How to Prevent a ZPIC Audit
The healthcare industry is as fickle as it is beneficial. Thanks to the wide selection of programs available, billions worldwide can benefit from reduced hospital bills and more affordable healthcare. However, as there are so many packages being claimed left and right, it’s easy for ill-doers to commit fraud to take advantage of the system.
One of the most commonly claimed healthcare packages in the US is Medicare and Medicaid. These two programs are government-run, and they are available for a wide selection of people. The Medicare program is intended for those who are 65 and above and those who are disabled and are 65 and below. The program doesn’t account for the income of the persons it serves.
On the other hand, Medicaid is made for people who are on the poverty line. The poverty line is dependent on how much money a household makes and how many people live in the household. To regulate these programs, an auditing program has been made called the Zone Program Integrity Contractor or ZPIC.
The ZPIC is a special auditing group that investigates any potential fraud in Medicare and Medicaid providers. Aside from that, the program also looks into possible wasting in the healthcare system. Taxpayer’s money funds Medicare and Medicaid after all, so it’s a must that every dollar is put to good use.
If you are a provider of these two widely available programs, the last thing you’d want is to prompt an investigation from the ZPIC. Not only does it put your integrity to shame, but it also creates a rift between you and your beneficiaries. If a ZPIC audit is the last thing you’d want, here are easy ways to avoid it.
Avoiding A ZPIC Audit
Obviously, one of the easiest and best ways to avoid a ZPIC audit is to make sure that you are submitting the right documents. This means not altering any of the data that is presented by your beneficiaries. A ZPIC audit is often initiated by data analysis according to this Ultimate Guide to ZPIC audits that further points out that any discrepancies on anomalies in the data gathered from you could increase your chances of getting audited. Whether intentional or voluntary, data discrepancies really can put a dent in your reputation as the provider. The ZPIC can easily detect something is amidst by comparing your data to the national average. For instance, if a patient of yours spends ten days in the hospital for high fever, whereas the national average is only 5, that will already stand out.
Fraudulent cases don’t always have to come from the service providers. In truth, some service providers are unable to see the source of investigations as well. If you’re a big service provider of Medicare and Medicaid, you’ll be processing many claims on a daily basis. This influx of claims could eventually force you to overlook discrepancies made by your clients themselves.
It’s imperative that you carefully go through all of the data and applications submitted by your beneficiaries. They could be taking advantage of the system, as well. If this is indeed the case, the ZPIC will still reprimand you for the matter as they will see it as oversight on your end.
Ideally, you’d also want to make sure that you aren’t partnered with any unregistered companies or organizations. For the ZPIC, this is a telltale sign that something is already amidst. Of course, you wouldn’t want to risk your beneficiaries by partnering with such companies anyway to avoid them at all costs.
Avoiding a ZPIC audit is as easy as making sure that you are running your agency as just and as properly as possible. The ZPIC will not initiate an investigation on providers that do their business rightly. It’s much easier to initiate getting a ZPIC analysis than it is to avoid having one. Do good, and nothing bad will happen. A simple mantra that you should live by.
You also need to keep in mind that these audits aren’t just there to detect fraud. They are also there to check if everything that is spent on the Medicare and Medicaid packages is just. The ZPIC also wants to ensure that the taxpayer’s money isn’t wasted. Regularly check on your beneficiaries to see if everything is being used properly.
What To Do In Case Of An Audit?
Once you get an audit, there’s no running away from it. In fact, the last thing you’d want to be doing is avoiding your responsibilities as a provider entirely. By cooperating with the auditor, you are basically showing that you are in no way trying to avoid the repercussions of something that you might not have intentionally done.
When an investigation begins, you need to keep in mind that the ZPIC can visit your location – regardless of whether they notify you or not. As that is the case, you’d want to make sure that you always have your documents prepared. It’s also a must that there’s someone to attend to the auditors as soon as possible.
Whether you’re a service provider or a beneficiary, it’s a must that you submit the right documents. By right documents, we mean documents that aren’t altered in any way. Any changes you make in the documents will put you in a bad light, so it’s best to be as honest as possible.
Managing a Medicare and Medicaid provider isn’t easy work considering the number of applicants each day. As a provider, it’s your duty to be as transparent and as just with regard to how you provide the healthcare programs. It’s your integrity on the line. Moreover, it’s important that everyone nationwide gets a fair shot as the two most accessible healthcare packages.
Most importantly, you need to cooperate with your auditor. Keep in mind that they are just doing their jobs and that they want to make sure that your packages are properly managed. Cooperating with them assures that things will go smoothly, and it will also increase your chances of getting out without repercussions.
