Learn What Happens After a ZPIC Audit

Are you currently facing a ZPIC audit? You might be wondering what’ gonna happen afterward. There are some instances that the audit results to negative consequences for healthcare providers. A ZPIC audit can have heart-breaking effects on your business which may include loss of income to penalties, worse, losing your business. At Oberheiden & McMurrey, LLC, these group of former prosecutors and ZPIC Audit Attorney will help you with your case.

However, there is also a possibility that you come out ahead. Don’t risk the future of your business by trusting your case in the wrong hands. Never navigate a ZPIC audit alone. Before we proceed with the possible outcomes, let us know first the basic mistakes that providers do to get to these devastating results.

Common Mistakes to Avoid.

A simple carelessness can lead to negative results in ZPIC Audits. We must understand that before this happens, we must brace ourselves and be prepared to protect our businesses. It is important to know the proper response and steps to be taken to avoid exposure to potential civil or criminal liabilities.

  • Non-compliance of Document requests. These documents are usually being asked by the ZPIC auditors. Failure to comply may result in noncompliance.
  • Lack in self-auditing. This is done to correct any overseen mistakes in coding and billing.
  • Leaving the Audit Process Solely to the Auditor. You should keep track of every step taken during the audit process.
  • Failing to Stay Up to Date on Coding Changes. You and your employees should be aware of changes in coding rules.

Possible Outcomes of  ZPIC Audit.

Depending on your situation, here are a few of the outcomes you can expect after a ZPIC audit.

Review of Pre-Payments.

Most of the time, the result of a ZPIC audit is by demanding a pre-payment review system for an undetermined amount of time. They will review and approve some of the provider’s Medicare claims. If there are errors of payment found by the ZPIC in their investigation, current and future cases will be reviewed. Medicare claims will go back to full swing once again if the pre-payment reviews are finished.

Monetary Compensation.

ZPIC has the option to reclaim cases that resulted in overpayments. The ZPIC has their own ways to implement this depending on the severity of their charges against the provider. They can be very keen on going through each case, or maybe demand a fee based on the extrapolation of previous overpayments.


Once the ZPIC suspects fraud, they will report the healthcare provider to law enforcement agencies. They don’t need that much evidence of fraud to report the provider. Law agencies involved can include the OIG or the office of the Inspector General. In three months time, the Office of the Inspector General can either reject the case or escalate it to the Department of Justice.

Revocation of License/Blacklist

This is probably the worst that can happen. A ZPIC can blacklist the provider from Medicare. It is best to cooperate with the auditor’s requests during the ZPIC investigations. The outcome of a ZPIC audit usually depends on what they can find in their investigation. In the provider is uncooperative, there is a possibility that they could also be charged with criminal charges and jail time.


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