Case Study: Aspire Health Plan achieves exemplary 0.54 CMS audit score with Optum mock-audit and consulting services

Payer Shines in CMS Program Audit with Help From Government Health Plan Audit Services

Aspire Health Plan, an HMO/HMO‑POS Medicare Advantage sponsor serving about 4,000 members in Monterey County, California, faced an imminent CMS program audit after a recent reorganization that brought several functions in‑house. To identify compliance vulnerabilities and prepare staff, Aspire engaged Optum for a mock audit and CMS audit support.

Optum delivered a tailored mock audit using an automated data‑universe analysis tool, reviewed call‑center logs, assessed compliance policies, and provided hands‑on training and ongoing support during the live CMS audit. With Optum’s assistance Aspire compiled 33 data universes in seven days, remediated identified risks, moved from a mock score of 2.69 to an exemplary .54 on the CMS audit (placing them among the top five of >60 plans), and validated stronger, sustainable compliance processes.

Aspire Health Plan

Melissa Hall

Director of Compliance