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

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.