Others titles

  • Prescription Drug Event reconciliation
  • PDE
  • Medicare Audit
  • Reconciliation by Parent Organization
  • Prescription Drug Event Reconciliation
  • PDE Reconciliation Data
  • Medicare Audit Paymants


  • Medicare Part D
  • Medicare Part D Plans
  • Medicaid Plan D
  • Account Reconciliation
  • Agreement Template
  • Medicare Reconciliation Data

Medicare Part D Plan Reconciliation Parent Organization

This dataset contains the results by parent organization of the audit of the Centers for Medicare & Medicaid Services’ Medicare Part D Prescription Drug Event (PDE) reconciliation process performed by an independent certified public accounting firm.

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On November 15, 2005, Medicare Part D, the prescription drug coverage program for senior and other eligible citizens, went into effect. Under this program, private health insurance companies and organizations (Plan sponsors) offer insurance coverage for prescription drugs in which Medicare and eligible Medicaid recipients can enroll. CMS contracted with Plan sponsors nationwide to offer the Part D benefits for qualified beneficiaries on January 1, 2006.

The audit contained in this data set, by the accounting firm KPMG, was performed “in accordance with auditing standards generally accepted in the United States of America.”

The objectives were to determine whether CMS controls over payments to Plan sponsors, PDE records, and year-end reconciliation provided reasonable assurance that:

– the inputs that drive the calculation of monthly payments are accurate and complete
– the Risk Adjustment Factor calculations by the Risk Adjustment Processing System are accurate
– monthly payments are accurately calculated and are tracked
– submitted PDE records are valid, accurate, and complete
– PDE data are complete before year-end reconciliation, and
– Direct or Indirect Remuneration (DIR) reporting is accurate and complete.

CMS has designed a layered compliance framework that uses as inputs beneficiary reported complaints, internal data analysis results, audits, and other continuous oversight activities to take compliance action against Plan sponsors when needed. In addition, monthly payments are accurately being calculated and tracked. However, (1) the bid review and audit process needs improvement to ensure that inputs to monthly payments are accurate and complete; (2) controls need to be improved to ensure that submitted PDE records are accurate and complete and PDE data are complete before year-end reconciliation; and (3) improved benchmarks and metrics are needed to ensure the completeness and accuracy of DIR before reconciliation.

About this Dataset

Data Info

Date Created


Last Modified




Update Frequency


Temporal Coverage


Spatial Coverage

United States


John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements


Source Citation



Medicare Part D, Medicare Part D Plans, Medicaid Plan D, Account Reconciliation, Agreement Template, Medicare Reconciliation Data

Other Titles

Prescription Drug Event reconciliation, PDE, Medicare Audit, Reconciliation by Parent Organization, Prescription Drug Event Reconciliation, PDE Reconciliation Data, Medicare Audit Paymants

Data Fields

Name Description Type Constraints
Parent_OrganizationParent organizationstring-
Number_Of_PlansNumber of plansintegerlevel : Ratio
Reconciliation_AmountTotal net reconciliation amount of all plans in the contract in a coverage yearnumber-
LICSNet reconciliation amount of the Low Income Cost Sharing Subsidy, which is calculated by subtracting the Prospective Low-income Cost-sharing Subsidy Amount for the Actual Low-income Subsidy Amountnumber-
ReinsuranceNet reinsurance reconciliation amount, which is calculated by subtracting the Prospective Reinsurance Subsidy Amount from the Actual Reinsurance Subsidy Amountnumber-
Risk_SharingNet risk-sharing reconciliation amountnumber-

Data Preview

Parent OrganizationNumber Of PlansReconciliation AmountLICSReinsuranceRisk Sharing
A&D Charitable Foundation, Inc.235852.8515697.6823561.31-3406.14
AHMC Central Health LLC6-11484890.08-1686006.87-2919691.85-6879191.36
AIDS Healthcare Foundation2-29854092.13-1822237.09-26289151.33-1742703.71
AMHP Holdings Corp.1-1084058.12-2077729.69416193.7577477.87
ATRIO Health Plans12978392.71-37873.0196976.68919289.04
Acute Care Health System, LLC2-67852.41-9130.3-63695.814973.7
Aegon N.V.229429661.325917023.3623512637.960.0
Aetna Inc.360856091180.8128763850.3569700454.9157626875.7
Affinity Health Services Holdings, Inc.5-271651.9560498.67-9598.48-322552.14
Albright Care Services2-52164.1-13406.7125350.01-64107.4