Why You Shouldn’t Ignore a ZPIC Request for Documentation

zpic documentation

If a ZPIC requests documentation from your practice, it’s vital that you comply with that request. A ZPIC audit can be a scary and intimidating process. It might be tempting to ignore a request for documentation and just hope it goes away. But remember that ZPICs have an important function. They help prevent Medicare fraud, which makes care more accessible for those who need it most.

Also, it’s important to keep in mind that a request for documentation doesn’t necessarily mean you will automatically face negative repercussions. Sometimes, once you provide the documentation that is requested, any questions are answered, and you won’t have any other issues to address.

However, ignoring the request for documentation can lead to far worse problems, that you wouldn’t have necessarily had to deal with if you had just provided the requested information.

What to Expect from a Documentation Request

If you get a ZPIC request for documents, it will most likely be a two-part request. The first part will ask for records related to your business, such as:

  • Business contracts and agreements with other providers, physicians, suppliers, individuals, or businesses. Summarize verbal agreements in writing.
  • A list of former and current employees who worked for you during a specific period, along with information about them including hire and termination date, reason for leaving, title, qualifications, last known address, and phone numbers.
  • Any leases, medical director contracts, or employment agreements you have signed.
  • A list of your practice locations, including addresses and phone numbers.

The second section of the request will list patient records and dates of service to be audited. A ZPIC might request documentation on eight to 300 claims, or more.

What Happens If You Fail to Respond?

If you fail to respond to the request for records or documents, your organization can be suspended from participation in the Medicare program. The ZPIC can also recommend a revocation action against your organization. In the face of a request for documentation, an attorney can protect your organization’s best interests, help you get more time if you need it, and help you prepare the correct documentation for the ZPIC’s review.

Failing to respond to a request for documentation can only make matters worse. Further, you could end up facing serious consequences that you might not have had to face, including complete suspension from the Medicare program.

Speak with an Experienced ZPIC Attorney Today

As you can probably guess, the best thing you can do is ensure that you have a qualified legal team on your side. If you have been contacted about providing documentation for a ZPIC, you should call us immediately for a consultation. You don’t want to risk making serious mistakes or accidentally failing to provide the information requested.

To learn more about a ZPIC audit and what you can expect if documents are requested, you can speak with one of our attorneys at Oberheiden, P.C. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.

3 Reasons Medical Professionals Need Experienced Audit Attorneys

audit attorney

As a medical professional, you’re busy with your patients and growing your practice. The last thing you probably think about is having a lawyer on retainer. After all, you aren’t doing anything illegal so why should you worry?

Unfortunately, when it comes to ZPIC audits medical businesses, things become more complicated. Even small errors can cost you your business and the reputation you’ve worked so hard to build. This is one reason it’s crucial that you have a qualified audit attorney on your side from the beginning. Other reasons you should consider keeping an audit attorney on your side include the following.

You Don’t Know What Your Staff is Doing

While your motto might be to provide the best care to your patients as possible, your staff might have other ideas. No matter how well you screen those that you hire, you can’t weed out everyone who turns in sloppy work, or people who write incomplete patient reports. Plus, you have your own work and can’t monitor every step your employees take. You might not be held responsible for these actions, but you could be, and your business could pay the price. An attorney can help you get through the process if your staff make errors that trigger an audit.

You Could be Audited at Any Time

Like nearly all medical professionals these days, you probably get reimbursed from some type of government agency, such as Medicare or Medicaid. With all the changes in regulations and rules, it can be tough to keep up while running a business. This can leave you and your practice vulnerable to action if you happen to be the subject of an audit. One of the most challenging aspects of being audited is that you will likely not be prepared and will need someone to guide you through the audit.

You Might Need a Buffer Between the Press

Even if you’ve done nothing wrong, there is a strong mentality of “guilty until proven innocent” when it comes to medical professionals. If you or your medical practice is the subject of some type of litigation or even a routine ZPIC audit, it could bring unwanted attention from the press. An attorney can not only speak on your behalf, but also help ensure that you retain your rights.

Even though your life as a medical professional is busy, retaining an experienced audit lawyer can be the best thing you do for your business.

Contact ZPIC Audit Attorneys at Oberheiden, P.C. Today

Even if you don’t think you’ll ever be audited, it’s important for your business that you make the necessary preparations just in case. You could save yourself thousands of dollars in penalties, a ruined reputation, and a destroyed business by making sure you have an experienced legal team on your side. If you are being audited or need help with an appeal, contact the attorneys at Oberheiden, P.C. at (888) 727-5159 or complete our online contact form today.

Agencies That Provide ZPIC Audit Oversight

ZPIC audits

You might have heard of ZPIC, which stands for Zone Program Integrity Contractors. It covers different regions, or zones, of the United States. The Centers for Medicine and Medicaid Services, CMS for short, created ZPIC to investigate potential waste, abuse, and fraud of the Medicaid system.

There are four companies that currently handle ZPIC investigations. Most of them cover two zones each, even though some zones are not contiguous. Here is an overview of the agencies that provide ZPIC audit oversight, and the zones they are responsible for throughout the country.

Zones Covered by ZPIC

The areas covered by each zone mostly contain states bordering each other, though a few of them are not consistent. For instance, Zone 1 contains California, Nevada, and a few Pacific islands while Zone 2 covers the Pacific Northwest, Central America, and Alaska. Although you might normally think Alaska and the Pacific Northwest would include California and end up in the same zone, in this case it isn’t.

Safeguard Services, LLC

Zones 1 and 7 fall under Safeguard Services, LLC. These zones include California, Nevada, Florida, Hawaii, and other US islands. California and Florida contain most of their offices with one of them in Puerto Rico. For those in California, however, this is the zone and the organization that is likely providing the audit oversight in your case.

NCI, Inc.

NCI, Inc. covers the rest of the Pacific Northwest, Alaska, most of central United States, and most of the south. They are one of the larger ZPICs with over 100 locations and 2000 employees and they perform more roles than auditing. NCI specializes in cyber security and other technological fields to assist in civilian and government protection. NCI’s headquarters is currently in Reston, Virginia.

Cahaba Safeguard Administrators

Cahaba Safeguard Administrators oversees Zones 3 and 6, which covers the northern United States and the northeastern seaboard states even though the company is based out of Alabama. CSA has been around for 70 years in total, and started as an insurance company before becoming a Medicare contractor 35 years ago. CSA has spent the last 15 years as a ZPIC with their specialization in statistical analysis to give auditors all the data they need for their investigations.

Health Integrity, LLC

Health Integrity, LLC, based in Maryland, protects the interests of Zone 4. This zone is by far the smallest in scope, protecting Colorado, New Mexico, Oklahoma, and Texas. Texas is renowned worldwide for their medical prowess, so they have their work cut out for them. Health Integrity, LLC includes a staff made up of experts who have a wide range of specializations and experience.

Experienced ZPIC Audit Attorneys at Oberheiden, P.C.

A ZPIC audit can be overwhelming and scary. However, you don’t have to panic. Our attorneys have the experience and skill your company needs to successfully navigate a ZPIC audit. If you are being audited or need help with an appeal, contact the attorneys at Oberheiden, P.C. at (888) 727-5159 or complete our online contact form today.

Not all attorneys of Oberheiden, P.C. are licensed in California and nothing contained in here is meant to constitute the unauthorized practice of law.