WPS Part D achieves best audit score from CMS

MADISON, Wis.—May 25, 2017—The Medicare Part D prescription drug plan at WPS Health Insurance received the best audit score in the nation for 2016, according to a new report from the Centers for Medicare & Medicaid Services (CMS).

CMS conducted 37 program audits covering Medicare Advantage organizations, Medicare Advantage prescription drug plans, and Medicare prescription drug plans. WPS had the best overall audit score.

“The WPS Part D program is a collaborative effort that requires expertise from all aspects of the company, especially Compliance, Medicare Market Solutions, and our Pharmacy departments,” said Mike Chester, Director of Pharmacy and Business Systems in Medical Affairs. “WPS’ investment in the Pharmacy team to provide program oversight was crucial to our success.”

Michelle Littel, Manager of Medicare Product Regulations at WPS, commented on the role of teamwork in operating a successful Part D program. “I think that what makes us successful is the fact we truly act as a team. We all bring our strengths to the table and work together. We could not accomplish what we do without each other.”

Jim Baird, Vice President, Medicare Market Solutions added, “In the end, it’s all about our customers. Our goal is to provide them with the highest-quality plans and the very best customer experience. They rely on us to provide coverage for vital health care needs and we want to always be there for them.”

The WPS achievement was recognized in a May 15 story published by Bloomberg Government, a national news service that covers the government sector.

The Medicare Advantage and prescription drug plans provide health care and prescription drug benefits for eligible individuals aged 65 years and older, and eligible individuals with disabilities. CMS contracts with private companies, referred to as “sponsors,” to provide these benefits to beneficiaries.

The audit evaluated WPS’ compliance in:

  • Compliance program effectiveness
  • Part D formulary and benefit administration
  • Part D coverage determinations, appeals, and grievances