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Regulatory Reference
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CMS Part D Compliance — Regulatory Reference

Fraud, waste, and abuse controls for Medicare drug plans — need-to-know, supervisory procedures, and alert rules apply to AI agents.

Key Provisions
  • Medicare Prescription Drug Benefit Manual Chapter 9
  • FWA training and detection requirements
  • Plan sponsor compliance program elements
  • Reporting and corrective action expectations
How AutoPIL Enforces It
  • Alert rules surface AI agent behavior consistent with FWA indicators
  • Audit chain provides FWA investigation evidence
  • Per-role access — only authorized investigation AI agents see member-level claims
Audit LogPolicy EngineSensitivity LabelsAgent RegistryAlert Rules
AutoPIL Policy IDs
PHM-CMS-FWA-001Part D FWA Alert Rules
PHM-CMS-CLM-001Claims Investigation AI Boundary
Official Sources

This page is a working reference and not a substitute for qualified legal review. Verify against official sources before use in compliance artifacts.

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