Pain Center Problems: Understanding ZPIC Audits
We heard from patient Pat Brunker Monday night. She’s right in the thick of the audit a ZPIC is conducing at the Alabama Pain Center. She gets crucial medicine from the APC.
But even people following along with the audit closely have trouble figuring out what exactly is happening with the clinic. Brunker says, “I don’t get it. I just don’t understand what’s going on here.”
The Center for Medicare and Medicaid Services provided us some documents to help with that.
The documents explain that Zone Program Integrity Contractors, or ZPICs, are charged with investigating Medicare fraud.
They do that by launching audits, like the one at Alabama Pain Center.
They’ve got a few tools at their disposal.
ZPICs are allowed to go through medical records, conduct interviews, and perform on-site visits.
They also have some hefty punishments at their disposal. They can identify the need for payment suspension, withhold payments outright, and even refer cases to law enforcement.
At the pain center, they’ve suspended payments for months, and patients have taken to the digital rooftops to declare it unfair.
Brunker says, “I have shouted from every email that I can imagine to try to get people to know what’s going on here, and I don’t know what else to do.”
For now, it seems all the Alabama Pain Center can do is wait for their appeal.