Zone Program Integrity Contractor

ZPIC Audits / UPIC Audits: The Impact of Transmittal 768 on the Medicare Appeals Process Timeline

(April 12, 2018): A big concern with the Medicare appeals process is the ghastly backlog at the Office of Medicare Hearings and Appeals (OMHA) for an Administrative Law Judge (ALJ) hearing coupled with the government’s authority to recoup alleged overpayments after the second level of appeal (reconsideration). There is renewed buzz regarding the backlog and […]

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The Texas Medical Board Remains Busy Due to High Number of Complaints Filed in 2012

(February 7, 2013): The Texas Medical Board (Medical Board) was quite busy in 2012. While the number of disciplinary action taken had dropped in some categories, it rose in others. In fact, the overall number of complaints filed with the Medical Board was the 2nd highest in the last decade. The Medical Board’s workload numbers

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Health Integrity Audits of Texas and Oklahoma Home Health Agencies are on the Rise.

(August 14, 2011): Home health agencies in Texas and Oklahoma remain under considerable scrutiny by Medicare contractors tasked with identifying fraud and abuse perpetrated against the Medicare Trust Fund. As discussed below, these Medicare contractors have a number of tools at their disposal, many of which can effectively place a home health agency in financial

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Lose Your Appeal at Reconsideration? Consider an ALJ Hearing

(June 18, 2011): As a review of the last several quarters of Medicare appeals statistics reflects, an overwhelming percentage of Medicare providers appealing alleged overpayments through the Medicare administrative appeals process have chosen to “throw in the towel,” so to speak, when they have lost at the reconsideration level. As you will recall, at the

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Is a ZPIC Tougher than a RAC or PSC When Conducting Medicare Audits?

(March 25, 2010): The Recovery Audit Contractor (RAC) program is an integral part of the Centers for Medicare & Medicaid Services’ (CMS’) “benefit integrity” efforts which seek to identify and recoup alleged overpayments paid to Medicare providers. Similarly, Program SafeGuard Contractors (PSCs) have been actively auditing Medicare providers and suppliers around the country. While the

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