Audits: Proven Strategies to Survive a ZPIC Investigation

Length: 60 minutes Expert: Wayne Miller, Esq.

Are you prepared to defeat the most dangerous weapon that Medicare currently has at its disposal, Zone Program Integrity Contractors (ZPICs)? ZPICs are so dangerous because they conduct “law enforcement-like” audits and investigations (that are on the rise). And, they don’t have to get CMS approval for the issues they choose to target; unlike other companies that Medicare contracts with.

Also, you need to know that ZPICs don’t discriminate. They go after almost every type of Medicare/Medicaid provider (Parts A, B, DME, Prosthetics, Orthotics, Supplies, Home Health and Hospice) regardless of size or specialty. Based on suspicions of fraud alone, ZPICs have the authority to get your reimbursement suspended. And if they find you have engaged in a pattern of inappropriate billing, then they can get Medicare to revoke your approval.

So, how can you protect yourself against these contractors? That’s where healthcare attorney, Wayne Miller, Esq., can help. During his online training session, Wayne will provide you with a breakdown of a real ZPIC case. He’ll walk you through how to accurately respond to ZPIC notifications so that you can significantly reduce the possibility of you being hit with full-blown allegations of fraud, and the serious consequences that go with them.

Here are just a few of the practical, real-world ZPIC survival strategies you’ll receive by ordering this 60-minute online training:

  • Identify denial “tells” that put you on top of the audit list
  • Respond to auditor inquiries more accurately to avoid serious outcomes
  • Reduce your chances of being suspended from Medicare and losing income
  • Delay your recoupment responsibilities after audit findings are issued
  • Increase appeal success with specific strategies that really work
  • Avoid audit interviews from generating ammunition against you
  • Master the use of the extended repayment system to avoid offsets
  • And so much more…

Who should order: If you bill Medicare or Medicaid you are at high risk of being audited. About 90% of ZPIC audits are a direct result of their analysis of your data that identifies claims that appear to be out-of-sync with those of your peers. The remainder of audits are generated because of complaints by your internal staff.

ZPICs have been underpublicized, reducing your ability to reduce your risk. They quietly investigate you, can stick you with a major overpayment obligation, and get your reimbursement halted in a snap. Don’t get caught in a ZPIC web. Order this must-have online training today.

IMPORTANT: While ZPICs aren’t paid based on how much money they recoup from you, they still have a strong financial incentive to relentlessly target your claims and identify reasons to audit you. CMS has clear recoupment expectations for its contractors and if they don’t perform as expected, they lose their CMS contracts. In 2016, the Office of the Inspector General (OIG) won or negotiated over $2.5 Billion in health care fraud judgments and settlements. So, ZPICs have a lot to lose.

Meet Your Expert

Wayne Miller
Esq.Partner, Compliance Law Group

Wayne has focused his practice in the areas of health care regulatory, administrative and transactional law throughout his nearly 30-year career. He has particular expertise in business, regulatory, certification and administrative matters for health care facilities. He also represents health care related businesses and for advisors and consultants to the health care industry.

In addition to his law degree, Wayne has a Masters Degree and experience in health care administration. He has served as editor and advisor for, or has been cited in, many national publications, including Medical Economics, Eli Research publications, FDAnews, the Ingenix Ambulatory Payment Report, the Health Care Law Sourcebook and the Health Care Law Newsletter. Wayne has been a featured speaker on national teleconferences sponsored by The Coding Institute and other organizations for many years.


It was nice with question and answer section.
Herbert Ezugha
MD, Neuro and Epilepsy care Inc