ZPICs Seek “Voluntary” Agreements from Physicians for Auto-Denial Edits for Home Health Services
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law According to the Centers for Medicare and Medicaid Services (CMS), the primary purpose of Zone Program Integrity Contractors (ZPICs) is to investigate instances of suspected fraud, waste, and abuse. The specific actions employed by ZPICs to fulfil this mission include: - Investigating potential fraud and abuse for CMS administrative action or referral to [...]
ZPIC or Medicare Audit and Site Visit Checklist
As a physician, medical group or other healthcare provider, if you receive a notice of an audit and site visit from Medicare, the Medicare Administrative Carrier (MAC) or the Zone Program Integrity Contractor (ZPIC), things happen fast with little opportunity to prepare. Hopefully this checklist will help you to prepare for the on-site visit that will shortly follow. Many items on this checklist may seem common sense to the reader; however, they would not be on here if I did not encounter them as problems [...]
Zone 4 Program Integrity Contractor (ZPIC) for Medicare and Medicaid Programs is Health Integrity, LCC
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Health Integrity, LCC, was named the Zone 4 Program Integrity Contractor (ZPIC) for the Medicare and Medicaid programs. As the ZPIC for Zone 4, Health Integrity has been performing benefit integrity activities aimed to reduce fraud, waste and abuse in Medicare and Medicaid data matching programs. A ZPIC is a business entity that contracts with Medicare and Medicaid and works with state Medicaid agencies, the Centers for Medicare [...]
Your Professional Therapist License Is a Valuable Asset; Insure It!
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Time and time again, I am contacted by mental health counselors, social workers, and other therapists who have worked hard for years, have paid tens of thousands of dollars for tuition, fees, books, and board, and made sacrifices in order to obtain a professional degree and a professional license. Yet they have not purchased professional insurance to protect their licenses. Your professional license is arguably your most valuable [...]
Your Professional Nursing License May Be Your Most Valuable Asset; Insure It!
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Suppose you had an item that you really wanted but was very expensive. Suppose this item cost you $80,000. Perhaps you took out a loan in order to pay for the item. Suppose in addition to paying $80,000 you also had to work for four years and contribute four years of your labor to help pay for the item. For this example, let's assume your four years of [...]
You’ve Been Instructed to Report Yourself to an Impaired Practitioners Program, Here’s What You Should Do Next!
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In an industry that revolves around helping others, dentists, physicians, and other health professionals sometimes find that they are the ones being pushed toward a treatment program. Long hours, heavy workloads, and stress among health care professionals can sometimes lead to unsafe, unprofessional behavior and impairment allegations. We routinely work with dentists, and other health professionals who are accused by employers, hospitals, competitors, or terminated employees of impairment [...]
You’ve Been Accused of Impairment or Misconduct, What Happens Now?
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In an industry that revolves around helping others, physicians and other health professionals sometimes find that they are the ones being pushed toward a treatment program. Long hours, heavy workloads, and stress among health care professionals can sometimes lead to unsafe, unprofessional behavior and impairment allegations. We routinely work with nurses, and other health professionals who are accused by employers, hospitals, competitors, or terminated employees of impairment due [...]