UPIC / ZPIC Referrals of MDs and NPs to State Boards!
You aren’t paranoid, your utilization, coding and billing practices are, in fact, being watched. The Centers for Medicare and Medicaid Services (CMS) currently utilizes Zone Program Integrity Contractors (ZPICs) to serve as program integrity contractors. You may have never been audited, been contacted by, or even heard of ZPIC. Nevertheless, that doesn’t mean that they aren’t monitoring your business practices on an ongoing basis.

Medical Director Agreements: Compensation Arrangements are Under the Microscope by HHS-OIG
After a hiatus of almost a year, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) has published a new “Special Fraud Alert” entitled “Fraud Alert: Physician Compensation Arrangements May Result in Significant Liability.” As this alert makes crystal clear, physicians who serve as medical directors for home health agencies, hospices and other organizations must exercise care to ensure that the business relationship does not violate the federal Anti-Kickback Statute. This article briefly discusses the potential criminal, civil and administrative liability you may suffer if your Medical Director arrangement does not fully comply with the law.

New Medicare Penalties with Quality and Safety Incentive Programs
The three Medicare quality and safety incentive programs, established under the Affordable Care Act (ACA) that will take effect this year are the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reductions Program, and the Hospital-Acquired Condition (HAC) Reduction Program.

Understanding Prepayment Review in 2015
One of the most recent trends involves pre-payment review of claims. In this process, government contractors will review a claim for problems before the claim may be paid. Unlike the traditional postpayment review process, if a health care provider is placed under prepayment review, there is very little you can do other try to identify the nature of deficiencies noted so that remedial action can be taken. Moreover, health care providers in prepayment review face expensive complications, including possible exclusion from Federal healthcare programs, if the problems which caused them to be subject to prepayment review go uncorrected.

CMS Guidance on the Role of the Medical Director
Medical directors act as important leaders for long term care facilities and help them provide quality care. CMS requires all long term facilities to designate a physician to serve in this role in order to receive Medicare payments for services provided. That practitioner must be currently licensed in the State(s) in which the facility(ies) s/he serves is (are) located.

ZPIC Audits
UPIC / ZPIC Referrals of MDs and NPs to State Boards!(June 9, 2017): You aren’t paranoid, your utilization, coding and billing practices...
ZPIC Audit: Will Your Case be Referred to DOJ or HHS-OIG for Fraud?(March 10, 2016): Has your practice, home health or hospice received an audit letter...
Providers Have a New Timeframe to Respond to ADRs(4/7/15) On February 4, 2015, the Centers for Medicare and Medicaid Services (CMS)...
ZPIC Prepayment Review(September 15, 2012): Over the last year, Zone Program Integrity Contractors (ZPICs)...
OIG Cautions About ZPIC Conflict of InterestFrom LilesParker.com ZPICs Have Conflict of Interest HHS-OIG recently released a...
Read More Posts From This CategoryMedicare Audits
ZPIC Update: The Impact of Being Placed on Medicare Prepayment Review.(March 9, 2016): Why have the number of prepayment reviews by Medicare contractors...
Medical Director Agreements: Compensation Arrangements are Under the Microscope by HHS-OIG(June 11, 2015): After a hiatus of almost a year, the Department of Health and Human...
New Medicare Penalties with Quality and Safety Incentive Programs(April 30, 2015): Starting this year, the Centers for Medicare and Medicaid Services...
Understanding Prepayment Review in 2015The Centers for Medicare & Medicaid (CMS) has instituted several methods to help...
CMS Guidance on the Role of the Medical DirectorLong term care facilities are required[1] to employ a physician to serve as its medical...
Read More Posts From This CategoryHEAT Enforcement
South Texas Health Care Providers Remain Under Considerable Scrutiny by HEAT Prosecutors and Investigators – Compliance Isn’t Optional – It’s Essential in 2011.(January 6, 2011): Three Houston-area residents, one of whom is a physician, were sentenced to prison on January 4th for their roles in a multi-million dollar durable medical equipment (DME) Medicare fraud scheme. Each of the three defendants were also ordered to pay restitution to the Federal government, in amounts ranging from $29,052 to $1.4... [Read more of this review]
Home Health Agency “Patient Recruiter” Sentenced to 63 Months in Prison for Allegedly Committing Health Care Fraud(October 18, 2010): The U.S. Attorney’s Office for the Eastern District of Michigan, working with the FBI and HHS-OIG has announced the sentencing of yet another defendant convicted of home health fraud. As the Department of Justice’s Press Release reflects, the defendant, a nurse who worked as a “patient recruiter“ and operator... [Read more of this review]
President Obama’s 2011 Funding Request Provides for Expansion of the HEAT Program to Additional Cities(October 4, 2010): As DOJ has recently noted in its own blog, over the last Fiscal Year, DOJ (including its 94 U.S. Attorneys’ Offices), HHS’ Office of Inspector General (HHS-OIG), and the Centers for Medicare and Medicaid Services (CMS), have been extraordinarily active in jointly pursuing health care providers allegedly engaging in fraud... [Read more of this review]
Medicare Fraud Strike Force Operation Leads to Charges against 94 Defendants, including 4 in South Texas(July 17, 2010): Yesterday, the Department of Justice (DOJ) announced charges against 94 physicians, medical assistants, and health care company owners and executives in connection with alleged false Medicare claims amounting to more than $251 million. 24 defendants from Miami account for approximately $103 million of that amount. Four defendants... [Read more of this review]
Texas Psychiatrist Indicted and Arrested(July 9, 2010): On June 14, 2010 the U.S. Attorney’s Office for the Western District of Texas announced that a Federal Grand Jury had returned a 99-count indictment against a pain management physician who operated clinics in San Antonio and El Paso. The physician was charged with 21 counts of health care fraud, 20 counts of false statements relating... [Read more of this review]
Read More Posts From This Category