Compliance Program Policy and Guidance

Federal regulations at 42 C.F.R. §§422.503 and 423.504 specify the requirements for Medicare Plans to implement an effective Compliance Program.

This section contains information related to the CMS' Compliance Program Policy and Guidance and will assist Medicare Plans and the public in understanding Part C and Part D compliance program requirements.

Compliance Program Guidelines

The Compliance Program Guidelines reflect CMS’ interpretation of the Compliance Program requirements and related provisions.  These guidelines were issued as Chapter 9 of the Medicare Prescription Drug Benefit Manual and Chapter 21 of the Medicare Managed Care Manual. Both Chapters are identical and apply equally to the Medicare Advantage Organizations and Prescription Drug Plan Sponsors.

The final guidelines can be found in the "Related Links" section below.

Compliance Guidelines Focused Trainings

The Program Compliance and Oversight Group, Division of Compliance Enforcement, will be conducting a series of focused trainings for the industry via webinar.  Initially, topics will consist of each of the seven elements of an effective compliance program as well as a session on FDR oversight.  All of the trainings will be publicized on HPMS. Because we have limited audio capacity, the trainings will be offered on a first come, first served basis, measured by the first 600 participants to actually call into the audio line the day of training.  Therefore, we encourage multiple participants from the same organization to share one audio line. 

Each presentation will be posted on this website in PDF format shortly following the actual training day.