With fraud, waste, and abuse (FWA) accounting for up to 10% of healthcare expenditures, the Centers for Medicare & Medicaid Services (CMS) has ramped up audit efforts to ensure compliance. Among these, Unified Program Integrity Contractor (UPIC) audits stand out as one of the most rigorous and high-risk audits providers can face. Failing a UPIC audit can lead to financial …

Curatio Scientia Advisors in collaboration with Armory Hill Advocates releases the “2023 Patient Access: State Legal and Regulatory Environment Survey” Given the dynamic nature of state government activity we sought to validate the following: Patient access to prescription drug therapy is greatly affected by various state and local policy and regulatory parameters. There is no formalized process or aggregating compendium, …

While every provider of the Medicare program is a candidate for an audit, typically, the UPIC audit selection is based on consumer complaints or data analysis. A consumer complaint comes from the company’s employees or the beneficiaries. Meanwhile, data analysis will search for a large number or mix of cases. Those cases will involve patients who’ve received hospice care, stayed in acute …

The Centers for Medicare and Medicaid Services (CMS) created the UPIC (formerly ZPIC) audit to identify and stop fraud and abuse in Medicare and Medicaid. The main goal of a UPIC is to help CMS: Find fraud, abuse, and waste Perform regional Medicare and Medicaid data analysis Complaint resolution Investigate suspected fraudulent activities The UPIC uses the above and additional techniques to …