ZPIC Audits Cripple Miami Provider

MIAMI — Carolina Ferreiro-Diaz, CEO and owner of Pharma-Express in Miami, has been in the home medical equipment business for a dozen years, and while she has dealt with declining reimbursement, increasingly oppressive rules and regulations and impending competitive bidding, she has never felt as threatened as she does now.

Ferreiro-Diaz's full-line HME company is one of scores targeted by Zone Program Integrity Contractors for a 100 percent prepayment audit. CMS has established ZPICs to do both post and prepay audits as a way of curbing improper Medicare payments.

But those audits have proven to be more than onerous, according to reports surfacing in several states, most notably Florida and Texas. Stakeholders say that the ZPICs are zeroing in on small providers to such an extent that they can barely run their businesses because they are so consumed with trying to assemble all the paperwork the auditors demand.

"Every single day, the agency contracted by Medicare to carry out the audit [SafeGuard Services] sends us letters automatically denying the claims for payment submitted by our firm until all documentation is provided to them within 30 days, and then we must wait for 90 to 120 days [for payment]," a frustrated Ferreiro-Diaz told HomeCare.

"We firmly believe that this 100 percent payment process audit that stops payments to our company so radically is with the intention to put an economic strain on us, as well as on all of the other providers, [and] make our business impossible to operate, thus servicing Medicare's goal of having less providers," Ferreiro-Diaz continued.

"All of this is without any prior history on our part or any fraud or anything of that sort," she added. "We have run a clean business for 12 years."

Of all the different types of audits affecting HME providers, the ZPIC audit can be the most concerning, according to Mark Higley, vice president of development for VGM Group, Waterloo, Iowa. Higley put together an information sheet on ZPIC audits, including how to prepare for them and what to do if you receive an audit letter.

"Instead of random audits, ZPICs will have information in hand, and they will know exactly what they want to zero in on," Higley wrote. "Essentially, if you are being audited, it is because the ZPICs may already have evidence that there is a problem with your billing.