Medicare audit attorney | The Health Law Firm Blog

So, the ZPIC Medicare Auditor Wants to Talk to You? What You Should Expect

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

You are a physician, nurse or other health care provider who bills Medicare. You have received that dreaded letter from the Zone Program Integrity Contractor (ZPIC) for Medicare advising you that it is auditing you for the Centers for Medicare and Medicaid Services (CMS). You know that the words “Program Integrity” by themselves mean that possible fraud is being investigated, at least that is the suspicion giving rise to this particular audit.

To read an earlier blog which I wrote […]

By The Health Law Firm|2024-03-14T10:00:15-04:00May 10, 2019|The Health Law Firm Blog|

Cardiologists Face Higher Scrutiny by CMS

By Lance O. Leider, J.D., The Health Law Firm

As the U.S. population ages and heart disease continues to be a leading cause of health issues, cardiologists and cardiology practices are finding themselves billing Medicare for more and more visits and procedures.

Along with that increase in reimbursement from Medicare comes an increase in scrutiny. According to the Centers for Medicare and Medicaid Services (CMS), more than sixteen percent (16%) of total Medicare spending in 2010, was for cardiovascular care.

Some experts predict that this number will increase as cardiologists continue to adopt state-of-the-art technology and procedural techniques when treating their patients.

All of this means that whistleblowers, Recovery Audit Contractor (RAC) auditors, […]

By The Health Law Firm|2024-03-14T10:00:50-04:00June 1, 2018|Medicaid audit, Medicare Audit, The Health Law Firm Blog|

CMS Woes: Zone Program Integrity Contractors (ZPICs) Criticized for Oversight in Fraud Investigations

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Zone Program Integrity Contractors (ZPIC) are private companies or business entities, that have contracted with the Centers for Medicare and Medicaid Services (CMS). Their purpose is to carry out certain functions related to auditing for possible fraud, that Medicare regional carriers (now called Medicare Administrative Contractors or “MACs”) performed in the past. They are specifically charged by CMS to data mine, identify, and investigate potentially fraudulent behavior in Medicare providers.

Because of this, health care providers that receive a letter from the ZPIC often see […]

By The Health Law Firm|2024-03-14T10:01:30-04:00May 15, 2018|Health Facilities Law Blog|

CMS Woes: Zone Program Integrity Contractors (ZPICs) Criticized for Oversight in Fraud Investigations

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Zone Program Integrity Contractors (ZPIC) are private companies or business entities, that have contracted with the Centers for Medicare and Medicaid Services (CMS). Their purpose is to carry out certain functions related to auditing for possible fraud, that Medicare regional carriers (now called Medicare Administrative Contractors or “MACs”) performed in the past. They are specifically charged by CMS to data mine, identify, and investigate potentially fraudulent behavior in Medicare providers.

Because of this, health care providers that receive a letter from the ZPIC often see it as a potential death sentence, and certainly […]

By The Health Law Firm|2024-03-14T10:01:53-04:00May 15, 2018|Mental Health Law Blog|