CMS Awards Advize Health with a Prime Contract
Orlando, FL, January 2, 2025 – Advize Health, an industry leader in program integrity, has been awarded a prime contract to provide the Centers for Medicare & Medicaid Services’ (CMS) Medicare Parts C and D Oversight and Enforcement Group (MOEG) with technical expertise. This expertise will be applied to performance audits, audit support services, and other oversight and enforcement activities targeting Medicare private plan organizations, including:
- Medicare Advantage Organizations (MAOs)
- Medicare Prescription Drug Plans (PDPs)
- Programs of All-Inclusive Care for the Elderly (PACE)
As part of this contract, Advize Health will conduct audit and oversight activities to evaluate healthcare organizations’ compliance with regulatory requirements and offer technical assistance. Additionally, the team will assess vulnerabilities in the management, administration, and oversight of Medicare and PACE programs to help strengthen program integrity and ensure the delivery of high-quality healthcare.
Medicare Program Background
Medicare Part D: Prescription Drug Benefit
Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established the prescription drug benefit under Part D of Title XVIII of the Social Security Act, implemented in 2006. CMS contracts with Prescription Drug Plans (PDPs), which are licensed, risk-bearing entities administering this benefit. Nearly all Medicare Advantage Organizations (MAOs) also offer Part D benefits as Medicare Advantage Prescription Drug Plans (MA-PDs). All Part D plans must offer the standard benefit but may vary within defined parameters.
For detailed information about the Part D program, refer to SSA Title XVIII and 42 CFR Part 423.
Medicare Part C: Medicare Advantage Program
Title II of the MMA modified Medicare+Choice (M+C) into the Medicare Advantage (MA) program, also implemented in 2006. This program aims to make managed care more accessible and efficient, offering beneficiaries options to meet their needs.
For detailed information about the MA program, refer to SSA Title XVIII and 42 CFR Part 422.
PACE: Programs of All-Inclusive Care for the Elderly
The PACE program began as a demonstration project under the Omnibus Budget Reconciliation Act and became a permanent program in 1999. It is a state option for Medicaid programs, designed to provide health and long-term care services to frail, elderly individuals at risk of institutionalization. The PACE program operates through a three-way agreement among CMS, the state administering agency, and the PACE organization. Most participants are dual-eligible for Medicare and Medicaid.
For more information about the PACE program, refer to 42 USC § 1395eee and 42 CFR Part 460.
About Advize Health
At a time when the cost and quality of healthcare, as well as both technology and services, are at the forefront of conversation in the U.S., Advize Health is working with clients to effectively address the rising costs incurred by fraud, waste, abuse, error and omissions. Through fully integrating technology and services provided by Advize, healthcare organizations from small to large are able to achieve greater program integrity results while improving patient quality of care and supporting better health outcomes for those they serve. Advize Health is headquartered in Orlando, FL, and employs retired HHS-OIG experts, health insurance experts, doctors, nurses, coders and auditors nationally. For more information, visit our LinkedIn page.
Media Contact
Jeanmarie Loria, CEO
📞 407.583.7379
📧 Jloria@advizehealth.com
Business Development Contact
Dan Leslie, Director of Business Development
📧 dleslie@advizehealth.com
📞 503.781.9051