Medicare UPIC Audit: Ensuring Integrity in Healthcare Services

The Centers for Medicare & Medicaid Services (CMS) has been taking steps to ensure the integrity of healthcare services under the Medicare program. One of these measures is the Unified Program Integrity Contractors (UPICs), which were introduced as a recent addition to the acronym soup of Medicare Contractors.

Background Information on UPIC Contractors

In June, CMS issued Transmittal 10184 (Change Request (CR) 11812), providing information about updates being made to the Medicare Program Integrity Manual. According to this transmittal, the UPICs were inserted in several places in this document, highlighting their significance in ensuring program integrity.

Geographical Jurisdictions and Contractors

The UPIC contracts operate in five separate geographical jurisdictions in the United States. These jurisdictions include:

* South-Eastern States: West Virginia, Virginia, North Carolina, South Carolina, Tennessee, Alabama, Georgia, and Florida (Contractor: SafeGuard Services LLC)

* Northeastern States: Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, and District of Columbia (Contractor: SafeGuard Services LLC)

* Midwestern States: Iowa, Illinois, Indiana, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, and Wisconsin (Contractor: CoventBridge Group)

* Southwestern States: Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, and Mississippi (Contractor: Qlarant)

* Western States: Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming (Contractor: Qlarant)

Activities Performed by UPICs

Specifically, the UPICs perform integrity-related activities associated with the following:

* Fraud, waste, and abuse detection, deterrence, and prevention activities for Medicare and Medicaid claims processed in the United States

* The Medicare-Medicaid data match program (Medi-Medi)

* Home Health and Hospice (HH+H), Medicaid, and other programs

In conclusion, the UPIC audit is an essential step in ensuring the integrity of healthcare services under the Medicare program. With the introduction of the UPIC contractors, CMS has taken a significant step towards combating fraud, waste, and abuse in the system. By understanding the geographical jurisdictions and activities performed by the UPICs, stakeholders can better appreciate the importance of this initiative.

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