Program Audits
The purpose of this web page is to increase transparency related to the Medicare Advantage and Prescription Drug Plan program audits and other various types of audits to help drive the industry towards improvements in the delivery of health care services in the Medicare Advantage and Prescription Drug program. Information regarding the Program Audit Process and Protocols, Program Audit and Enforcement Reports, and HPMS Memo’s relating to the Program Audit process are located in the Downloads section below. Please see the Related Links section to view Medicare Advantage and Prescription Drug manual chapters and Program Audit related training. NOTE: To access Program Audit Results data, please click on Program Audit Results in the left navigation pane.
Specific questions relating to Program Audits may be submitted at the following mailbox: part_c_part_d_audit@cms.hhs.gov
Downloads
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2023 Program Audit Process Overview (PDF) -
2022 Program Audit Process Overview (PDF) -
Final Protocols for the Medicare Part C and Part D Program Audits and Industry-Wide Part C Timeliness Monitoring Project (CMS-10717) (ZIP) -
User Group Resource Document 2023 (PDF) -
Audit Submission Checklist (XLSX) -
Audit Submission Checklist (PDF) -
2022 MMP Audit Protocols And Data Requests (ZIP) -
2020 MMP Audit Protocols And Data Requests (ZIP) -
2022 Program Audit Enforcement Report (PDF) -
2021 Program Audit Enforcement Report (PDF)