Upic medicare audit. Leave a Comment (August 31, 2010): I.
Upic medicare audit Mailing Address: SGS Suite 201 3450 Lakeside Drive Miramar, FL 33027 (954) 988-2851 SGS Accepts esMD transactions. The main goal of (Updated December 2020): Of the many contractors working for the Centers for Medicare and Medicaid Services (CMS), Unified Program Integrity Contractors (UPICs) are by far the serious As UPIC audits increase during 2021, it is essential that health care providers and suppliers review their processes to better ensure that services Unified Program Integrity Contractors (UPICs) are contracted by CMS to conduct detailed medical review, data analysis, and audits of healthcare providers to investigate possibilities of Medicare or Medicaid fraud, waste, and abuse. įighting UPIC findings is challenging at any stage of the appeals process, and it can be just as overwhelming as the We are builders and inventors who develop our software as a single comprehensive health record. ). Today’s Presenters Provider Outreach and Education Consultants • Laura Brown, CPC • Lori Langevin • Gail Toussaint. While these audits have rooted Created by the Centers for Medicare and Medicaid Services (CMS), UPIC audits are used to identify and remedy fraud in Medicare and Medicaid. 12871; Issued: 10-11-24; Effective: 11-14-24; Implementation: 11-14-24) Know the difference between the Medicare audit contractors Understand the provider’s role in the Medicare audit process. UPICs and other CMS contractors are actively auditing Medicare hospice claims. They also identify any Medicare Audit Types: What Home Health Agencies Need to Know. UPIC audits often begin with a data analysis and involve both medical records and provider claims to identify patterns of fraudulent behavior. In fact, this threat could be the riskiest part – other Unlike their predecessors, [8] UPICs are authorized to audit both Medicare and Medicaid hospice claims. Lori Foley, Office Managing Principal, PYA, and Brenna Jenny, Partner, Sidley Austin LLP, discuss some of the basic responsibilities of UPICs, what differentiates UPIC audits from other CMS audits, how UPIC audits progress from probe to referral, recommendations for Medicare claims audits can be a complex and frustrating experience for healthcare providers who choose to accept Medicare. Medicare Audit Attorney Hotline: 888-680-1745. These do not have the same limitations in the False Claims Act. Each UPIC submits a Basis of Estimate to CMS that reflects how the UPIC anticipates allocating its resources, time, and workload across Medicare, Medicaid, and Medi-Medi activities. Centers for Medicare & Medicaid UPICs such as CoventBridge are private contractors monitoring both Medicare and Medicaid programs from fraud, waste, and abuse. 1 (800) 475-1906 - Liles Parker PLLC . They develop investigations early, and in a timely manner, take immediate action to ensure Medicare Trust Fund monies are not inappropriately paid. ) 100-08: "Once a suppression is lifted or expires, Unified Program Integrity Contractor (UPIC) The goal of the UPIC is to identify cases of suspected fraud, investigate them, and take action to ensure any inappropriate Medicare payments are recouped. (See Medicare Claims Processing Manual Pub UPIC: Unified Program Integrity Contractors (UPICs) About Each MCRP Contractor Medicare Administrative Contractors (MACs) A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare In addition, we sent a survey to each UPIC to ask about the challenges it faced in performing these activities. 1 – Medicare FFS Recovery Audit Program . 3 - Definitions (Rev. Whistleblowers play a key role in these audits by providing crucial When there are more red flags, the UPIC may decide to open an investigation or audit. It's made to work together inside and outside the traditional walls of a health system. com. Therefore, providers should consult an experienced healthcare attorney to ensure that any applied penalties are as limited as possible. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss these trends which include extrapolation, Medicaid nursing home The UPIC’s audit results can lead to broader and deeper audits that add significant administrative work and potential for consequential legal and/or financial actions by CMS against your Home Health Agency. sgsdetect. In the West — which also includes “The stairs are steeper in UPIC audits, which I think are some of the most serious and costly audits for hospices to deal with,” Pekarske told Hospice News. A UPIC (Unified Program Integrity Contractor) is a type of Medicare contractor that combines several program integrity functions that were previously handled by different entities. We went through the 1st appeal level with the MAC and our documentation passed with flying colors. Under this contract, Qlarant supports CMS’ audit, oversight and fraud, waste and abuse detection, deterrence and prevention for Medicare and Medicaid claims in the seven (7 (Updated December 2020): Of the many contractors working for the Centers for Medicare and Medicaid Services (CMS), Unified Program Integrity Contractors (UPICs) are by far the serious financial threat to your practice, home health, hospice or DME company. (800) 516-5234; info@ircm. Learn TMS billing practices, audit risks, compliance requirements, how to reduce regulatory risks and respond Our work continues in the Medicare Part D MEDIC contract that includes investigations of Part C and D under the I-MEDIC contract and audits under the MEDIC audit contract. Medicare Audit Contractors • Supplemental Medical Review Contractor • Unified Program Integrity Contractor Browse > Home / Medicare Audits / Data Mining is Being Used by DOJ to Target Health Care Providers | UPIC Audits | Medicare Audits DOJ/HHS Regional Health Care Fraud Summits are Here — Data Mining is Being Used for Targeting. Centers for Medicare & Medicaid Services (CMS) contracts UPIC entities to conduct investigations and audits related to potential fraud, waste or abuse. The UPIC MW contract performs program integrity functions to detect fraud, waste and abuse in Medicare Parts A, B, Durable Medical Equipment (DME), Home Health, Hospice, and Medicaid in the states of Iowa, Illinois, Indiana, Kansas, Kentucky, Michigan, Minnesota, Missouri, UPIC audits often focus on: (1) kickbacks; (2) routine waiver of co-payments; (3) false certificates of medical necessity, plans of care, or other records; (4) billing for services not rendered; (5) misrepresenting the diagnosis During a podcast, “UPIC Audits: How Providers Should Respond,” Lori Foley, PYA Managing Principal of Revenue & Compliance Advisory and Atlanta Office Managing Principal, along with Brenna Jenny, Partner with Sidley Austin LLP, discuss Medicare Unified Program Integrity Contractors (UPIC) and the UPIC audit process. Handling a TPE Audit Notice In Florida and other designated high-risk fraud areas across the nation, who has not heard of a UPIC or ZPIC? Program Integrity became an integral part of the Centers for Medicare and Medicaid Services (CMS) in 1996 when the Health Insurance, Portability, and Accountability Act (HIPAA) was enacted. UPIC audits often begin with a Oberheiden, P. Our team of former federal healthcare prosecutors, many of which previously held positions involving oversight of Medicare audits and related issues, offer clients a wealth of government and private practice experience when it comes to avoiding The UPIC audit occurred last October. com; 134 N 4th St, Brooklyn, NY 11249; Make A 3. We also sent CMS a questionnaire asking about the effects of the unification of Medicare and Medicaid program While these audits are the most common, Medicare and Medicaid Providers may encounter other audits, including audits conducted directly by CMS’s Center for Program Integrity and quality of care The alphabet soup of Medicare audits has expanded over the years, and the Hospice Audit team has seen them all. OIG’s recommendation to ramp up UPIC Medicaid program integrity activities will in all likelihood be followed by targeted efforts by UPICs to audit Medicaid fee-for-service and managed care claims. They develop investigations early, and in a timely Facing a ZPIC, UPIC, TPE, CERT or other type of Medicare audit? Get informed with this definitive guide to Medicare audits so that you can understand the process. They will ask you a lot of questions about your practice. He had over 20 years of legal experience and had exclusively worked in the area of health care regulatory compliance for more than a decade. Knowing the conditions of the payments from Medicare Part B could be the difference between a burgeoning business and one CMS awarded the UPIC West contract to Qlarant in 2017. ” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. 2 – Communication with Recovery Audit Contractors (RACs) 9. UPIC Dental Audits: A number of dentists and dental practices around the country are currently receiving audit letters from Qlarant [2], the UPIC responsible for conducting both Medicare and Medicaid program integrity audits in the Western Jurisdiction. Providers, therefore, should be prepared to identify and promptly and diligently respond to any audit requests from government contractors. UPICs primary goal is to investigate instances of suspected fraud, waste, and abuse in Medicare or Medicaid claims. 220. The recent pause in audits as a result of Transcranial Magnetic Stimulation TMS providers and claims are Audited by Medicare MACs & UPICs. For Free consultation of civil & criminal attorneys, call Liles Parker : 1 (800) 475-1906. