By Adam Turteltaub

An audit by a Unified Program Integrity Contractor auditor, better known as a UPIC audit, can be a very scary thing. Providers are often shocked and even indignant to receive a letter notifying them of the audit and alleging fraud.

Jon Rawlson (LinkedIn), President & Founder of Armory Hill Advocates, reminds us that the audit was likely not triggered by an allegation but by an algorithm catching outlier events such as a provider processing claims outside of their normal daily work, utilizing a DME, a skin substitute or some other expensive item that is outside the norm.

Once you have calmed down after reviewing the letter, he advises acting immediately but calmly. Begin reviewing the documents you have been providing the Medicare program and bring in whatever help you need. And, don’t forget you have a five step appeal process that enables you to prove  your innocence.

But, be mindful of the timeline the government gives. The consequences can be grave if you miss a deadline.

Listen in to learn more, and if you’re a member of SCCE or HCCA, be sure to read his article on the subject in Compliance Today magazine.

Listen now

Sponsored by Ethena - automated compliance training, an employee hotline, and case management, all in one tool.