Upon discovering areas of noncompliance in a Final Audit Report from the Centers for Medicare & Medicaid Services (CMS), the Medicare Advantage or Part D Sponsors face immediate pressure to act. The Sponsor may be required to undergo an Independent Audit Validation (IAV) to verify that corrective actions have been effectively implemented. CMS allows just 180 days to complete the process; failure to do so can result in serious sanctions.
Therefore, the most critical decision a Sponsor can make is the first one: choosing a qualified, conflict-free Independent Auditor.
MetaStar fills that role with their newest service line: Medicare Independent Audit Validation (IAV) As a trusted partner in healthcare quality and regulatory auditing for over 50 years, MetaStar brings deep experience, proven processes, and the clinical and technical expertise required to support clients through the IAV process from start to finish.
“This service is a natural extension of our audit and validation capabilities,” said Manny Martin, Vice President of Commercial Services at MetaStar. “We are already deeply engaged in Medicare Data Validation and CMS audit work, so IAV fits right in with our other service lines.”
Sponsors required to complete an IAV have already had a CMS Program Audit and received a Corrective Action Plan (CAP) based on identified deficiencies. The IAV is designed to assess whether those corrective actions have been fully implemented and whether the original issues have been resolved.
“These Corrective Action Plans are tailored specifically to CMS findings, and our audit is then tailored to those CAPs,” explained Matt Walder, Medicare Data and Independent Audit Validation Practice Leader at MetaStar.
MetaStar splits the IAV process into four phases:
The full process typically takes eight to 12 weeks, though timing may vary depending on a variety of circumstances as well as CMS response times and data readiness.
As CMS increases its oversight of Medicare Advantage Organizations (MAOs), the demand for qualified Independent Auditors will also increase. CMS Administrator Dr. Mehmet Oz recently announced that the number of Medicare Advantage audits will expand from approximately 60 per year to over 550 annually, covering nearly all eligible plans.
“The audit could happen at any time,” Walder said. “CMS can give very little notice and will expect systems and documentation to be audit-ready.”
With that in mind, Martin added, “We asked ourselves: ‘Why aren’t we already doing this?’ It just made sense. We’re positioned to help both current and new clients through a high-stakes regulatory process.”
MetaStar stands apart from firms that toggle between consulting and auditing roles. MetaStar is audit-focused and doesn’t just know the CMS requirements—we understand the purpose behind them. This knowledge allows MetaStar auditors the ability to not just do the work but understand how the work impacts your organization today and moving forward.
CMS requires the auditor to be completely independent from the Sponsor’s CAP development or implementation. MetaStar’s goal is to objectively report on how well the implemented CAP measures are working, and to do that, they need to be completely independent from other processes. MetaStar meets that standard without compromise.
“We’ve worked in Medicare compliance auditing since the beginning,” Martin explains. “No other licensed organization has been in this space longer than MetaStar.” That’s only one of the differences MetaStar provides.
MetaStar also offers:
“We don’t just understand the CMS requirements,” Martin says. “We understand the intent behind them. That understanding shapes how we guide, validate, and report.”
Independent Audit Validation is a time-sensitive, high-stakes compliance requirement. MetaStar is the smart solution that helps you meet that obligation confidently and effectively.
To learn more, contact:
Manny Martin
Vice President, Commercial Services
mmartin@metastar.com