The Health Insurance Portability and Accountability Act
(HIPAA) of 1996 established the Medicare Integrity Program (MIP) in order to
strengthen CMS’s ability to detect and deter fraud, waste, and abuse in the
Medicare program. As part of the MIP, CMS created a uniform type of
administrative entity called Medicare Administrative Contractors (MACs). In
accordance with the newly established MAC jurisdictions, seven geographical
entities called Zone Program Integrity Contractors (ZPICs)/Unified Program
Integrity Contractors (UPICs) were created to perform program integrity
functions for Medicare Parts A, B, Durable Medical Equipment (including
prosthetics and orthotics), Home Health and Hospice, and Medicare-Medicaid data
matching.
A typical ZPIC/UPIC audit consists of a thorough evaluation
of all available information to confirm the veracity of the patient and billing
records a healthcare provider or business has on file to substantiate its
Medicare billings. Although ZPIC audits are somewhat comparable to Recovery
Audit Contractor (RAC) audits, ZPIC/UPIC investigations have the added
potential implication of federal Medicare fraud charges, which can result in
severe administrative penalties and even criminal prosecution. This makes it
even more important to consult with an experienced healthcare fraud defense
attorney as soon as possible after being contacted by a ZPIC/UPIC auditor.
For more information visit here #https://federal-lawyer.com/
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