Red Flags That Could Result in a ZPIC Audit

For many people, it’s assumed that if you don’t do anything wrong, you don’t have anything to worry about. However, when it comes to ZPIC audits, this isn’t always the case. You could inadvertently make a mistake or do something wrong that ends up being costly.

It’s expected that health care expenditures will reach the $4.35 trillion mark by 2018. Of that amount, the Federal Bureau of Investigations (FBI) and the Office of Inspector General of Health and Human Services estimate that as much as 10 percent of those payments could be fraudulent in some way. Here are some of the red flags that could lead to a ZPIC audit.

Living in Certain Areas

Believe it or not, you could be more likely to be audited for simply living in a certain state. The Centers for Medicare & Medicaid Services (CMS) has designated several regions of the country as high-risk areas. If you practiced medicine in these areas in the past or if you do so currently, you might be at higher risk for an audit than other health care providers. These areas include Dallas, Los Angeles, Miami, New York, Detroit, and Houston.

You Aren’t Getting Documentation Upfront

Cutting corners and not getting the right documentation prior to performing a treatment or surgery sets you up for an audit. Even if you aren’t doing anything else that could raise suspicions, something as simple as a patient whose paper trail leads to you as a referral from another health care provider who happens to be getting audited, could bring your practice under fire.

You Attempt to Get Documentation After the Fact

It’s understandable that medical professionals are busy. Part of growing your practice is trying to see as many patients as possible during your open hours. Because the processing of these patients, especially new ones or those who need specialized treatments, can cause a backlog, you and your front office staff could resort to getting the proper documentation at a later date. While this practice is common, it isn’t a good one to get into the habit of performing on a regular basis. Attempting to backtrack and get documentation for a service that you’ve already performed could raise red flags that signal fraud to auditors.

Billing for the Maximum Amount

If your practice is in the habit of always billing for the maximum allowable amount for a certain product or treatment, your chances of an audit are going to increase. The same is true of those codes that are among those that are most often reimbursed by Medicare.

If you see yourself in any of the four scenarios, get prepared. You might need to speak with an attorney with ZPIC experience now, before you get audited.

Contact Experienced ZPIC Audit Attorneys Today

Don’t panic. If you are being audited or need help with an appeal, the attorneys at Oberheiden & McMurrey, LLP can help. Call us at (888) 727-5159 or complete our online contact form today.