After a ZPIC Audit: How to Get Your Overpayment Reduced or Eliminated

overpayment reduced

If your organization has been the subject of a ZPIC audit and you’ve been found to have filed fraudulent or erroneous Medicare or Medicaid claims, you may be asked to repay the overpayment. This overpayment amount can be substantial, especially if it is extrapolated. However – you may be able to get the debt reduced or even completely eliminated. Here’s how to get your overpayment changed to something you can handle after an audit.

Lessening the Burden of Overpayment

The first thing you should do when you discover that you’re to be the subject of a ZPIC audit is contact an attorney. A qualified attorney can help your organization through the complicated audit and appeals process. And in the unfortunate event that you’re found to owe an overpayment, he or she can help you minimize the burden of this debt. Rather than suffering through payments you can’t afford and letting it bring down your business even further, let us help investigate whether you have other options.

In most cases, if your business has been found to have been overpaid, you’ll need to work on paying back what is owed. However, if the payment seems to be difficult to manage, you do have options. You may be able to reduce or eliminate your overpayment based on several considerations, including:

  • Whether the ZPIC provided the appropriate information regarding its findings
  • Whether your clinical findings were correct
  • Whether the ZPIC reviewed and applied all of your provided documentation correctly
  • Whether the opinion of a clinical expert or physician was needed, and if so, whether it was sought
  • Whether the ZPIC was able to show a high or sustained error rate

Other considerations might include whether you were subject to a prior educational intervention that did not succeed, or whether the ZPIC used appropriate sampling and statistical methods.

In any event, it will be best for your business and staff to consult an attorney. Your attorney can evaluate your case on the basis of all of these considerations. Furthermore, they may be able to challenge the ZPIC’s methods and extrapolations in order to reduce or eliminate your overpayment burden.

Speak with an Experienced Attorney at Oberheiden & McMurrey, LLP

Dealing with and addressing any part of a ZPIC audit can be confusing and complicated. Fortunately, you don’t have to attempt to navigate this process alone. A qualified and experienced legal team can help you manage an overpayment and may even be able to help you get it reduced or eliminated entirely. Let our attorneys help you and your business through the ZPIC audit process, whether you have just received notice of an investigation, or are working on an appeal.

To learn more about a ZPIC audit, overpayments, and appeals, you can speak with one of our experienced attorneys at Oberheiden & McMurrey, LLP. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.

What to Do About Medicare Overpayments

medicare overpayments

One of the mistakes that organizations make involves Medicare overpayments, whether intentionally or accidentally. If, despite your best efforts to remain in ZPIC compliance, you find that you have received more money than you were owed for a Medicare claim, don’t panic. The world hasn’t ended.

The best thing to do if you’ve received a Medicare overpayment is to give back the extra money. You have 60 days from the date an overpayment is identified to repay the money. However, while it might be tempting to just keep the overpayment and ignore it, the consequences that might follow are usually not worth it. Instead, here’s what to do if you’ve received more than you should have.

Return What Doesn’t Belong to You

If you think you’ve received a Medicare overpayment, it’s usually best to consult your attorney immediately so you don’t make any mistakes. He or she will be able to review your documentation and ascertain whether you have, in fact, been given an overpayment. If you have, returning the extra money should be sufficient to absolve you of Medicare fraud suspicion.

Sometimes providers are granted overpayments through no fault of their own – but an honest provider returns the money. Keep in mind that there are severe consequences for Medicare fraud and keeping an overpayment can be considered fraudulent.

What to Do If You Find that the Money Should Be Yours

An overpayment doesn’t always mean fraudulent activity. It also doesn’t mean your business shouldn’t have received the higher payment. It’s possible you are entitled to the extra payment. If your attorney reviews the claim and finds that the evidence suggests that you’re owed the money you’ve been paid, you still have the right to appeal the denial of a claim.

Many providers think it’s best to simply pay back the money Medicare wants in order to resolve the case quickly. When it’s a small amount of money, it may seem easier just to fork it over than deal with the expense, trouble, and time of appealing the ZPIC’s denial.