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The Centers for Medicare & Medicaid Services (CMS) awarded a contract to Referral to Law Enforcement Agencies In the most serious cases of fraud, UPIC auditors refer the case to the DOJ or U. 1 – RAC Points of Contact The Medicare fee for service (FFS) Recovery Audit Program identifies and corrects Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future UPIC Audit Lawyers. After 12 months, but within 4 years from the date of the initial/review determination, contractors must establish good cause. SUBJECT: Update to the Medicaid Program Integrity Manual (PIM) I. Medicare penalties may be a real The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that the targeted probe and educate (TPE) program would resume ending the temporary suspension since in place since March 2020 due to the COVID-19 public health emergency (PHE). 33 of Chapter 4 in Publication (Pub. In addition to the guidance listed below, please refer to the Medicare PIM at Section 4. Need help with an SFP or PPEO hospice audit? Call Liles Parker for assistance. The purpose of the audit is to ensure compliance with Medicare reimbursement coverage policies, including but not limited to National and Local Medicare UPIC Audit Defense Lawyers in Houston Qlarant Investigation & Audit Defense. UPIC’s are private sector organizations that review Medicare claims in order to assist the government in recovering So it's the UPIC scenario, which there are now four primary UPIC providers that are regionally set up across the country, it presents a scary atmosphere for providers who are used to routine RAC audits, which are a routine audit by CMS. UPIC’s goal is to detect and prevent fraud waste and abuse in Medicare and Medicaid claims. If a provider fails to repay the overpayment within 30 days, interest will be Medicare Audit Contractors Several initiatives to prevent or identify improper payments before CMS processes a claim, and to identify and recover improper payments after paying a claim The overall goal is to reduce improper payments by identifying and addressing coverage and coding billing errors for all providers types CMS IOM Publication 100-08, Medicare Program Integrity Unified Program Integrity Contractor (UPIC) Coordination with Other Contractors Related to the Recovery Audit Contractor (RAC) Data Warehouse (RACDW) - Exclusion Clarification The purpose of this Change Request (CR) is to revise the following statement in section 4. 2. It must be filed within 90 days of the MAC decision. CoventBridge (USA) Inc. Type Contractor; Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Review Jurisdiction C CGS Administrators, LLC P. S. As a result, more than three dozen hospitals across the U. Skip to UPIC audits can lead to both civil and criminal penalties following further OIG investigation. – Medicare Audit Defense Lawyers Former Medicare Prosecutors & Defense Counsel. The Centers for Medicare and Medicaid Services (CMS) created the UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid. 6289 Learn UPIC audit activities, medical / dental records or documentation requirements & their impact on healthcare providers. The UPIC West is a task order contract under the Unified Program Integrity Contractor (UPIC) IDIQ vehicle. Data Analysis: Discussions should take place between all SE UPIC SafeGuard Services (SGS) https://www. The key to passing these audits is to keep your cool, have your CMS awarded the UPIC Southwest contract to Qlarant in 2017. The U. If claims are denied during the — October 7, 2024 . advises clients from across the country with UPIC / ZPIC audits, OESSA forms, and hospice and home health certifications. UPICs have nearly replaced ZPICs (Zone Program Integrity Contractors) as the primary mechanism for CMS to pursue fraud and abuse audits. Therefore, from the moment your agency receives the UPIC’s audit request through the Office of Medicare Hearings and Appeals process, it is vital to dedicate Learn about hospice audits, Medicare compliance, SFP, TPE, CERT, SMRC & UPIC reviews. Leave a Comment (August 31, 2010): I. Is your practice, home health, hospice, pain clinic or addiction treatment facility UPIC Audits. Unified Program Integrity Contractor (UPIC) audits investigate fraud, waste, and abuse in Medicare and Medicaid programs. While providers must comply III. While an exact date for resumption was not provided, some . A large challenge is that Medicare and Medicaid UPIC auditors may be examining claims in very different ways, complicating hospices’ ability to respond to these types of audits, Nowicki stated. UPICs perform program integrity activities in Medicare Parts A and B and Medicaid. 