UPICs are coming: Will you be ready?

Lisa Shuman | October 2014

Currently, the Centers for Medicare & Medicaid Services (CMS) use separate Medicare and Medicaid integrity contractors to predict, detect, prevent, and deter threats to the integrity of the Medicare and Medicaid program.  CMS has plans to establish Unified Program Integrity Contractors (UPICs) to reorganize and consolidate the work of the Medicaid Integrity Contractors (MICs) and the Medicare Zone Program Integrity Contractors (ZPICs).  This will bring further consolidation and increased claims data transparency and availability to integrity contractors.  For the provider community, this will mean more and improved surveillance and increased potential for government scrutiny of claims payments by federal healthcare programs.  Simply put, CMS contractors will not only have more data, but even more knowledge about healthcare organizations’ claims and payments than ever before, due to this consolidation.  In light of these developments, any provider, plan, or supplier will have to think strategically and take proactive measures.  Those that want to thrive and succeed in the market should take action now, before UPICs are operative.

About the Author

Ms. Shuman assists health care organizations to develop, implement and evaluate their compliance programs and HIPAA privacy programs. Ms. Shuman specializes in our firm’s HIPAA Privacy services, including leading privacy investigations, breach risk assessments, breach notification letters, breach reporting to the Office for Civil Rights and corrective actions plans. She specializes in serving as Interim Privacy Officer for large health care systems, managed care organizations, comprehensive cancer center and health care business associate.