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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 Closed
American Health (Triple S Management Corp.) 1.00 30 0 30 2012 No Closed
AMERIGROUP Corporation 1.13 35 0 31 2012 No Closed
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 Closed
Blue Cross & Blue Shield of Rhode Island 1.03 29 1 30 2012 No Closed
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 Closed
Care 1st Health Plan 1.77 47 4 31 2012 Yes Closed
CareOregon, Inc. 1.64 46 0 28 2012 No Closed
Centene Corporation 2.17 45 10 30 2012 Yes Closed
Central Health Plan of California 0.93 20 4 30 2012 No 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 Closed
Health Alliance Plan 1.52 39 4 31 2012 Yes Closed
HealthSun Health Plans, Inc. 1.72 44 3 29 2012 Yes Closed
HF Managment Services, LLC 0.94 29 0 31 2012 No Closed
Horizon Blue Cross & Blue Shield of New Jersey 1.75 56 0 32 2012 No Closed
IASIS Healthcare 1.96 47 0 24 2012 No Closed
IDJB Investments, LLC 1.22 25 7 32 2012 Yes Contract Non-renewed/Closed
Independence Blue Cross 1.19 37 0 31 2012 No Closed
Indiana University Health 1.14 33 0 29 2012 No Closed
Liberty Health Advantage, Inc. 1.17 26 4 29 2012 No Closed
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 Closed
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 Closed
Torchmark Corporation 2.52 43 5 21 2012 Yes Closed
Triple S Salud (Triple S Management Corp.) 2.00 40 11 31 2012 Yes Closed
Universal American Corporation 2.16 27 21 32 2012 Yes Closed
Visiting Nurse Service of New York 1.22 37 1 32 2012 No Closed
Aetna, Inc. 1.62 30 2 21 2013 Yes Closed
Blue Cross and Blue Shield of North Carolina 2.57 38 8 21 2013 Yes Closed
Anthem Insurance Company & BCBSMA & BCBSRI & BCBSVT 1.29 18 2 17 2013 Yes Closed
Blue Cross and Blue Shield of Arizona, Inc. 1.53 18 4 17 2013 Yes Closed
Blue Cross and Blue Shield of Florida 1.52 30 1 21 2013 Yes Closed
California Physicians’ Service 1.05 22 0 21 2013 No Closed
Cambia Health Solutions, Inc. 1.38 21 4 21 2013 Yes Closed
CareSource Management Group Co. 1.05 21 0 20 2013 No Closed
Coventry Health Care, Inc. 1.48 25 3 21 2013 Yes Closed
Cuatro LLC 2.52 37 8 21 2013 Yes Closed
Express Scripts Holding Company 2.47 28 7 17 2013 Yes Closed
Florida Healthcare Plus 1.71 32 2 21 2013 Yes Closed
Geisinger Health System 2.30 36 5 20 2013 Yes Closed
Health Alliance Plan 2.10 21 0 10 2013 No Closed
Health Services Group 2.60 42 5 20 2013 Yes Closed
HealthPartners, Inc. 1.00 14 3 20 2013 Yes Closed
Independent Health Association, Inc. 3.95 57 11 20 2013 Yes Closed
Lifetime Healthcare, Inc. 2.35 35 6 20 2013 Yes Closed
Medica Holding Company 1.20 24 0 20 2013 No Closed
Ministry Health Care, Inc. 1.90 32 4 21 2013 Yes Closed
Orange County Health Authority 2.95 43 14 21 2013 Yes Closed
RCGM, LLC 4.06 41 12 16 2013 No Closed
Simply Healthcare Holdings, Inc. 3.43 38 17 21 2013 Yes Closed
TUFTS Associated HMO, Inc. 2.52 39 7 21 2013 Yes Closed
UCare Minnesota 1.67 31 2 21 2013 Yes Closed
Universal Healthcare 4.00 20 6 8 2013 No Closed
USAble Mutual Insurance Company 1.90 34 2 20 2013 Yes Closed
Vanguard Health System 4.14 59 14 21 2013 Yes Closed
WellCare Health Plans, Inc. 1.52 28 2 21 2013 Yes Closed
Aegon N.V. 1.06 13 2 16 2014 No Closed
AlohaCare 1.86 31 5 22 2014 Yes Closed
Aultman Health Foundation 1.35 17 5 20 2014 Yes Closed
