CMS Proposes Major Rule Changes to Increase Payment Accuracy and Improve Program Integrity in Medicare Part C and Part D

On Jan. 10, the Centers for Medicare & Medicaid Services published proposed rules labeled as ‘‘policy and technical’’ changes to the Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) Programs. Comments on the proposed rules are due March 7.

If adopted as drafted, these rules will not only impact how Medicare Advantage Organizations (MAO) and Part D Prescription Drug Plan (PDP) sponsors operate and interact with their contractors, beneficiaries, and the government, but will also impact the operations of all health care entities involved in providing drug products under Part C and Part D, including pharmacy benefit managers (PBMs), pharmacies, physicians, and pharmaceutical manufacturers.

Originally published in BNA’s Health Care Fraud Report on March 5, 2014.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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