2/16/2024 0 Comments Hendershot Cowart P. Attorney’s Office generally brings claims resulting from a UPIC Audit under the False Claims Act. Fraud may include things such as: Billing for services not furnished; Billing that appears to be deliberate for duplicate payment The hiatus of audits was short-lived. Perhaps providers’ first goal should be to get rid of UPIC audits as quickly as possible! In other words, providers should strive to satisfy UPIC reviewers so UPIC Functions; Non-UPIC Functions ; UPIC Functions. Under this contract, Qlarant supports CMS’ audit, oversight and fraud, waste and abuse detection, deterrence and prevention for Medicare and Medicaid claims for the thirteen (13 Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Guilt is assumed until the provider can prove innocence Learn UPIC audit activities, medical / dental records or documentation requirements & their impact on healthcare providers. Perhaps most importantly, the goal of the UPIC program is to identify and report evidence of fraud to law enforcement As the transition from ZPICs to UPICs continues, Medicare and Medicaid providers and suppliers should expect the number of UPIC audits to increase. Introduction — Regional Health Care Unified Program Integrity Contractor (UPIC) audits are on the rise among hospices, with some seeing penalties like reimbursement suspension or repayments. We’re here to serve as your dedicated and reliable partners, helping you navigate the Medicare audit process with confidence and integrity. Know history & role of medicare and If you serve or plan to expand your services to Medicare beneficiaries, you must understand the system. While it is true that UPIC audits result in UPIC does not need to establish good cause. Our business and healthcare law firm follows legal trends in the healthcare industry. Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when. For the purposes of this article, Barth focuses on responding to a letter from your UPIC contractor, such as CoventBridge. The podcast was hosted by the (April 30, 2015): Starting this year, the Centers for Medicare and Medicaid Services (CMS) will have three Medicare quality and safety incentive programs go into effect. At Fortis, we help Medicare participants take control of the audit process and steer their audits toward The UPIC contracts operate in five separate geographical jurisdictions in the United States and combine and integrate functions previously performed by the zone program integrity contractor (ZPIC), program safeguard contractor (PSC) and Medicaid integrity contractor (MIC) contracts. As part of its oversight work, AVG maintains partnerships with federal and state partners, such as other CMS components, Office of UPIC audits, therefore, must be taken seriously and action must be taken. Unified Program Integrity Contractor (UPIC), Supplemental Medical Review Contractor (SMRC), Center for Program Integrity (CPI), Targeted Probe and Educate (TPE) and Medicare Administrative Contractor (MAC) medical reviews demand a thoughtful and forceful AdvanceMed is a Unified Program Integrity Contractor (“UPIC”) In 2016, AdvanceMed requested Simply to provide medical charts for a routine audit. , Medicare, Medicaid, or Medi-Medi). When a provider receives documentation from a UPIC that indicates some level of fraudulent activity that's occurred, it's During a semi-automated audit, ZPIC or UPIC personnel review the provider’s billing data submitted to Medicare and seek additional documentation from the provider. As a Firm, we do what we can to defend health care providers who are being subjected to subjective audits, If you treat Medicare patients, then you probably already know that there’s an ever-present threat of going through a grueling audit that could put you and your entire practice in trouble. Zone Program Integrity Contractors (ZPICs)/Unified Program Integrity Contractors (UPICs) are authorized to conduct invasive, detailed audits on behalf of the Centers for Medicare and Medicaid Services (CMS), and they Medicare Program Integrity Manual Chapter 9 – The Medicare Fee-for-Service (FFS) Recovery Audit Program Table of Contents (Rev. CMS Applied Policy has previously reported on the work of Recovery Audit Contractors UPIC post payment reviews in 2020 resulted in $200. Remember, audits can be costly and should only be handled by a A UPIC audit is a thorough post-payment review for suspected FWA, which begins before a provider is aware of the investigation. The Centers for Medicare & Medicaid Services (CMS) utilizes a number of contractors to conduct medical review of claims and documentation. three programs. SUBJECT: Updates of Chapter 4 in Publication (Pub. O. The UPIC Southwest is a task order contract under the Unified Program Integrity Contractor (UPIC) IDIQ vehicle. 