Blue Cross Blue Shield of Massachusetts, Inc. 0.40 8 0 20 2014 No Closed
California Physicians' Service 1.42 25 1 19 2014 No Closed
Capital Blue Cross 3.00 26 17 20 2014 Yes Closed
Capital District Physicians' Health Plan, Inc. 0.80 10 3 20 2014 No Closed
CareFirst, Inc. 1.44 15 4 16 2014 No Closed
Catamaran Corporation 0.40 6 0 15 2014 No Closed
Catholic Health Initiatives 2.35 25 11 20 2014 No Closed
Chinese Hospital Association 2014 3.09 44 12 22 2014 Yes Closed
Elderplan 0.61 14 0 23 2014 No Closed
Health First, Inc. 1.85 13 12 20 2014 Yes Closed
Health Plan of the Upper Ohio Valley 2.37 25 10 19 2014 Yes Closed
Heartland Fidelity Insurance Company 0.31 3 1 16 2014 No Closed
Honored Citizens Choice Health Plan 2.10 30 6 20 2014 No Closed
Inland Empire Health Plan 2.36 20 16 22 2014 Yes Closed
Kelsey-Seybold Medical Group, PLLC 0.55 11 0 20 2014 No Closed
Local Initiative Health Authority for LA County 2.39 37 9 23 2014 Yes Closed
New West Health Services 1.90 22 8 20 2014 Yes Closed
PacificSource Health Plans 1.15 17 3 20 2014 Yes Closed
Providence Health & Services 1.90 22 8 20 2014 Yes Closed
Southwest Catholic Health Network 1.61 31 3 23 2014 Yes Closed
Summa Health System 3.25 35 15 20 2014 Yes Closed
SWH Holdings, Inc. 1.95 35 4 22 2014 Yes Closed
UAB Health System 0.48 9 1 23 2014 No Closed
Veritage, LLC. 1.55 25 3 20 2014 No Closed
Humana 3.20 30 17 20 2015 Yes Closed
Aetna, Inc. 0.82 8 3 17 2015 No Closed
CVS Health Corporation (CVS Caremark) 1.23 4 6 13 2015 Yes Closed
Envision Topco Holdings, LLC 2.23 17 6 13 2015 Yes Closed
Torchmark 2.00 16 5 13 2015 Yes Closed
Medical Card System (MCS) 2.60 28 12 20 2015 Yes Closed
N. Texas 3.35 31 13 17 2015 Yes Closed
Intermountain Health Care 1.82 17 7 17 2015 Yes Closed
Highmark 1.41 18 3 17 2015 No Closed
Touchstone 1.30 18 4 20 2015 No No longer in Medicare program
IJKG 1.44 13 5 16 2015 No Closed
BCBS of Michigan 0.47 6 1 17 2015 No Closed
Independence Health Group 1.90 18 10 20 2015 Yes Closed
Emblem Health 1.15 19 2 20 2015 No Closed
AHMC 1.70 24 5 20 2015 Yes Validation in Progress
CHE Trinity 1.47 19 3 17 2015 Yes Closed
Universal Care 1.45 21 4 20 2015 Yes Closed
Cigna 1.90 16 11 20 2015 Yes Closed
Health Net 2.20 22 11 20 2015 Yes Closed
Tenet 2.15 19 12 20 2015 Yes Closed
Ultimate Health Plan 2.47 26 8 17 2015 Yes Closed
Orange County Health Authority 0.53 4 2 15 2015 No Closed
AvMed, Inc. 1.59 21 3 17 2016 Yes Closed
Banner Health 1.35 24 1 20 2016 No Closed
BCBS MN, MT, NE, WY, Wellmark IA and SD 0.31 4 0 13 2016 No Closed
Blue Cross & Blue Shield of Rhode Island 0.65 11 0 17 2016 No Closed
Caidan Enterprises, Inc. 0.90 14 2 20 2016 Yes Closed
Centene Corporation 1.60 26 3 20 2016 Yes Closed
CommunityCare Managed Healthcare Plans of OK, Inc. 1.06 8 5 17 2016 Yes Closed
Essence Group Holdings Corporation 0.76 11 1 17 2016 No Closed
Fallon Community Health Plan 1.35 21 3 20 2016 Yes Closed
First Health of the Carolinas, Inc. 1.11 10 0 9 2016 Yes Closed
Gateway Health Plan, LP 0.65 8 2 20 2016 No Closed
Golden State Medicare Health Plan 1.20 7 2 10 2016 No Closed
Hawaii Medical Service Association 1.35 18 2 17 2016 No Closed
Health Care Service Corporation 1.15 21 1 20 2016 Yes Closed
Health Partners Plans, Inc. 1.55 25 3 20 2016 Yes Closed
Health Plan of San Mateo 1.80 20 8 20 2016 Yes Closed
Healthfirst, Inc. 1.50 19 5 20 2016 Yes Closed
HealthNow New York, Inc. 1.24 17 2 17 2016 No Closed
