that Part D enforcement is a top priority, and whistleblowers undoubtedly will assist them in their