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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 part_c_part_d_audit@cms.hhs.gov.

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Sponsor Name Overall Audit Score Number of CARs Number of ICARs Number of Audit Elements Tested Audit Year Enforcement Action Issued? Audit Status
Advantage Health Solutions 1.00 27 1 29 2012 No Closed
Alameda Alliance for Health 1.69 44 0 26 2012 No Audit Closed and Corrected
American Health (Triple S Management Corp.) 1.00 30 0 30 2012 No Audit Closed and Corrected
AMERIGROUP Corporation 1.13 35 0 31 2012 No Audit Closed and Corrected
ATRIO Health Plans 1.81 52 3 32 2012 No Closed
Aveta, Inc. 1.23 22 8 31 2012 Yes Closed
BCBS of AL & BCBS of TN 0.79 19 0 24 2012 No Audit Closed and Corrected
Blue Cross & Blue Shield of Rhode Island 1.03 29 1 30 2012 No Audit Closed and Corrected
Blue Cross Blue Shield of Alabama 1.06 33 0 31 2012 No Closed
Blue Cross Blue Shield of Tennessee 0.88 28 0 32 2012 No Audit Closed and Corrected
Care 1st Health Plan 1.77 47 4 31 2012 Yes Audit Closed and Corrected
CareOregon, Inc. 1.64 46 0 28 2012 No Closed
Centene Corporation 2.17 45 10 30 2012 Yes Audit Closed and Corrected
Central Health Plan of California 0.93 20 4 30 2012 No Audit Closed
Community Health Plan of Washington 1.77 53 1 31 2012 No Closed
Easy Choice Health Plan, Inc. 1.53 40 3 30 2012 No Audit Closed and Corrected
Health Alliance Plan 1.52 39 4 31 2012 Yes Closed
HealthSun Health Plans, Inc. 1.72 44 3 29 2012 Yes Audit Closed and Corrected
HF Managment Services, LLC 0.94 29 0 31 2012 No Audit Closed and Corrected
Horizon Blue Cross & Blue Shield of New Jersey 1.75 56 0 32 2012 No Audit Closed and Corrected
IASIS Healthcare 1.96 47 0 24 2012 No Audit Closed and Corrected
IDJB Investments, LLC 1.22 25 7 32 2012 Yes Contract Non-renewed/Closed
Independence Blue Cross 1.19 37 0 31 2012 No Audit Closed and Corrected
Indiana University Health 1.14 33 0 29 2012 No Audit Closed and Corrected
Liberty Health Advantage, Inc. 1.17 26 4 29 2012 No Audit Closed and Corrected
MAPFRE PRAICO CORPORATION 2.77 41 21 30 2012 Yes No Longer In Medicare Program
Munich American Holding Corporation, Inc. 1.91 25 19 33 2012 Yes Audit Closed and Corrected
New York Health and Hospitals Corporation 0.84 26 0 31 2012 No Closed
Public Health Trust of Miami-Dade County 1.79 26 13 29 2012 Yes No Longer in Medicare Program
The New York State Catholic Health Plan, Inc. 2.03 47 8 31 2012 Yes Audit Closed and Corrected
Torchmark Corporation 2.52 43 5 21 2012 Yes Validation in 2015
Triple S Salud (Triple S Management Corp.) 2.00 40 11 31 2012 Yes Audit Closed and Corrected
Universal American Corporation 2.16 27 21 32 2012 Yes Audit Closed and Corrected
Visiting Nurse Service of New York 1.22 37 1 32 2012 No Audit Closed and Corrected
Aetna, Inc. 1.62 30 2 21 2013 Yes Audit Closed and Corrected
Blue Cross and Blue Shield of North Carolina 2.57 38 8 21 2013 Yes Audit Closed and Corrected
Anthem Insurance Company & BCBSMA & BCBSRI & BCBSVT 1.29 18 2 17 2013 Yes Audit Closed and Corrected
Blue Cross and Blue Shield of Arizona, Inc. 1.53 18 4 17 2013 Yes Audit Closed and Corrected
Blue Cross and Blue Shield of Florida 1.52 30 1 21 2013 Yes Audit Closed and Corrected
California Physicians’ Service 1.05 22 0 21 2013 No Audit Closed and Corrected
Cambia Health Solutions, Inc. 1.38 21 4 21 2013 Yes Audit Closed and Corrected
CareSource Management Group Co. 1.05 21 0 20 2013 No Audit Closed
Coventry Health Care, Inc. 1.48 25 3 21 2013 Yes Audit Closed and Corrected
Cuatro LLC 2.52 37 8 21 2013 Yes Audit Closed and Corrected
