Zone Program Integrity Contractors, also known as ZPIC, investigate any and all instances of suspected Medicare fraud, Medicare waste, or abuse. Zone Program Integrity Contractors perform both a medical review and data analysis. Norman Spencer Law Group healthcare attorneys can help you during the ZPIC audit process. We can potentially save you substantial amounts of money.
Norman Spencer Law Group Medicare ZPIC Audit Defense
During a Zone Program Integrity Contractor audit, the individual contractor might request and/or review any pertinent medical records. They can conduct their patient interviews, identify any specific need for either prepayment or auto-denial claim edits. Also, they can withhold payments as needed, and refer any cases of suspected Medicare fraud to law enforcement and other authorities.
It is important that you have competent legal representation as early in the process as possible. Do not ever submit any documentation to the auditor before you speak with our attorneys. We have years of experience representing clients in Medicare and Medicaid audits. Call us today for a consultation!
What’s the ZPIC Audit Process?
Sometimes a MAC investigates a provider for improper billing and is unable to dismiss this behavior as either some kind of error or misunderstanding. They will then refer the case to the Zone Program Integrity Contractor. The ZPIC auditor will then go ahead and perform one or more of the following:
- Review of a sample of claims
- Interview a number of patients
- Interview employees at the provider’s office or at home
- Look for previous violations by the provider
- Perform data analysis
If the ZPIC Contractor audit reveals some kind of pattern of improper Medicare billing, those ZPIC auditors will then discuss this matter with the Office of Inspector General. ZPIC Contractors will refer the case to the OIG if they believe that potential fraud exists. The Zone Program Integrity Contractors work closely with law enforcement.
Better Outcomes for ZPIC Audit
If the ZPIC finds that a medical provider is engaging in some kind of improper Medicare billing, but that particular practice doesn’t warrant any type of criminal activity, the Contractor can educate that provider on more appropriate billing practices. The ZPIC Contractor might simply inform the provider of the improper practice, educate them on what the proper procedure to be followed is. They will then inform the provider of the continuation of this action might very well result in administrative sanctions.
If the Zone Program Integrity Contractor decides to only educate or otherwise warn this provider, then a detailed report will be created and might even be submitted to the OIG for future reference.
The Importance of Working With a Professional
Medicare Zone Program Integrity Contractor audits are serious and should never be handled without an experienced Medicare fraud defense lawyer. Often ZPIC Contractor audits will result in Civil Monetary Penalties, or CMPs, and also criminal charges. With that said, you should get in touch with the Norman Spencer Law Group immediately if you receive a notification of a Zone Program Integrity Contractor audit.
What is Considered Medicare Fraud Leading to a ZPIC Audit?
Healthcare professionals can be convicted of Medicare fraud if they either willfully or knowingly submitted any kind of false claim for reimbursement. They can also be convicted if they engage in kickbacks schemes. The government will have to prove beyond a reasonable doubt that your actions were done either willfully or knowingly. However, proof of specific intent or actual knowledge of the fraud or scam is unnecessary. That means that you can be convicted if you’re found to have acted with either reckless disregard or deliberate ignorance of the claim being false.
In many of these cases, it all comes down to whether the healthcare professional acted willfully or knowingly. In other Medicare fraud cases, the issues are quite a bit more complex. The defense attorneys at the Norman Spencer Law Group have worked for more than a decade in the healthcare field, successfully representing licensed healthcare professionals at all stages of their case.
What if the Audit Uncovers Medicare Fraud?
Besides providing a strong defense in audits, we are highly experienced in defending clients against charges related to fraud. If the auditor determines that you committed fraud, you need to speak with our office as soon as possible. We can help you to resolve the issues before the case becomes criminal.
What Are the Penalties of a ZPIC Audit?
Medicare fraud convictions carry civil and legal consequences. This can include things like restitution, civil monetary penalties, jail time, and other penalties and collateral consequences. As you might imagine, consequences are dictated by the specific statute that’s been violated. Accusations of Medicare fraud carry a potential risk of imprisonment and draconic fines and penalties.
Norman Spencer Law Group Has the Experience to Help
The Norman Spencer Law Group attorneys have years of experience handling cases of nearly every size and type, and complexity is not an issue for us either. Not only do we have a proven track record of success, but we have extensive experience at both the state and federal levels.
We can help you no matter where you might be in the country. So if you’re facing legal trouble, get in touch with us as soon as possible. Someone from our team will be in touch right away and get started on getting you the help that you need.