Unified Program Integrity Contractors – An Overview by Wayne van Halem, founder and President of the van Halem Group Atlanta, GA - Unified Program Integrity Contractors (UPICs) have been around now since 2016. These audit contractors are tasked with identifying and preventing fraud, waste and abuse. Unfortunately, what we often see are auditors identifying claim errors and overpayments versus identifying actual fraudulent activity.  The original UPIC contracts were valued between...

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The Medicare audit process and coverage criteria do not work properly. They must be modified in order to reduce their negative impact on home medical equipment providers’ operational and financial resources, and consequently, their ability to continue caring for patients. AAHomecare is concerned that the audit standards used by Medicare contractors are having the following unintended consequences: Eligible Medicare beneficiaries are not receiving medically necessary and covered...

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