How Prepared Is Your
MA Compliance Program?
OIG released its first Medicare Advantage-specific compliance guidance in 26 years. Every law firm says “conduct a gap assessment.” This free tool does it in 10 minutes — 44 questions across 8 domains, scored and weighted for your organization type.
How It Works
Three steps to a comprehensive compliance gap assessment
Select Your Org Type
Choose from 6 organization types — MAO, RA vendor, UM vendor, marketing, provider, or other. This customizes scoring weights to match your risk profile.
Answer 44 Questions
Work through 8 compliance domains, answering Yes, Partial, or No for each question derived directly from the OIG ICPG.
Get Your Scored Report
Receive an overall compliance score, domain-by-domain breakdown, priority gap analysis, red flag alerts, and a downloadable PDF report.
8 ICPG Compliance Domains
Seven risk areas from ICPG Section II plus the Seven Elements compliance framework from Section III — covering every dimension of MA compliance.
Access to Care
Network adequacy, provider directory accuracy, prior authorization safeguards, utilization management oversight, and enrollee grievance trend analysis.
Marketing & Enrollment
Pre-distribution material review, agent/broker oversight, compensation compliance, special enrollment monitoring, and TPMO/lead generation controls.
Risk Adjustment & Data Integrity
Coding accuracy audits, chart review vendor oversight, in-home health assessment safeguards, unsupported diagnosis deletion, 60-day overpayment returns, and RADV readiness.
Quality of Care
Excluded provider screening, Star Ratings data integrity, provider credentialing verification, and quality data accuracy monitoring.
Oversight of Third Parties (FDRs)
FDR inventory and risk tiering, pre-delegation due diligence, contractual compliance provisions, ongoing monitoring and audits, exclusion screening, and downstream delegation oversight.
Vertically Integrated Organizations & Ownership
Subsidiary compliance officer independence, data access firewalls, medical loss ratio safeguards, and investor/PE governance considerations.
Submission of Accurate Data
Encounter data accuracy and completeness, Part D prescription drug event validation, bid and pricing data integrity, and claims payment accuracy monitoring.
Compliance Program Effectiveness
The seven elements of an effective compliance program: written policies, qualified CO, board oversight, specialized training, anonymous reporting, risk assessments, disciplinary framework, and prompt investigation.
Ready to Assess Your Compliance Program?
The OIG expects every MA organization to evaluate its compliance program against the new ICPG. Start your free gap assessment now.
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