However, allowing ZPIC to deny a claim that shouldn’t have been denied can reflect poorly on your organization. Every ZPIC denial raises your error rate, and the higher your error rate, the more likely you are to be audited in the future.

An Experienced ZPIC Attorney Can Help

Although you might not think something like an overpayment warrants a meeting with an attorney, it’s in your best interest and safer for your business to find out how to handle the extra money. It is never a good idea to just keep the overpayment without investigating why you have received it. And, to ensure you aren’t later charged with fraud, an attorney should investigate the details.

To learn more about a ZPIC compliance and Medicare payments, you can speak with one of our attorneys at Oberheiden & McMurrey, LLP. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.

How to Foster a Culture of ZPIC Compliance in Your Organization

zpic organization compliance

Although there isn’t always any way to avoid a ZPIC audit, there are ways you can protect your business and employees a little more. One of the ways to do this is to foster a culture of compliance in your organization from the very beginning. This might seem fairly simple. However, if you aren’t sure of the regulations involved or the mistakes that might lead to serious consequences for your business, you might be more at risk than you think.

If you’re worried about the possibility of a ZPIC audit you may be able to fend off trouble by implementing a ZPIC compliance plan in your organization. If you can get your clinical and administrative staff to make compliance procedures a part of every Medicare claim, you’ll be fully prepared when it comes time for a ZPIC audit. But how exactly can you foster a culture of ZPIC compliance in your organization?

First of All – Know the Regulations

One of the most important parts of ensuring compliance is possessing knowledge of the regulations. You simply must know them. Otherwise, it’s far too easy to make mistakes and not even realize it. ZPIC audit reviewers have been increasingly active in recent years, but you can protect your organization from claim denials by making sure every member of the team understands the regulations and statutory provisions involved in billing, coding, and documenting Medicare claims.

This means, establishing sound records management procedures that involve staff members at all levels of the organization. What can clinical staff members do to ensure regulatory compliance? What can administrative staff members do? Helpful ways to ensure everyone in your organization is knowledgeable of regulations include the following:

  • Provide plenty of training and continuing education opportunities for all staff members. All members of the team need to learn the intake and records management processes needed to ensure regulatory and statutory compliance.
  • Make sure that training efforts emphasize the importance of ZPIC compliance, both from a regulatory and ethical standpoint.
  • Offer employees incentives for participating in continuing education and training opportunities, so that they can keep their skills fresh.
  • Your messages should be positive, consistent, and ever-present in the organization, so that regulatory compliance procedures are never far from employees’ thoughts.

Speak with an Experienced ZPIC Compliance Attorney Today

Even if you have taken measures to ensure everyone in your organization is prepared and compliant, you could still face a ZPIC audit. However, if you take steps to prepare before an audit happens, you have a better chance at a positive review. If you aren’t sure how to set up a culture of compliance, our attorneys may be able to help answer some of your questions and navigate the process on your behalf.

To learn more about ZPIC compliance, audits, and appeals, you can speak with one of our attorneys at Oberheiden & McMurrey, LLP. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.

Here’s What You Need to Know About ZPIC Investigative Methods

zpic investigative methods

When a ZPIC investigates your organization for Medicare fraud, it will conduct multiple types of investigations to determine whether the alleged fraud occurred, and its magnitude. ZPIC reviews will also be used to determine whether Medicare payments to your organizations were appropriate, even if there is no evidence that you committed fraud.

Although it sounds intimidating and overwhelming, the investigation might be less painful than you imagine. To give you an idea of what to expect, here is a look at some of the investigative methods a ZPIC may use.

ZPIC Audit Investigative Methods

Often, the ZPIC will review a sample of the claims you have submitted recently to look for evidence of unjustified payments or fraud. Such a review may include requests for documentation or other evidence.

The ZPIC may also interview beneficiaries, usually by telephone. You needn’t worry about the ZPIC interviewers causing your patients any alarm. The purpose of the interview is to determine whether a questionable claim is a one-time error.

