By Shelley Segal, CEO


As a Health Plan Executive and compliance team member, you know how critical it is to focus your resources on where you will gain the greatest return on investment (ROI). At Segal Medicare Experts (SME), we have decades of experience preparing organizations like yours for Centers for Medicare and Medicaid Services (CMS) program audits. Our experience shows us that when investments are made in mock audits and reviews, the ROI is significant (including reduced penalties, enforcement actions and reputational harm)! By engaging our team of experts, SME can identify deficiencies and non-compliance prior to a CMS audit, allowing for mitigation and remediation work to begin immediately.

The areas where organizations gain the greatest benefit from our work in a readiness review/mock CMS program audit are as follows:

  1. Universe Testing – Both data integrity and supplemental documentation.
  2. Case Sample Webinars – Understanding the required information to present.
  3. Tracer Development – Documenting the effectiveness of your compliance program.

Additionally, the readiness work we do with your organization ensures your processes, documentation and data are audit ready, before you receive an audit notice (also known as the “Engagement Letter”) from CMS. Prepare for an audit now, versus during critical business deadlines such as application submissions, bid submission (6/5/23) and AEP readiness.

Call SME today and schedule a complete mock CMS Program audit; or, schedule the audit process that best matches your needs. We can just scrub your universes as they are the key to a successful audit.

Segal Medicare Experts (SME) is here to help! We can conduct training on the CMS protocol, and mock webinars so you may be audit ready before the next engagement letters are sent July 1st!


Select the “easy” button!      Call us:

Segal Medicare Experts or 562.498.2218