CMS has updated the Medicare Program Integrity Manual to clarify that providers and suppliers have 45 days to produce documents in response to a pre-payment review Additional Documentation Request (ADR) issued by a Medicare Administrative Contractor (MAC) or Zone Program Integrity Contractors (ZPIC). MAC and ZPIC reviewers are instructed not to grant extensions to providers
ZPIC
GAO Calls for Improvements to Medicare Contractor Postpayment Review Process
By Debra A. McCurdy on
The Government Accountability Office (GAO) has issued a report entitled “Medicare Program Integrity: Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Postpayment Claims Reviews." In the report, the GAO assesses CMS policies and procedures to prevent certain Medicare contractors (Medicare Administrative Contractors, Zone Program Integrity Contractors, Recovery Auditors, and the Comprehensive Error…
GAO Examines Effectiveness of ZPIC Program Integrity Efforts
By Debra A. McCurdy on
A recent GAO report assesses the effectiveness of Medicare Zone Program Integrity Contractors (ZPICs) — contractors that perform program integrity activities designed to fight Medicare fraud, waste, and abuse. While the GAO notes that ZPICs take credit for over $250 million in Medicare savings in 2012 from actions such as stopping payment on suspect claims…
OIG Highlights Potential ZPIC Conflicts of Interest
By Debra A. McCurdy on
The OIG recently examined potential conflicts of interest that could affect the impartiality of Zone Program Integrity Contractors (ZPIC) — Medicare contractors that perform program integrity activities designed to fight Medicare fraud, waste, and abuse. The OIG found that most companies that submitted proposals for ZPIC contracts (offerors) and/or their subcontractors had business and contractual…
Medicare Overpayments Identified by Program Safeguard Contractors (PSCs)
By Debra A. McCurdy on
The HHS Office of Inspector General (OIG) has issued two reports on PSCs, which contract with CMS to perform selected Medicare program integrity tasks. First, the OIG reports that PSCs referred $835 million in overpayments for collection in 2007, but 18 PSCs were responsible for 62% of these referrals. In addition, overpayment amounts referred by PSCs …
Medicare DMEPOS/Home Health Fraud Initiative
By Debra A. McCurdy on
On October 6, 2008, CMS announced expanded efforts to combat Medicare DMEPOS and home health fraud and abuse, including targeted reviews of home health agencies (HHAs) in Florida and greater scrutiny of DMEPOS suppliers in Florida, California, Texas, Illinois, Michigan, North Carolina, and New York. In particular, CMS will be reviewing DMEPOS items with high expenditures …