Medicare Independent Auditor Validation


Attest offers IA Validation services to Medicare Advantage and Prescription Drug Plans to validate that any issues identified during a CMS program audit have been rectified. Attest will validate that all sanction and non-sanction related conditions have been corrected..

On February 12, 2015, CMS issued CMS-4159-F2 (See 80 FR 7912–7966) which finalized changes to 42 CFR §§422.503(d) (2) and 423.504(d) (2). In that final rule, CMS has the authority to require a sponsoring organization (hereinafter referred to as the Sponsor) to hire an IA to validate if the deficiencies that were found during a CMS full or partial program audit have been corrected. For all program audits from 2015 onward, CMS will notify the plan if an IA is required.

Meeting Your IA Validation Needs:

Attest will work with you and with CMS to develop a work plan and timeline that meets plan and CMS expectations. Because each validation will be unique based on your program audit results, we will work together to identify and define all tasks and timeframes.

After CMS work plan approval, Attest will execute the plan through documentation, universe, and sample reviews. We will then provide a validation report based on our review findings.

Descriptions of the process may be found here in the Phase IV: Audit Validation and Close Out section.

Through our diverse audit teams and client base, we have an unmatched level of experience reviewing and understanding Medicare Part C and Part D reporting, compliance reviews, vendors, transaction systems, and source code programming.

Medicare Data Validation Audits performed by Attest do not present a conflict of interest to performing IA work.