Possible Consequences of a ZPIC Audit

Coming under the fire of a ZPIC audit can have a variety of consequences for health care providers. Although some of the consequences are more severe than others, a ZPIC audit has every potential to destroy your business forever. To give you a small idea of what might be at risk, the following are some examples of actions that might be taken against a medical practice or provider after the initial probe audit is undertaken by the ZPIC.

Post-Payment Audit

As the name suggests, these ZPIC audits are conducted on Medicare claims that have already been paid out by the government. Unfortunately, in many cases, the ZPICs in charge of conducting these audits tend to apply a strict application of the applicable regulations. Any deviation from them, regardless of how minute or inconsequential, is treated as being suspect. This often results in a failure to comply with every single requirement, significantly increasing the amount the government allegedly overpaid.

Pre-Payment Audit

While a post-payment audit focuses on claims already paid, a pre-payment audit targets claims that a provider is attempting to collect on after providing a service. A pre-payment audit is particularly troublesome for a couple of reasons. Because the services, equipment, and staff time have already been used to provide treatment to the patient, the provider must endure an added layer of payment red tape. The pre-payment audit process can become significantly backlogged to the point where it places a medical practice in jeopardy of not being able to pay its bills on time.


ZPICs have the power to initiate actions that are designed to suspend the ability of a medical provider to be reimbursed for the Medicare services rendered. Given the uncertainty of the status of health care insurance, it’s expected that suspensions will continue to grow.


Like other aspects of the ZPIC audit process, revocations seem to hinge on the whim of the particular ZPIC that is assigned to a facility. A revocation might occur from slights as simple as being deemed “uncooperative” when a ZPIC was on site, or failing to properly give notice of a move to Medicare .

ZPICs also have the authority to refer medical professionals to the Department of Justice for criminal and civil charges. When a ZPIC audit is getting underway, no one can predict how it will turn out. Seeking out a qualified attorney early in the process provides necessary safeguards.

Contact Experienced ZPIC Audit Attorneys Today

Even if you believe you’ve managed your business exactly as you should, a ZPIC audit can have dire consequences. Because of the costs and the damage to your reputation that can come with an audit, you also risk losing your income and business completely. If you are being audited or you need help appealing, our attorneys have the experience and skills to help you through the process. Contact the attorneys at Oberheiden, P.C. at (888) 727-5159 or complete our online contact form today.