Additionally, the ZPIC auditors may look for comparable Medicare violations in the past, or instances in the past when you have been contacted by another Medicare contractor regarding such violations. These could include warning letters, educational letters, or contact reports.

Other investigative methods could include:

  • Data analysis and analysis of procedures performed
  • Random validation checks of the licenses of physicians in your organization
  • Reviews of telephone calls or written questionnaires confirming the need for DME or home health services

Investigative methods can also include the comparison of practice and billing trends against local, national, and regional trends, as well as review of certificates of medical necessity. These investigative methods will help the ZPIC determine whether fraud has taken place.

There are other methods that could be part of the investigation. In order to ensure you are prepared as much as possible, it’s important to have a legal team on your side who have been through the process. Although the investigation itself can be scary, it can be less stressful for you and your staff if you have people who have experience with ZPIC audits on your side.

Qualified ZPIC Attorneys at Oberheiden & McMurrey, LLP

Fortunately, you don’t have to navigate the investigation or the ZPIC audit alone. In fact, it’s best for your business to consult a qualified ZPIC audit attorney as soon as possible. If you have been contacted about a ZPIC investigation, you should call us immediately for a consultation. Don’t risk making serious mistakes or accidentally failing to provide the information requested.

To learn more about a ZPIC audit and what you can expect throughout the investigation, the audit, and even the appeal process, you can speak with one of our attorneys at Oberheiden & McMurrey, LLP. You have a lot on the line and should make sure you have someone on your side to represent your best interests. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.

What to Do if You Get a ZPIC Demand Letter Without a Record Request

zpic demand letter

If you get a ZPIC demand letter without a record request that means you’ve been the subject of an automatic review. Automatic reviews are implemented in order to detect obvious mistakes in billing. They’re usually done by computer and are typically fairly simple to handle. The good news is, you might not have to do anything further.

However, in order to ensure you address any concerns and requests thoroughly, you’ll want to let an experienced lawyer take a look at your demand letter. Otherwise, here’s a brief explanation of what you can do if you receive a demand letter that is not accompanied by a record request.

Review Your Records for a Mistake

Make sure you fully understand the reason why the claim or claims were flagged in the review. Go back over your own records to look for the mistake. This step is especially important in addressing the demand letter and preventing your business from facing costly consequences. Review your records thoroughly. If you aren’t sure what to look for in reviewing your documentation, consult one of our attorneys.

Find Out Why the Overpayment Was Made

Common reasons why overpayments are flagged in an automatic review include:

  • The service provided cannot be covered by Medicare or Medicaid.
  • The service is “medically unbelievable,” meaning that it doesn’t make sense from an anatomical standpoint, or is medically unreasonable.
  • You have failed to respond to a record request for a previous, complex review in a timely manner.

There could be a number of other reasons an overpayment was made so make sure you track down exactly what might have happened.

Decide Whether You Want to Appeal

Do you want to appeal the findings? Talk to your attorney about whether an appeal is the best decision for you. Appeals can be time-consuming and costly, but having a history of claim denials can make you more vulnerable to future audits.

Take Action

You’ll need to take corrective action right away to fix your mistake and keep your organization from attracting any more scrutiny. If you are not appealing the decision, pay the overpayment. A payment plan may be possible, or you may be able to get some of the debt forgiven.

Contact Experienced ZPIC Attorneys at Oberheiden & McMurrey, LLP

Getting a ZPIC demand letter can be scary and intimidating, especially if you aren’t sure what to do next. Our attorneys have the experience and knowledge you need to help you navigate the ZPIC audit process, and figure out the best way for you and your business to proceed. Don’t risk making a costly mistake attempting to navigate the process alone, or even worse, ignoring the letter you have received.

To learn more about a ZPIC audit and what you can expect – whether or not documentation is requested – you can speak with one of our attorneys at Oberheiden & McMurrey, LLP. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.