June 2018

ZPICs Seek “Voluntary” Agreements from Physicians for Auto-Denial Edits for Home Health Services

By |2024-03-14T10:00:53-04:00June 1, 2018|Medicare, The Health Law Firm Blog, ZPIC|

MLS Blog Label 2By 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 law enforcement;
–  Conducting investigations in accordance with the priorities established by Center for Program Integrity’s (CPI) Fraud Prevention System;
–  Performing medical review, as appropriate;
–  […]

More Medicare Audits Now Than Ever Before

By |2024-03-14T10:00:59-04:00June 1, 2018|CMS, Medicare, Medicare Fraud, Recovery Audit Contractor, The Health Law Firm Blog, ZPIC|

6 Indest-2008-3George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in the Legal Specialty of Health Law

A Medicare audit, whether it is performed by a contractor of the Centers for Medicare & Medicaid Services (CMS), or by another organization, can be a daunting process. It is never “routine” and should never be taken lightly.

Because of the efforts to reduce expenditures on entitlement programs and the success that the government has had in recovering large sums of Medicare overpayments, we are seeing a tremendous increase in Medicare fraud initiatives, including but not limited to audits by Medicare Administrative Contractors (MACs), audits by Zone Program Integrity Contractors (ZPICs), Recovery […]

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