Audit To Determine Whether CMS Oversight of Its Preclusion List Ensured That Certain Revoked Providers Did Not Receive Payment for Medicare Part C and Part D Services

CMS contracts with Medicare Advantage plans and private prescription drug plans (collectively known as sponsors) to offer Part C and Part D managed care benefits to eligible enrollees. CMS maintains a list known as the Preclusion List that includes excluded providers and other providers who have been or could have been revoked from the Medicare program for conduct that CMS determines is detrimental to the best interest of the Medicare program. Federal regulations prohibit sponsors from making payments for services provided or prescriptions written by providers on the Preclusion List. We will analyze CMS data to identify any revoked providers not included on the Preclusion List; report on why they were not included, as determined by CMS; and point out potential vulnerabilities in not including revoked providers on the Preclusion List.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
June 2024	Centers for Medicare and Medicaid Services	Audit To Determine Whether CMS Oversight of Its Preclusion List Ensured That Certain Revoked Providers Did Not Receive Payment for Medicare Part C and Part D Services	Office of Audit Services	WA-24-0051 (W-00-24-35916)	2025