MAC

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Pierce the Corporate Veil — Are You Personally Liable for a UPIC Overpayment?

(Updated January 9, 2021): Owners of healthcare companies often wonder whether the government can pierce the corporate veil and try to hold the owners personally liable for overpayment claims when facing a program integrity audit by a Unified Program Integrity Contractor (UPIC). [1] This rarely happens, but assuming that a provider does not prevail in […]

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CMS Announces Home Health Pre-Claim Review Demonstration Project for Five States

(July 5, 2016) The Centers for Medicare and Medicaid Services (CMS) has announced a home health pre-claim review demonstration project to be initiated in five states. According to CMS, the purpose of the new project is to prevent improper Medicare payments, enhance quality of care, and deter waste, fraud, and abuse in the Medicare program.

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Medicare Administrative Contractor Changes — MAC Changes and Update.

(July 5, 2012): Recently, the Centers for Medicare & Medicaid Services (CMS) has done some realignment of its Medicare Administrative Contractor (MAC or AC) jurisdictions for Medicare Parts A and B. In addition, it has actively sought proposals through a competitive bidding process to get the most cost-effective contractors processing Medicare claims. Because of all

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ZPIC Participation in ALJ Hearings is Increasing

(February 12, 2011): Over the last year, we have noted an important trend when representing Medicare providers in post-payment overpayment cases at the Administrative Law Judge (ALJ) level of appeal. Medicare contractors are actively attending and participating in many ALJ hearings. In fact, it is now common for a Zone Program Integrity Contractor (ZPIC) to

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Keeping an Eye on the Medicare AdQIC

(May 16, 2023): The Medicare program is enormous. The Centers for Medicare & Medicaid Services (CMS) estimates that Medicare Administrative Contractors (MAC) process 1.2 billion[1] fee-for-service claims each year in connection with the original[2] (or traditional) Medicare program. If you have ever been involved in a Medicare postpayment audit (or even a prepayment audit[3]) where

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