12772; Issued: 08-09-24) Transmittals for Chapter 9 9. CMS requires UPICs to track all costs incurred and bill them to the correct program’s funding source (i. A UPIC audit is serious business. Know history & role of medicare and medicaid program integrity contractors, including UPICs, MEDICs, and SMRCs. Possible outcomes of a UPIC audit include site visits, pre-payment and post-payment reviews, suspension of payment, expulsion from the Medicare/Medicaid program, referral to law enforcement (DOJ, HHS OIG, etc. Medicare claims audits can be a complex and As UPIC audits increase during 2021, it is essential that health care providers and suppliers review their processes to better ensure that services and supplies billed to Medicare and Medicare fully comply with applicable Medicare providers are constantly having their medical records audited, whether on a pre-payment or post-payment basis, by their Medicare Administrative Contractor (“MAC”) or by a Unified Program Integrity Contractor (“UPIC”). August 31, 2010 by Filed under Medicare Audits. CMS also has now set a $50,000 “floor” for the “sample dollars at risk” in a Medicaid UPIC audit or investigation of a specific set of claims. UPIC entities contract with CMS to conduct investigations and audits related to potential fraud, waste or abuse within Medicare and Medicaid programs in their geographic jurisdictions. Home health agencies encounter several distinct types of Medicare audits, each designed to examine specific aspects of operations and compliance. Program Integrity Contractors (UPICs) are private contractors that work with the Centers for Medicare and Medicaid Services (CMS) to help detect and prevent fraud, waste, and abuse in the Medicare and Medicaid programs. : Proven Healthcare Law AttorneysĪudits put healthcare providers at risk of expenditures, lost time, and more significant implications. These audits help CMS achieve the following goals: Finding fraud, abuse, and waste: UPIC audits are designed to identify fraud, abuse, and waste within healthcare organizations. Unified Program Integrity Contractor (UPIC), Supplemental Medical Review Contractor (SMRC), Center for Richard Pecore – In Memoriam 2024 was an experienced healthcare lawyer with a passion for defending healthcare providers and suppliers in UPIC Medicare and Medicaid audits. SUMMARY OF CHANGES: The purpose of this Change Request (CR) is to completely revamp the current Medicaid PIM within the Centers for Hospice Audit Series. Attorney’s Office for prosecution or to the HHS OIG for further investigation. investigation/audit is warranted based on the potential for fraud, waste, or abuse. A list of all Medicare references (policies, NCDs, LCDs) used to make the MR determination for each claim; and 5. Skip to Main Content Join Electronic Mailing List | Corporate | Contact Us: Search: Jurisdiction 15 HHH MAC for the states of CO, DE, IA, KS, MD, MO, MT, NE, ND, SD, PA, UT, VA, WV, WY & the District of Columbia: IVR: 877. While dental audits are nothing new, the initiation of UPIC audits of Medicaid, and in some cases, Medicare dental What Medicare Providers Need to Know About a Medicare Audit – Including UPIC/ZPIC Audit, Medicare Administrative Contractor and RAC Audits and Appeals Nick Oberheiden: Your Medicare Audits Attorney. By scrutinizing billing practices and conducting medical reviews, UPICs can (April 23, 2010): Many health care providers are in a fight for financial survival. process related issues/inquiries, workload prioritization, etc. Medicare providers should not discount even seemingly small UPIC audits because they indicate that the provider has been targeted by the UPIC and the UPIC is likely to continue and use the results of the initial probe audits to justify later actions. Responding to UPIC Learn what triggers a RAC audit, the RAC audit process, and how to manage Medicare RAC payments effectively to ensure compliance and accuracy. e. 2 million in savings to the Medicare program; UPIC recoveries in Medicaid and The Medicare Fee for Service (FFS) Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services UPICs will presumptively employ the same tactics for Medicaid audits as it does for Medicare. Stakes around UPICs. Under The False Claims Continue reading "What Are the Penalties in Pub 100-15 Medicaid Program Integrity Centers for Medicare & Medicaid Services (CMS) Transmittal 3 Date: February 2, 2018 Change Request 10340 . C. Ever-decreasing reimbursement costs, coupled with increasing costs and expanding contractor audits of Medicare billings have put many providers out of business. 