![]() ![]() Department of Health and Human Services (HHS) Office of Inspector General (OIG) found “wide unexplained disparities in program integrity activities across UPICs” during 2019 in both Medicare fee-for-service and Medicaid programs, even after adjusting for the size of their respective geographic oversight responsibilities.įor example, UPIC contractors conducted “substantially more Medicare fee-for-service program integrity work” that year compared to those for state Medicaid programs. Some of these got to million dollar amounts, it’s become pretty standard to see that.”Ī recent study from the U.S. Those were often high-stakes audits that involved claims data extrapolation and review of longer length of stay patients. UPICs really dominated our work over the past couple of years. And it just keeps increasing,” Nowicki told Hospice News. “In a typical year, we see three, four or five hospice audit matters in a month, but last year it was more than double that. The law firm has seen greater numbers of these audits among its hospice clients, with some providers facing severe financial impacts, he said. ![]() The frequency of UPIC audits have surpassed those of other types in the hospice space during recent years, according to Bryan Nowicki, partner at Husch Blackwell. ![]() It’s bridging the auditors’ gaps in that knowledge and using regulatory resources efficiently without detriment to quality providers and hospice beneficiaries.” “To make real change in an efficient way, auditors must really understand what is important in hospice care. “The overpayment issues that result in millions for hospices can sometimes feel like a disconnect between data analysis and identifying problems around credible information,” Pekarske said. This is a jump from the $113.6 million in FY 2019īut UPICs and hospice providers sometimes disagree on what constitutes an improper payment. Various UPIC administrative actions are designed to recap savings for Medicare and Medicaid, including claims denials, payment suspensions, overpayment recovery, and in some cases provider revocations and deactivations or law enforcement referrals.ĭuring 2020, UPIC post-payment reviews reclaimed $200.2 million in improper payments, according to the CMS report. ![]()
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