Program Audit Results

This website contains information regarding Part C and Part D program audit results.  Program audits evaluate sponsors’ compliance with a number of core program requirements, key among those are the sponsors’ ability to provide beneficiaries with access to medically necessary services and prescription drugs. CMS generates an audit score for every sponsor based on the number and severity of non-compliant conditions detected in a sponsor’s operations. In this scoring system, a lower score represents better performance on the audit. Because the audit score is generated based on the number of non-compliant conditions discovered, the maximum audit score is unlimited. Also, the scoring system is weighted to ensure that conditions that have the potential to impact beneficiary access to care have a greater impact on the overall score. The audit score is calculated by assigning points to identified conditions of non-compliance: 0 points to observations, 1 point to each Corrective Action Required (CAR), 2 points to each Immediate Corrective Action Required (ICAR), and dividing the sum of these points by the number of audit elements tested. The following is the formula for calculating the audit score:

Audit score = (# CARs) + (# of ICARs X 2) / # of audited elements tested

The chart below lists the overall audit score of each sponsor audited and provides additional detail on the number of audit elements tested during each audit, the number of Corrective Actions Required (CARs) and Immediate Corrective Actions Required (ICARs), the audit year, whether an enforcement action was taken as a result of the audit, and a status on the progress of the audit.

In addition to the information provided in the table below, please refer to the Part C and Part D Program Audit and Enforcement Reports for a graphical representation of the overall and individual program area audit scores of more recently audited sponsors.  These reports can be found in the Downloads section of the Program Audits page. 

For questions on any of this information, please send an email to

Showing 1-10 of 226 entries
Sponsor Name Overall Audit Score Number of CARs Number of ICARs Number of Audit Elements Tested Audit Year Enforcement Audit Status
Advantage Health Solutions 1.00 27 1 29 2012 No Closed
Aegon N.V. 1.06 13 2 16 2014 No Closed
Aetna, Inc. 1.62 30 2 21 2013 Yes Closed
Aetna, Inc. 0.82 8 3 17 2015 No Closed
Affinity Health Services Holdings, Inc. 1.44 15 4 16 2017 Yes Closed
AHMC 1.70 24 5 20 2015 Yes Closed
AIDS Healthcare Foundation 1.44 21 1 16 2018 No Validation Pending
Alameda Alliance for Health 1.69 44 0 26 2012 No Closed
Alignment Healthcare USA LLC 0.31 5 0 16 2018 No Closed
AllCare Health, Inc. 1.08 12 1 13 2017 No Closed
Page Last Modified:
12/06/2019 10:51 AM