The Centers for Medicare & Medicaid Services 2021 Part C and Part D Program Audit and Enforcement Report Published!

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By Shelley Segal, CEO


The CMS report provides information on the program audit process, a current snapshot of the program audit landscape, and a summary of the 2021 program audits, as well as CMS’ enforcement actions.

The total number of currently-active sponsors audited between 2019 and 2021 is 42, or approximately 20 percent of the sponsors with currently active Medicare contracts. CMS conducted 27 audits in 2021.

2022 Part C and Part D Program Audits are happening now…. are you audit ready?

CMS imposed 16 Civil Money Penalties (CMPs) for referrals received in 2021 totaling $1,043,953 with an average of $65,247 per CMP. The highest CMP imposed was $146,068, and the lowest CMP imposed was $9,328.

2021 Audit Results – The data analyses resulting from the 2021 program audits yield an average overall audit score of 0.44. Here is a graph of the 2021 Overall Audit Scores



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