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Defending Against a ZPIC or other Potential Fraud Investigation by the OIG

Sarah Mendiola

W&W Director of Clinical Services and Senior Associate, Sarah Mendiola, will present at the Spring Meeting of the Iowa Chapter of the HFMA on April 16th.  Ms. Mendiola’s presentation, “Defending Against a ZPIC or other Potential Fraud Investigation by the OIG,” will explore the growth in auditing that is being performed by ZPICs and the OIG.  The presentation will explore how providers can best defend their organizations when faced with potential fraud allegations and discuss what the auditors are potentially looking for.  In order to understand the unique impact of a ZPIC audit, Ms. Mendiola will present a case study to analyze statistical sampling and the effect of extrapolation on an organization. Using this case study attendees will be provided with a walk through of the steps of the audit and an explanation of how to recognize and respond to the ZPIC, and if necessary, how to subsequently appeal.  Ms. Mendiola will also take a look at what lies ahead and the activity that providers can expect to see from the OIG in the future.

Learning Objectives:
• Analyze an example of a ZPIC audit from the medical records request through the appeals process to understand the potential ramifications an organization may face.
• Understand the OIGs recent areas of focus and the impact that they can have on an organization by reviewing a sample case study.
• Gain a prospective view of what these auditors will be auditing in the future.
• Understand how the auditing landscape is changing, potentially aligning physician and hospital interests for “related” claims, and what this means to providers.

Where: Iowa HFMA, Spring Meeting, Hilton Garden Inn, 8600 North Park Drive, Johnston, Iowa

When: April 16-17, 2015

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