In the past 20 years or so, there has been a concerted effort by the federal government to crack down on the number of fraudulent claims that are submitted to Medicare by medical providers. One of the ways that the government prevents fraudulent claims is through prepayment audits. If your practice has been notified that you are the subject of a prepayment audit, you should contact an Illinois professional license defense attorney for legal assistance.
Zone Program Integrity Contactors
Prepaid audits fall under the bailiwick of the Centers for Medicare and Medicaid Services. The agency often employs Zone Program Integrity Contactors (ZPICS) to conduct these investigations into potential waste, abuse, and fraud. In some cases, ZPICS will use methods to mine the practices’ algorithms in an attempt to see if they can find any abnormalities in billing which could indicate fraud is taking place.
Issues That Can Result in a Prepayment Audit
There are certain issues that can result in ZPICS knocking at your door or a denial of claims:
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