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Review of Medicare Contractor Information Security Program Evaluations for Fiscal Year 2013

Federal law requires that each Medicare contractor have its information security program evaluated annually by an independent entity, and these evaluations must address the eight major requirements enumerated in the Federal Information Security Management Act of 2002 (FISMA). To comply with this provision, CMS contracted with PricewaterhouseCoopers (PwC) to evaluate information security programs at the Medicare administrative contractors (MACs), fiscal intermediaries, and carriers using a set of agreed-upon procedures. The Act also requires evaluations of the information security controls for a subset of systems but does not specify the criteria for these evaluations. PwC expanded the scope of its evaluations to test segments of the Medicare claims processing systems hosted at the Medicare data centers, which support each of the MACs, fiscal intermediaries, and carriers.

OIG must submit to Congress annual reports on the results of these evaluations, to include assessments of their scope and sufficiency. This report fulfills that responsibility for fiscal year 2013.

The scope of the work and sufficiency of documentation for all reported gaps were sufficient for the nine Medicare contractors reviewed by PwC. The total number of gaps identified at the Medicare contractors decreased from the previous year. Deficiencies remain in the FISMA control areas tested, including findings repeated from the previous year. CMS should ensure that all gaps are remediated by the Medicare contractors in a timely manner. CMS had no comments on the draft report.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201