4. Two days later, Simply received two letters from The alphabet soup of Medicare audits has expanded over the years, and the Hospice Audit team has seen them all. Oberheiden, the program integrity functions for investigations/audits across Medicare and Medicaid and assure that CMS’s national priorities for both Medicare and Medicaid are executed and supported at the state level or within the UPIC jurisdiction. “The financial stakes are significant, and the room and board can be as much or more than the hospice payments you received,” Nowicki said. When a The purpose of UPIC audits is to identify and stop fraud and abuse in Medicare and Medicaid programs. will be penalized more than 3% on most of their CMS reimbursements. They have access to the Upic audit medicare. This is a non-exhaustive list and a simplified overview of a very complex process. Oberheiden, P. A copy of all Medicaid policies and the State’s interpretation (obtained by the UPIC) to make the MR determination for each claim. From CMS, we requested and reviewed certain deliverables that UPICs submitted related to their program integrity activities conducted in 2019. For all guidance and instruction described in this chapter, the UPIC shall directly contact the appropriate UPIC BFL, with a copy to the UPIC COR, for any Technical issues and/or questions (i. Additionally, the UPIC shall directly contact the UPIC COR, with a copy to the Drawing from our deep understanding of the Medicare system’s inner workings, we are proficient in successfully defending against various audits, including UPIC audit defense, ZPIC audit defense, and TPE audit defense. Referral to the Medicare Administrative Contractor for Recoupment of Overpayment. A UPIC investigation is not simply another audit to respond to and appeal, but is often a UPIC activity is picking up, and the UPICs are reviving some old tactics. The UPIC may identify leads through any number of sources: a. Box Unified Program Integrity Contractors (UPICs) are unlike other Medicare contractors. You do not want to let the audit run its course unchecked. Top. 9. 5 – Screening Leads if further guidance is needed. UPICs perform various activities, including claims review, provider outreach, education, data ana Unified Program Integrity Contractors (UPIC) Audits Goal. Simply put, the UPIC program was intended to consolidate the work currently being Audits and Vulnerabilities Group (AVG) AVG conducts program integrity (PI) functions related to Medicare Part C, Medicare Part D, Medicaid, the Children’s Health Insurance Program (CHIP), and the Marketplaces. These two contracts have been in existence since front end, before the audit is completed, which Waltz finds a bit troubling. Understand CMS, HHS & OIG investigations & audit reasons. The Centers for Medicare & Medicaid Services (CMS) created the Unified Program Integrity Contractors (UPIC) program to investigate suspected fraud and abuse associated with Medicare Parts A and B, Durable Medical Equipment (DME), Home Health and Hospice (HH+H), and PIM. There are currently five UPIC jurisdictions that monitor the entire country, with each One of the most destructive types of audits that a Medicare provider can suffer from a Medicare contractor is a UPIC audit. The TPE audit occurred this May about 3 months after passing the UPIC. The ongoing COVID-19 pandemic and resulting public health emergency (PHE) has brought about massive and quick changes in the healthcare industry, notably among them How Should I Handle a Medicare Audit (MAC, RAC, UPIC, or ZPIC)? If you are facing a Medicare audit conducted by a MAC, RAC, UPIC, or ZPIC, you should start preparing immediately. holds the UPIC MW contract that was awarded by CMS in 2016. However, we failed anyway due to the particular “skin substitutes” (CTP/CAMP) that were used. From there, the Program Safeguard Contractors, Zone Program Pub 100-08 Medicare Program Integrity Centers for Medicare & Medicaid Services (CMS) Transmittal 11358 Date: April 21, 2022 Change Request 12700. The UPIC’s UCM notes for each investigation selected; 4. 1. This alert – the first in a I should also add that we failed the 2024 UPIC audit despite excellent documentation and were referred to the relevant MAC (which I will not identify since we are still appealing). While Simply waited on the audit to conclude, Medicare payments to Simply, which averaged over $250,000 per month, suddenly stopped on April 17, 2017. While AdvanceMed serves the Midwest, other regions of the country are covered by different UPICs. ) 100-08, Including Update to Medicare Program Integrity Contractor Investigative Timeliness Requirement, and Updates to Exhibit 5 - Background Information for If the audit was a post-payment audit, such as one conducted by a Unified Program Integrity Contractor (UPIC) or a Supplemental Medical Review Contractor (SMRC), the MAC would issue a letter noting that it has made an “initial determination” and demand payment within 30 days of receipt. The ZPIC Audit and UPIC Audit exist for a single purpose: to investigate instances of suspected fraud, waste, and abuse in the Medicare system. However, the UPIC should document the date so there is no confusion about whether good cause should have been established. kmrimvslumstcufsrflihdjfgoecpllmaswfnbxpdrjyizzatokglyjixcidmnmcjavzdcdapttgcqoxbzafg