New ZPIC Medicare Audits: Are You Ready?

Preparing for Heightened CMS Enforcement Against Fraud and Abuse

Recording of a 90-minute CLE webinar with Q&A


Conducted on Thursday, July 29, 2010

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will provide guidance for healthcare counsel to understand and prepare for CMS's new Zone Program Integrity Contractor (ZPIC) audits. The panel will outline proactive steps to minimize the risk of such audits and offer strategies for appealing unfavorable audit results.

Description

The Centers for Medicare & Medicaid’s new Zone Program Integrity Contractors (ZPICs) audits present healthcare providers with a major new enforcement challenge. ZPICs, CMS’s latest weapon to detect fraud and abuse, target both the medical necessity of a claim and coding errors.

ZPIC audits are disruptive, time consuming and expensive. ZPICs differ from recovery audit contractors because they can arrive unannounced, demand medical records, and interview both providers and beneficiaries. Further, ZPICs can conduct both pre-payment and post-payment reviews.

Listen as our authoritative panel of healthcare attorneys examines the role of ZPICs and ZPIC audits, and offers strategies to reduce the changes of ZPIC audits, cope with an audit if the ZPICs arrive, and appeal unfavorable ZPIC audit results.

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Outline

  1. Role of ZPICs
    1. Identifying vulnerabilities in the Medicare program
    2. Identifying and investigating potential fraud cases
    3. Referring cases for prosecution
    4. Data analysis
  2. ZPICs audits
    1. Contractor authority
    2. Role of extrapolation
    3. Fraud and abuse consideration
  3. Preparing for ZPICs
    1. Compliance program
    2. Risk assessments
    3. Training
  4. Strategies for responding to inquiries and appealing ZPICs

Benefits

The panel will review these and other key questions:

  • What can a healthcare provider expect to happen during a ZPIC audit?
  • What are the key steps healthcare providers can take to minimize the risk of a ZPIC audit—and prepare for a potential ZPIC audit?
  • What are the best practices for healthcare providers to challenge an unfavorable audit outcome?

Faculty

Sara Kay Wheeler
Sara Kay Wheeler

Partner
King & Spalding

She has extensive experience in the creation and implementation of corporate compliance programs and investigations,...  |  Read More

Steve Lokensgard
Steve Lokensgard

Special Counsel
Faegre & Benson

He has extensive experience with identifying and managing regulatory and financial risk. He assists healthcare clients...  |  Read More

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