Nationwide UPIC, ZPIC Audit Representation

Texas Health and Medical Law Attorneys: 713-909-7323

The Unified Program Integrity Contractors (UPICs) perform fraud, waste, and abuse detection, deterrence and prevention activities for Medicare and Medicaid claims, a function previously performed by the Zone Program Integrity Contractor (ZPIC) program. Common targets for UPIC audits include Durable Medical Equipment (DME) suppliers, home health and hospice agencies, private practices, and diagnostic testing labs.

UPIC (still commonly referred to as ZPIC) audits can subject providers and medical businesses to considerable expenses, lost productivity, and the potential for recoupment. Auditors can also refer allegations of health care fraud for civil and / or criminal investigation and prosecution. The risks associated with UPIC audits and other matters of health care compliance cannot be understated.

At Hendershot Cowart P.C., our nationally recognized health and medical law attorneys understand the gravity of these audits, as well as the critical need to help clients reduce their risks, prepare for audits, and effectively navigate the process.

We Help Our Clients Through:

  • Proactive audit prevention for new and existing practices
  • Comprehensive compliance and self-auditing plans
  • Communication and negotiation with auditors
  • Executive and employee interview preparation
  • Document preservation and production
  • Guidance through the UPIC / ZPIC appeal process
  • Health care fraud investigations and defense

Hendershot Cowart P.C. leverages decades of experience in medical law and health care compliance to represent physicians, providers, and businesses in all areas of Medicare and Medicaid fraud defense.

Call 713-909-7323 or contact us online to speak with an attorney.

Understanding UPIC Audits

UPICs are private companies contracted by CMS to investigate suspected fraud and abuse. While UPIC or ZPIC audits are similar to those performed by RACs and MACs, they pose the added potential for fraud allegations, as well as administrative penalties such as recoupment, fines, provider exclusion, and criminal prosecution.

UPICs don’t conduct random audits. They initiate focused reviews, medical record requests, and interviews.

A UPIC/ZPIC auditor reviews Medicare billing records on her computer for patterns that may indicate healthcare fraud

Unannounced Visits When Fraud Is Suspected Are Due to Issues Such As:

  • Direct complaints / complaints to the Office of Inspector General (OIG)
  • Referrals from government contractors (RACs or MACs)
  • High frequency of certain services based on local and national patterns
  • Unusual billing trends or lengths of stay
  • Inaccurate or improper billing
  • Mismatched claims with physician records

Preparing Providers and Suppliers for UPIC, ZPIC Audits

UPIC audits can be high stakes and concerning matters for providers, but they can be navigated effectively with proper preparation and the help of proven lawyers. Our goals when representing clients in UPIC matters focused on safeguarding clients from liabilities.

We Achieve This Through:

  • Creation and implementation of sound compliance plans
  • Proactive assessment of billing and coding practices
  • Response, interview, and communication preparation
  • Documentation, billing, and coding record production
  • Minimizing exposure to risks and prosecution
  • Medicare appeals (redetermination, reconsideration, ALJ hearings, etc.)
  • Medical license defense and health care fraud defense
  • Assistance with subpoenas, CIDs, and OIG investigations

Facing an Audit or Investigation? Put Proven Lawyers on Your Side.

When facing any Medicare audit or investigation, providers need to know the stakes are high, and timely action a necessity. In addition to providing a range of proactive health care compliance services, Hendershot Cowart P.C. also delivers the immediate responsive representation clients require when facing any health care audit or fraud investigation. If you face these issues, the time to act is now.

Call 713-909-7323 or complete an online case evaluation form 24/7 to learn how health care lawyers can help you. Our Houston-based law firm serves clients across Texas and beyond.

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