CMS-10191 CPE Compliance Officer Questionnaire

ATTACHMENT I-B
MEDICARE ADVANTAGE AND PRESCRIPTION DRUG COMPLIANCE PROGRAM
EFFECTIVENESS (CPE)
COMPLIANCE OFFICER QUESTIONNAIRE (CO-Q)
(Rev. 2. 10-2016)
Name of Sponsoring Organization:
MA-PD/PDP Contract Numbers:
Name and Title of Person Completing Questionnaire:
Date of Completion:
Directions for Completing the Compliance Officer Questionnaire:
This questionnaire will assist CMS with understanding the sponsoring organization’s mechanisms for
overseeing the performance and effectiveness of the compliance program from the compliance officer’s
perspective.
The responses to these questions may be discussed during the onsite portion of the CPE audit.
We recognize that your time is valuable and appreciate your availability to provide responses to our
questions regarding the compliance program.
If multiple individuals are responsible for the operations and oversight of the compliance
program (e.g. Corporate Compliance Officer, Medicare Compliance Officer, SVP of Audit and
Compliance) and have different responses to the questions, please consolidate responses and
incorporate into one document.
Please specifically note the following when completing the questionnaire:
•

“You” refers to your organization, not necessarily a specific person.

•

“Employees” refer to employees, including senior management, who support your Medicare
business.

•

“Compliance Officer” refers to the compliance officer who oversees the Medicare business.

•

“CEO” refers to the Chief Executive Officer of the organization or the most senior officer,
usually the President or Senior Vice President of the Medicare line of business.

•

“Compliance Program” refers to your Medicare compliance program.

•

If the Medicare contract holder is a wholly owned subsidiary of a parent company, references
to the governing body, CEO and highest level of the organization’s management are to the
board, CEO and management of the company (parent or subsidiary/contract holder) that the
organization has chosen to oversee its Medicare compliance program.

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MEDICARE ADVANTAGE AND PRESCRIPTION DRUG COMPLIANCE PROGRAM
EFFECTIVENESS (CPE)
COMPLIANCE OFFICER QUESTIONNAIRE (CO-Q)
•

“FDRs” refer to the organization’s first-tier, downstream and related entities contracted to
perform an administrative or healthcare service to enrollees on behalf of the Sponsor.

Unless specific reference is made in the question to the term “governing body”, it means either the full
board or a committee of the board of directors delegated to conduct oversight of the day-to-day operation
of the Medicare compliance program on behalf of the full governing body.
1. How long have you been employed with the sponsor and served as the Compliance Officer of the
Medicare line of business?

2. Briefly describe your background and how it relates to your role as an effective Compliance
Officer for the sponsor.

3. Provide a general view of your responsibilities as the Compliance Officer.

4. Do you have any other responsibilities in addition to being the Compliance Officer for this
organization? If yes, please describe those positions and responsibilities.

5. What are some of the tools used to keep the compliance department up-to-date on tasks and
assignments that have been delegated to both operational and FDRs?

6. What resources do you use on a regular basis to keep the organization current on CMS
compliance, audit, and enforcement information and activities?

7. Provide an example of a compliance issue you had to deal with during the audit review period
that involved a Medicare operational area and/or a first-tier, downstream or related entity (FDR)
and impacted a significant number of your enrollees from receiving their health or drug benefits
time in accordance with CMS requirements. Describe what happened and how you handled it.

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MEDICARE ADVANTAGE AND PRESCRIPTION DRUG COMPLIANCE PROGRAM
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COMPLIANCE OFFICER QUESTIONNAIRE (CO-Q)
8. Provide an example of a time when communicating compliance issues to the compliance
committee, senior management or governing body regarding was challenging. Briefly discuss
how you handled it.

9. Describe a recent experience you had with a miscommunication with an employee(s) when
dealing with suspected, detected or reported incidents of noncompliance or fraud, waste and
abuse (FWA)? How did you or the compliance department solve the problem?

10. During the audit review period, have you ever had to make a decision when no or limited
internal or CMS policy was available to provide guidance on how to handle the issue?
Describe what happened and how you handled it.

11. What has been your experience in dealing with poor compliance performance of Medicare
operations within your organization? Provide an example.

12. In your position as Compliance Officer, what types of decisions do you make at your level
without consulting with senior management ultimately responsible for the Medicare
Advantage and/or Part D contract with CMS? What are some of indicators that tell you to
escalate the decision or issue to senior management?

13. CMS understands that every compliance issue is not presented to senior management or the
governing body. Explain the criteria used by the compliance department for escalating
issues to the CEO and senior management that present high-impact risks to the organization.
Include how/when the parties are advised of operational and regulatory compliance
activities (e.g. critical discussions with the CMS Account Manager, Notices of NonCompliance, Civil Money Penalties, Marketing/Enrollment Sanctions, etc.).

14. How do you keep your organization current on CMS regulations, policy requirements and
expectations for various operational areas?

15. How do you measure employee, FDRs and governing body member awareness and understanding
of the compliance program?

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COMPLIANCE OFFICER QUESTIONNAIRE (CO-Q)
16. What mechanisms are in place to communicate operational area concerns/issues to the
compliance department?

17. What have been major obstacles with executing an effective compliance program which you
have had to overcome in your role as the Compliance Officer? How did you deal with them?

18. What indicators tell you, as the compliance officer, that the Medicare compliance
function/system is working well with finding and fixing compliance issues and fraud, waste
and abuse incidents? Are they effective for your organization?

19. What suggestions or changes would you make to encourage transparency and strengthen the
communication between your organization and CMS (e.g. Central Office, Regional Office,
and Account Manager) as it relates to compliance issues?

20. Are there any recent initiatives or upcoming initiatives to improve the current state of your
organization’s compliance culture?

21. Would you like to share any best practices that may assist others with succeeding in this
complex area of implementing and overseeing an effective compliance program?

22. Do you have any questions or comments for CMS?

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