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Review of SilverScript Insurance Company’s Internal Controls To Guard Against Fraud, Waste and Abuse for the Medicare Part D Program

Filed under: Center for Medicare and Medicaid Services

Although most of SilverScript Insurance Company’s (SSIC) internal controls were adequate, SSIC had several internal control weaknesses that compromised its ability to detect, correct and prevent fraud, waste, and abuse in the Part D program during the period of January 1, 2007, through December 31, 2008.  As a result of these weaknesses, SSIC paid claims totaling at least $46,000 to physicians or other health care professionals who are excluded from Federal health care programs.  In addition, the internal control weaknesses increased the risk that additional improper payments may have occurred.

Filed under: Center for Medicare and Medicaid Services