Successful UPIC Audit Appeal

We represented a hospice provider in successfully appealing a Unified Program Integrity Contractor (UPIC) audit, which utilized a statistically valid random sample to calculate an extrapolated overpayment of $7.6 million. On appeal, we secured a reversal of almost all but two technical denials, resulting in a substantial reduction in the extrapolated overpayment and a refund of almost the entire extrapolated amount previously recouped. After presentation of legal arguments and clinical and statistical experts, the Administrative Law Judge (ALJ) affirmed the hospice care was appropriate and properly documented, identifying only two minor technical issues.

We represented a hospice provider in successfully appealing a Unified Program Integrity Contractor (UPIC) audit, which utilized a statistically valid random sample to calculate an extrapolated overpayment of $7.6 million. On appeal, we secured a reversal of almost all but two technical denials, resulting in a substantial reduction in the extrapolated overpayment and a refund of almost the entire extrapolated amount previously recouped. After presentation of legal arguments and clinical and statistical experts, the Administrative Law Judge (ALJ) affirmed the hospice care was appropriate and properly documented, identifying only two minor technical issues.