Independent Care Health Plan, Inc. 2.10 13 4 10 2016 Yes Closed
InterValley Health Plan 0.71 9 1 17 2016 No Closed
Kinderhook Capital Fund III, L.P. 1.70 7 5 10 2016 No Closed
MedStar Health, Inc. 2.00 16 2 10 2016 No Closed
Ministry Health Care, Inc. 1.10 20 1 20 2016 No Closed
Molina Healthcare, Inc. 1.65 23 4 20 2016 No Closed
MVP Health Care, Inc. 0.88 11 2 17 2016 Yes Closed
PH Holdings, LLC 0.85 11 3 20 2016 Yes Closed
Premera 0.76 9 2 17 2016 No Closed
Premier Health Partners 2.70 17 5 10 2016 No Closed
Presbyterian Healthcare Services 1.29 12 5 17 2016 Yes Closed
Samaritan Health Services 1.55 25 3 20 2016 No Closed
SCAN Health Plan 1.30 20 3 20 2016 Yes Closed
Spectrum Health System 0.47 8 0 17 2016 No Closed
The New York State Catholic Health Plan, Inc. 1.05 17 2 20 2016 No Closed
UnitedHealth Group, Inc. 1.20 12 6 20 2016 Yes Closed
UPMC Health System 1.05 19 1 20 2016 No Closed
WellCare Health Plans, Inc. 1.45 19 5 20 2016 Yes Closed
Wisconsin Physicians Services 0.23 3 0 13 2016 No Closed
Affinity Health Services Holdings, Inc. 1.44 15 4 16 2017 Yes Closed
AllCare Health, Inc. 1.08 12 1 13 2017 No Closed
Anthem Insurance Co. & BCBSMA & BCBSRI & BCBSVT 0.00 0 0 9 2017 No Closed
Anthem, Inc. 0.81 8 2 16 2017 No Validation in Progress
Aware Integrated, Inc. 0.75 8 2 16 2017 No Closed
Baylor Scott & White Holdings 2.08 19 4 13 2017 Yes Closed
Blue Cross and Blue Shield of North Carolina 0.77 8 1 13 2017 No Closed
Blue Cross Blue Shield of Alabama 0.69 7 1 13 2017 Yes Closed
Blue Cross Blue Shield of Idaho Health Services, Inc. 1.25 12 4 16 2017 No Closed
Blue Cross Blue Shield of Kansas 0.89 4 2 9 2017 No Closed
Blue Cross of Blue Shield of Tennessee 0.44 5 1 16 2017 Yes Closed
Cambia Health Solutions 1.15 9 3 13 2017 Yes Closed
CareSource Managment Group Co. 1.38 18 0 13 2017 No Validation in Progress
Constellation Health, LLC 1.63 22 2 16 2017 No Validation in Progress
Educators Mutual Insurance Association 1.33 10 1 9 2017 No Closed
Express Scripts Holding Company 1.00 5 2 9 2017 Yes Closed
FamilyCare Incorporated 1.44 16 3 16 2017 No Closed
Guidewell Mutual Holding Corporation 0.81 7 3 16 2017 No Closed
Guidewell Mutual Holding Corporation (H1035) 1.62 9 6 13 2017 Yes Closed
Guidewell Mutual Holding Corporation (H5938) 0.46 6 0 13 2017 No Closed
HealthSun Health Plans, Inc. 0.85 7 2 13 2017 No Closed
Henry Ford Health System 1.38 10 4 13 2017 Yes Closed
Indiana University Health 1.69 19 1 13 2017 Yes Closed
InnovaCare, Inc. 0.13 2 0 16 2017 No Closed
Kaiser Foundation Health Plan, Inc. 0.88 9 2 16 2017 Yes Validation in Progress
Liberty Health Advantage, Inc. 1.63 20 3 16 2017 No Closed
Lifetime Healthcare, Inc. 0.62 6 1 13 2017 Yes Closed
Magellan Health, Inc. 2.44 10 6 9 2017 Yes Closed
Magellan Health, Inc. (Follow-up Audit) 1.00 5 2 9 2017 Yes Closed
Martin's Point Health Care, Inc. 0.63 6 2 16 2017 No Closed
Medical Mutual of Ohio 1.00 7 3 13 2017 Yes Closed
Piedmont Community Health Plan 1.00 11 1 13 2017 No Closed
Promedica Health System 0.62 6 1 13 2017 No Validation in Progress
Renown Health 1.08 8 3 13 2017 No Closed
SSM Healthcare Corporation 1.77 8 7 13 2017 Yes Closed
The Carle Foundation 1.85 12 6 13 2017 No Closed
Ucare Minnesota 1.13 12 3 16 2017 Yes Closed
USAble Mutual Insurance Company 1.08 8 3 13 2017 Yes Closed
Vantage Holdings, Inc. 1.25 14 3 16 2017 Yes Closed