Compliance Spotlight to Shine Brightly on FMOs

By Julie Mason, Principal

After years of intense oversight of Medicare Advantage (MA) and Part D plans (plans) by CMS, those same plans have, in turn, intensified their oversight of contracted entities, including FMOs and similar sales organizations.  And while CMS has required contractor oversight for a while, there has been a significant uptick in the depth and breadth this year.

Because the plans’ attention had been directed toward patient care-focused contractors like provider groups and pharmacy benefit managers, FMOs and similar sales organizations had avoided much of the plans’ scrutiny. As compliance by those same PBMs and provider groups has been brought under control, however, the target of intervention by MA plans is shifting downstream. You will be hearing from them…if you haven’t already.

What is your status: have you deployed an effective compliance program that is keeping your clients happy?

CMS’ requirements for compliance programs are detailed and specific, and while those requirements only apply directly to MA and Part D plans, those plans have come to expect the same types of programs from their FMOs. Some FMOs have already taken steps to create or enhance their compliance program, while others have never invested in compliance and don’t know where to begin. What is your status: have you deployed an effective compliance program that is keeping your clients happy?

How can you demonstrate an effective compliance program that will keep your MA and Part D clients happy? Building an effective compliance program without a solid understanding of the CMS requirements leaves you guessing at the best solution and FMO best practices. And why would you guess when you risk impaired relationships—or even contract termination—with your MA and Part D plan clients? Why not get help instead?

Medicare Compliance Solutions (MCS) has decades of experience in the Medicare Just this

year, we have seen a 200% increase in inquiries from FMOs and similar sales organizations about compliance program requirements, and we’re currently based on CMS requirements. Let us help you do the same. Call Julie Mason at 415.596.5277 or Shelley Segal at 562.334.7980, or click below to talk to us.

                                           Julie Mason, Principal

Julie MasonMCS co-founder Julie Mason began her Medicare career more than twenty-five years ago when she joined the Centers for Medicare and Medicaid Services (then HCFA, the Health Care Financing Administration) in the Washington, D.C. office. In 1992, she joined CMS’ San Francisco Regional Office, where she spent the next 16 years as a leader in the Medicare managed care division. Julie has developed extensive knowledge of complex Medicare managed care laws, regulations, and policy guidance, applying it to monitor and audit numerous Medicare health plans. She has conducted dozens of CMS audits and new Medicare Advantage application reviews.

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