Express Scripts Holding Company 2.47 28 7 17 2013 Yes Validation Pending
Florida Healthcare Plus 1.71 32 2 21 2013 Yes Audit Closed and Corrected
Geisinger Health System 2.30 36 5 20 2013 Yes Audit Closed and Corrected
Health Alliance Plan 2.10 21 0 10 2013 No Audit Closed and Corrected
Health Services Group 2.60 42 5 20 2013 Yes Audit Closed and Corrected
HealthPartners, Inc. 1.00 14 3 20 2013 Yes Audit Closed and Corrected
Independent Health Association, Inc. 3.95 57 11 20 2013 Yes Audit Closed and Corrected
Lifetime Healthcare, Inc. 2.35 35 6 20 2013 Yes Audit Closed and Corrected
Medica Holding Company 1.20 24 0 20 2013 No Audit Closed and Corrected
Ministry Health Care, Inc. 1.90 32 4 21 2013 Yes Audit Closed and Corrected
Orange County Health Authority 2.95 43 14 21 2013 Yes 2015 Reaudit
RCGM, LLC 4.06 41 12 16 2013 No Validation Pending
Simply Healthcare Holdings, Inc. 3.43 38 17 21 2013 Yes Audit Closed and Corrected
TUFTS Associated HMO, Inc. 2.52 39 7 21 2013 Yes Audit Closed and Corrected
UCare Minnesota 1.67 31 2 21 2013 Yes Audit Closed and Corrected
Universal Healthcare 4.00 20 6 8 2013 No Audit Closed
USAble Mutual Insurance Company 1.90 34 2 20 2013 Yes Audit Closed and Corrected
Vanguard Health System 4.14 59 14 21 2013 Yes 2015 Reaudit
WellCare Health Plans, Inc. 1.52 28 2 21 2013 Yes Audit Closed and Corrected
Aegon N.V. 1.06 13 2 16 2014 No Audit Closed and Corrected
AlohaCare 1.86 31 5 22 2014 Yes Audit Closed and Corrected
Aultman Health Foundation 1.35 17 5 20 2014 Yes Audit Closed and Corrected
Blue Cross Blue Shield of Massachusetts, Inc. 0.40 8 0 20 2014 No Audit Closed and Corrected
California Physicians' Service 1.42 25 1 19 2014 No Audit Closed and Corrected
Capital Blue Cross 3.00 26 17 20 2014 Yes Audit Closed and Corrected
Capital District Physicians' Health Plan, Inc. 0.80 10 3 20 2014 No Audit Closed and Corrected
CareFirst, Inc. 1.44 15 4 16 2014 No Audit Closed and Corrected
Catamaran Corporation 0.40 6 0 15 2014 No Audit Closed and Corrected
Catholic Health Initiatives 2.35 25 11 20 2014 No Audit Closed and Corrected
Chinese Hospital Association 2014 3.09 44 12 22 2014 Yes Validation Pending
Elderplan 0.61 14 0 23 2014 No Audit Closed and Corrected
Health First, Inc. 1.85 13 12 20 2014 Yes Validation Pending
Health Plan of the Upper Ohio Valley 2.37 25 10 19 2014 Yes Audit Closed and Corrected
Heartland Fidelity Insurance Company 0.31 3 1 16 2014 No Audit Closed and Corrected
Honored Citizens Choice Health Plan 2.10 30 6 20 2014 No Validation in Progress
Inland Empire Health Plan 2.36 20 16 22 2014 Yes Audit Closed and Corrected
Kelsey-Seybold Medical Group, PLLC 0.55 11 0 20 2014 No Audit Closed and Corrected
Local Initiative Health Authority for LA County 2.39 37 9 23 2014 Yes Audit Closed and Corrected
New West Health Services 1.90 22 8 20 2014 Yes Audit Closed and Corrected
PacificSource Health Plans 1.15 17 3 20 2014 Yes Audit Closed and Corrected
Providence Health & Services 1.90 22 8 20 2014 Yes Audit Closed and Corrected
Southwest Catholic Health Network 1.61 31 3 23 2014 Yes Validation Pending
Summa Health System 3.25 35 15 20 2014 Yes Audit Closed and Corrected
SWH Holdings, Inc. 1.95 35 4 22 2014 Yes Audit Closed and Corrected
UAB Health System 0.48 9 1 23 2014 No Audit Closed and Corrected
Veritage, LLC. 1.55 25 3 20 2014 No Validation in Progress
Humana 3.20 30 17 20 2015 Yes Audit Closed and Corrected
Aetna, Inc. 0.82 8 3 17 2015 No Audit Closed and Corrected
CVS Health Corporation (CVS Caremark) 1.23 4 6 13 2015 Yes Audit Closed and Corrected
Envision Topco Holdings, LLC 2.23 17 6 13 2015 Yes Audit Closed and Corrected
Torchmark 2.00 16 5 13 2015 Yes Audit Closed and Corrected
