![]() Perform data analysis in coordination with CPI's Fraud Prevention System, IDR and One PI.Perform medical review, as appropriate.Conduct investigations in accordance with the priorities established by CPI's Fraud Prevention System.Investigate potential fraud and abuse for CMS administrative action or referral to law enforcement.They also identify any improper payments that are to be recouped by the MAC (Medicare Administrative Contractor)." ![]() They develop investigations early, and in a timely manner, take immediate action to ensure Medicare Trust Fund monies are not inappropriately paid. "UPICs primary goal is to investigate instances of suspected fraud, waste, and abuse in Medicare or Medicaid claims. The UPICs and the MEDIC work under the direction of the Center for Program Integrity (CPI) in CMS." ( Noridian Website Quote)Īccording to CMS, CMS often receives referrals of potential improper payments from MACs, UPIC, and other investigative agencies. Medicare Part C and D program integrity efforts are handled separately by one national contractor known as the Medicare Drug Integrity Contractor (MEDIC). UPICs essentially identify monies that need to be recouped by the MACs.Īccording to Noridian, "UPICs were created to perform program integrity functions for Medicare Parts A, B, Durable Medical Equipment Prosthetics, Orthotics, and Supplies, Home Health and Hospice, Medicaid and Medicare-Medicaid data matching. ![]() A UPIC is a "United Program Integrity Contractor." That means, it is a contractor that is looking for improper payment (fraud) and the results can be devastating, even ruinous for home health and hospice agencies.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |