What Happens in a ZPIC Audit?

ZPIC audits

Unlike other types of audits, a ZPIC audit is not simply one that is random. Instead, the ZPIC is looking specifically for any instances or indicators that fraudulent behavior has taken place. If you or your medical practice has received notification that a ZPIC audit is impending, here’s a brief idea of what you can expect from the process.

Uncovering Fraud is the Priority

As you’re probably already aware, a ZPIC is not randomly looking for inconsistencies. Instead, he or she is focused squarely on fraud and any issues that might point to a willful intent to defraud the government of Medicare funds.

Requests for Documentation are Encompassing

ZPICs have been handed an enormous amount of power by the government. As government contractors, ZPICs can request your Medicare medical records and other documentation without specifying a look-back period. They are also not limited in the number of documents they can request. It isn’t unusual to hear of medical professionals receiving tens or even hundreds of such requests each day. For many facilities, just managing and complying with the document requests is overwhelming.

Data Analysis is Deployed

ZPICs have the latest in data analysis techniques at their disposal. They’ll probe samples, use statistical sampling, and analyze the data to reach conclusions about your intent. When it comes to a ZPIC audit, it’s much more complicated than just spotting a blatant act of fraud.

Interviews are Conducted

You can expect the ZPICs involved in your audit to conduct interviews with both your staff and your patients. They will likely ask pointed questions of your staff regarding your policies and processes when it comes to handling Medicare documentation. The ZPIC will also dive deep into your patient records to learn if a particular procedure was necessary or even performed as you have indicated.

Onsite Visits are the Norm

As part of the ZPIC auditing process, onsite visits without prior notice are to be expected. One way to prepare for this inevitability is to update your medical billing processes as soon as you’ve been notified that you’re the subject of a ZPIC audit. Be sure to have all your staff read it thoroughly and sign off on it.

Depending on the outcome of the ZPIC audit, further action could be initiated. This could include the withholding of payment, automatically denying claims, or referring your case to law enforcement. It’s important that you contact an attorney with experience with ZPIC audits to protect yourself and the practice you’ve built.

Experienced ZPIC Audit Attorneys Can Help

Although the process might vary depending on the practice and the circumstances, one thing that’s certain is that a ZPIC audit can be overwhelming and stressful. After all, your business and your livelihood may be on the line. An experienced legal team can help you navigate this process in the best way possible.

If you are being audited or you want to prepare for an audit, we can help. Contact the attorneys at Oberheiden & McMurrey, LLP at (888) 727-5159 or complete our online contact form today.