Medicare-Overpayment

preparing for UPIC-lilesparker

Preparing for a UPIC Audit? Examine These Eight Claim Elements

(Updated January 9, 2021): Each year, our attorneys and paralegals review and assess literally thousands of Medicare claims which have been audited (and denied) by Unified Program Integrity Contractors (UPICs) and other contractors working for the Centers for Medicare and Medicaid Services (CMS).  Are you preparing for a UPIC audit?  If your Medicare or Medicaid […]

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The OIG Identifies Substantial SNF Medicare Overpayments

(November 18, 2012): A recent report issued by the Department of Health and Human Services, Office of Inspector General (OIG), OEI-02-09-00200 (Report), found substantial errors in payments made by Medicare to skilled nursing facilities (SNFs) for FY 2009. The Report also found substantial errors in SNF reporting on the Minimum Data Set (MDS) forms. Specifically,

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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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Region B RAC CGI Announces that it will Begin Review of Eighteen Projects that Involve Medical Necessity

(August 25, 2010): CGI Technologies and Solutions, Inc., (CGI), has announced it will immediately begin reviews on 18 newly approved projects that involve the medical necessity of selected inpatient DRG payments. A complete list of the “issues” currently being examined by CGI can be found on its website. Recovery Audit Contractors (RACs), such as CGI,

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Don’t Take ZPIC Extrapolation Calculations at Face Value

(July 14, 2010): Imagine a Zone Program Integrity Contractor (ZPIC) handing you a claim analysis rife with alleged errors, an indecipherable list of statistical formulae, and an extrapolated recovery demand that will cripple your practice or clinic. What steps should you take to analyze their work? Based on our experience, providers can and should carefully

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Can a ZPIC Extrapolate the Alleged Damages in a Medicare Claims Audit?

(July 12, 2010): Can a ZPIC extrapolate the alleged damages in a case. If the ZPIC’s statistical methodology is properly handled, the extrapolation of alleged damages can be a surefire way of destroying a provider’s practice. We’ve known it for years and yet the government’s passion for statistical sampling only seems to be growing. This

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