Medical Card System (MCS) 2.60 28 12 20 2015 Yes Audit Closed and Corrected
N. Texas 3.35 31 13 17 2015 Yes Audit Closed and Corrected
Intermountain Health Care 1.82 17 7 17 2015 Yes Audit Closed and Corrected
Highmark 1.41 18 3 17 2015 No Audit Closed and Corrected
Touchstone 1.30 18 4 20 2015 No No longer in Medicare program
IJKG 1.44 13 5 16 2015 No Validation in Progress
BCBS of Michigan 0.47 6 1 17 2015 No Audit Closed and Corrected
Independence Health Group 1.90 18 10 20 2015 Yes Audit Closed and Corrected
Emblem Health 1.15 19 2 20 2015 No Validation in Progress
AHMC 1.70 24 5 20 2015 Yes Validation in Progress
CHE Trinity 1.47 19 3 17 2015 Yes Audit Closed and Corrected
Universal Care 1.45 21 4 20 2015 Yes Audit Closed and Corrected
Cigna 1.90 16 11 20 2015 Yes Validation in Progress
Health Net 2.20 22 11 20 2015 Yes Validation in Progress
Tenet 2.15 19 12 20 2015 Yes Validation in Progress
Ultimate Health Plan 2.47 26 8 17 2015 Yes Audit Closed and Corrected
Orange County Health Authority 0.53 4 2 15 2015 No Audit Closed and corrected
AvMed, Inc. 1.59 21 3 17 2016 Yes Validation in Progress
Banner Health 1.35 24 1 20 2016 No Validation in Progress
BCBS MN, MT, NE, WY, Wellmark IA and SD 0.31 4 0 13 2016 No Validation in Progress
Blue Cross & Blue Shield of Rhode Island 0.65 11 0 17 2016 No Validation in Progress
Caidan Enterprises, Inc. 0.90 14 2 20 2016 Yes Validation in Progress
Centene Corporation 1.60 26 3 20 2016 Yes Validation in Progress
CommunityCare Managed Healthcare Plans of OK, Inc. 1.06 8 5 17 2016 Yes Validation in Progress
Essence Group Holdings Corporation 0.76 11 1 17 2016 No Audit Closed
Fallon Community Health Plan 1.35 21 3 20 2016 Yes Audit Closed
First Health of the Carolinas, Inc. 1.11 10 0 9 2016 Yes Validation in Progress
Gateway Health Plan, LP 0.65 8 2 20 2016 No Validation in Progress
Golden State Medicare Health Plan 1.20 7 2 10 2016 No Validation in Progress
Hawaii Medical Service Association 1.35 18 2 17 2016 No Validation in Progress
Health Care Service Corporation 1.15 21 1 20 2016 Yes Validation in Progress
Health Partners Plans, Inc. 1.55 25 3 20 2016 Yes Validation in Progress
Health Plan of San Mateo 1.80 20 8 20 2016 Yes Validation in Progress
Healthfirst, Inc. 1.50 19 5 20 2016 Yes Validation in Progress
HealthNow New York, Inc. 1.24 17 2 17 2016 No Validation in Progress
Independent Care Health Plan, Inc. 2.10 13 4 10 2016 Yes Validation in Progress
InterValley Health Plan 0.71 9 1 17 2016 No Validation in Progress
Kinderhook Capital Fund III, L.P. 1.70 7 5 10 2016 No Validation in Progress
MedStar Health, Inc. 2.00 16 2 10 2016 No Validation in Progress
Ministry Health Care, Inc. 1.10 20 1 20 2016 No Validation in Progress
Molina Healthcare, Inc. 1.65 23 4 20 2016 No Validation in Progress
MVP Health Care, Inc. 0.88 11 2 17 2016 Yes Validation in Progress
PH Holdings, LLC 0.85 11 3 20 2016 Yes Validation in Progress
Premera 0.76 9 2 17 2016 No Validation in Progress
Premier Health Partners 2.70 17 5 10 2016 No Validation in Progress
Presbyterian Healthcare Services 1.29 12 5 17 2016 Yes Validation in Progress
Samaritan Health Services 1.55 25 3 20 2016 No Validation in Progress
SCAN Health Plan 1.30 20 3 20 2016 Yes Validation in Progress
Spectrum Health System 0.47 8 0 17 2016 No Audit Closed
The New York State Catholic Health Plan, Inc. 1.05 17 2 20 2016 No Validation in Progress
UnitedHealth Group, Inc. 1.20 12 6 20 2016 Yes Validation in Progress
UPMC Health System 1.05 19 1 20 2016 No Validation in Progress
WellCare Health Plans, Inc. 1.45 19 5 20 2016 Yes Validation in Progress
Wisconsin Physicians Services 0.23 3 0 13 2016 No Validation in Progress