Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: November 15, 2019

CMS/CPI’s Division of Plan Oversight and Accountability is responsible for safeguarding the integrity of the Medicare Advantage (Part C) and Prescription Drug (Part D) programs. This page provides general updates on the Medicare Part C and Part D Recovery Audit Contractor (RAC) programs. In the coming months CMS will be providing additional information and tools for Medicare Advantage and Part D plan sponsors that include frequently asked questions (FAQs), standardized appeal form(s) and instructions. View our Resources Page.

Part C Updates and New Information

Current Appeals

• Coming soon

Part D Updates and New Information

Current Audits

• Coming soon

Current Appeals: Level I Decisions

• Reconsideration (Level 1): 2012-2013 DEA Schedule Refill Errors

Current Appeals: Level II Decisions

Current Appeals: Level III Decisions

• CMS Administrator Review (Level 3): 2012-2013 Excluded Provider
• CMS Administrator Review (Level 3): 2013 Unauthorized Prescriber
• CMS Administrator Review (Level 3): 2010-2011 DEA Schedule Refill Errors

Completed Audits

The Part D RAC contractor has finished:

• Excluded Provider Audit Review for Calendar Year (CY) 2007-2011
• Unauthorized Prescribers for CY 2009-2012.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.