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Dr. Nick Oberheiden

Aaron Wiley
Former State &
Federal Prosecutor

S. Amanda Marshall
Former U.S. Attorney

Bill McMurrey
Former DOJ-Trial Attorney

Lynette Byrd
Former Assistant
U.S. Attorney

  • Federal Criminal Defense
  • Federal Trial Lawyers
  • Search Warrant Defense
  • Grand Jury Subpoenas
  • OIG Subpoenas
  • Whistleblower Cases
  • FBI, DEA, IRS, OIG, HHS Cases
Understanding the Ins and Outs of a ZPIC Compliance Plan

Categories: Health Care Law

ZPIC denial decision audit

If you’re a small-to-mid-sized provider practice and you don’t have a ZPIC compliance plan in place – you’re not alone. Many smaller providers become so overwhelmed with the day-to-day realities of caring for patients that they let building and implementing a compliance plan fall by the wayside. But drafting and implementing such a plan can help you be prepared for a ZPIC audit before such an audit ever takes place.

However, trying to determine where you should start can be complicated. To get you started, here are a few things you should know about creating and maintaining a ZPIC compliance plan for your business.

Make Sure You Avoid Fraudulent Activity

Although it might seem like an obvious element, it’s important that you, your organization, and your employees avoid any fraudulent activity. However, sometimes people can engage in activities considered fraudulent without even knowing it. This is just one of the reasons it’s important to have a plan in place, to protect your business and its employees. A ZPIC compliance plan is a strategy you can implement to stay on the right side of Medicare billing regulations, so that you can rest assured that no one in your practice is committing Medicare fraud, inadvertently or otherwise.

You need to put a ZPIC compliance plan tailored to the unique needs of your practice into place immediately. Section 6401 of the Affordable Care Act (ACA) requires all medical providers who wish to participate in the Medicare program to establish such a plan. If you have difficulty with any part of this process, you should consult a qualified attorney for assistance.

Compare Your Practices with Regulatory Provisions

First, review the statutory and regulatory provisions related to any services your practice bills to Medicare. Then, compare your actual documentation, coding, and billing practices with Medicare guidelines. Immediately take steps to fill any gaps between your practice’s billing, coding, and documentation practices and the Medicare rules regarding these practices. If you find an overpayment, you need to repay this money to the government within 60 days.

Before you perform an analysis of your billing, coding, and documentation practices, it’s a good idea to enlist the help of an attorney who can ensure that your internal review is accurate and your compliance plan effective.

Let a Trusted and Experienced Federal Attorney Help with Your ZPIC Compliance

Does your organization or facility have a ZPIC compliance plan? Chances are, you aren’t as prepared for a ZPIC audit as you might think. In order to protect your business, employees, and clients, you’ll need to ensure you have a qualified ZPIC legal team on your side from the beginning to the end.

Make sure you don’t make costly mistakes that can affect your business and its employees. To learn more about defending yourself against a ZPIC audit or if you need assistance filing a ZPIC appeal, you can contact the attorneys at Oberheiden, P.C.. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.

Who Will Handle Your Case

When you hire us, you will not work with paralegals or junior lawyers. Each lawyer in our Health Care Practice Group has handled at least one hundred (100) matters in the health care industry. So, when you call, you can expect a lawyer that immediately connects with your concerns and who brings in a wealth of experience and competence. For example, you need someone like Lynette S. Byrd, a former federal prosecutor in health care matters, who recently left the government and who is now sharing the valuable insights she gained as a health care prosecutor with our clients.

Bill C. McMurrey

Bill C.

Dr. Nick Oberheiden

Dr. Nick

Lynette S. Byrd

Lynette S.