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FEDERAL REGULATORY DEFENSE COUNSEL / UPIC AUDITS AND CMS SUSPENSION OF PAYMENTS

Nothing is more disheartening for a medical practice or healthcare business than to learn that the federal government is suspending critically needed payments, based on its contractor’s determination of an overpayment. Often, this news can come without any prior notice or realization by the healthcare provider that it is the subject of a federal audit.  For some healthcare businesses, this type of blow to cash flow — suspension of payments — can be a death knell.

Our Georgia-based business and healthcare law firm represents medical practices, physicians and healthcare business owners in regulatory matters, including Uniform Program Integrity Contractor (UPIC) audits and CMS suspension of payment circumstances.  Healthcare providers are under great scrutiny by the government and its contractors to reduces the risks of overpayment.  Where UPICs are involved, the financial stakes can be very high for healthcare providers.  We can assist you in interpreting any written or other communications received by CMS, developing a prudent, responsive plan of action, and advocating on your behalf. 

Georgia-based Business and Healthcare Law Firm

CMS has made it a top priority to recover alleged overpayments.  Private contractors are hired to audit healthcare providers and businesses and financially incentivized to find overpayments.  If you receive a written notification from CMS or its contractor that an over determination has been made or that an audit is proceeding, it may be important for you to contact your healthcare law counsel before responding to determine how best to respond and protect your legal rights.

Our law firm assists healthcare providers and businesses in review and analysis of, and properly responding to, CMS and/or its UPIC.  UPIC contracts reflect a strategic combination of Zone Program Integrity Contractors (ZPIC’s) and Medicaid Integrity Contractors (MIC’s) to coordinate Medicare and Medicaid auditing. Our services in this regard may involve:

  • Assisting in education of staff to prevent mistakes
  • Reviewing and analyzing and providing legal advice regarding regulatory and statutory provisions
  • Working with qualified healthcare consultants to ensure coding, documentation and billing practices adhere to proper form
  • Review and preparation of documents production in response to a request for documents from the UPIC
  • Representation, advocacy and negotiations in UPIC audit and appeals process

It is important to understand that a genuine belief that you are doing things correctly does not immunize your medical practice or healthcare business from a suspension of payments by CMS as part of a UPIC audit.  While certain fraud and abuse laws are only violated based on scienter, a finding of bad intent is not necessary to result in a UPIC-generated suspension of payments.  It also important, therefore, to have a robust compliance plan in place to mitigate the risks of a UPIC audit.  Medical practices, physicians and other healthcare providers must take appropriate precautions to reduce the likelihood of becoming the target of an audit.

Devoted, Highly Experienced Healthcare Lawyers

Our business and health care law firm’s focus is protecting healthcare providers and professionals. We are glad to speak with you about how we might protect your interests regarding UTIC audits. Our law firm is “AV” by Martindale Hubbell. To schedule a confidential consultation, email us at info@hamillittle.com.Or call us at our Atlanta office (404.685.1662) or our Augusta office (706.722.7886).