As time goes on, the rate of investigations into Medicare fraud is only expected to increase. ZPICs are making an effort to root out all levels of fraud from the obvious to the subtle, and that has some health care providers wondering if they may find themselves targeted in the near future. The best way to protect yourself from an audit is to follow all guidelines to the letter and have a ZPIC lawyer monitor your facility. If you’re wondering what types of facilities might be more at risk, here’s a list of some of the top ZPIC audit targets.
Because hospices largely focus on the patient’s needs minute-to-minute, patient treatment protocols can change rapidly. Unfortunately, even if a facility judges that a patient requires a certain procedure or medication, it doesn’t mean Medicare will agree. ZPICs have investigated hospices for what some consider “going too far” with comfort care and other treatments that Medicare deems “unnecessary.”
Home Health Care Companies
ZPICs focus on home health care companies because there is so little public oversight into how they operate. While the vast majority of companies are legitimate and follow the rules, recent reports have indicated an increased rate of fraudulent billing in certain states. This fact increases the risk for ZPIC audits for home health care companies.
Like home health care companies, private physician practices are also responsible for their own individual oversight. The reasons for an increased ZPIC audit rate, unfortunately, aren’t as clear. A small number occur because ZPICs are required to audit a random selection of approximately 120,000 practices, while the rest occur after abusive or fraudulent billing claims.
Diagnostic and Testing Facilities
Diagnostic and testing facilities have an increased rate of ZPIC audits because of the nature of the work they do. All providers are required to justify diagnostic tests, and this includes facilities, too. If a facility cannot provide proof that the patient required a test expressly, ZPICs may view it as abuse of the Medicare system. This includes unnecessary MRIs, blood tests, CAT scans, and ultrasounds.
These are just a few of the most common top ZPIC audit targets. Many other providers have an increased risk too. Always remember that it is possible to be randomly selected for an audit. If you are a provider who has recently received an audit notification, contact a ZPIC lawyer immediately.
Experienced ZPIC Audit Attorneys of Oberheiden & McMurrey, LLP
The truth is, any medical facility is at risk of being audited, sometimes for something as small as a numerical error. Unfortunately, an audit can turn your business upside down and completely destroy everything you have built. If you are at risk of being audited, you have a better chance at a positive outcome if you have qualified and experienced counsel to represent your best interests.