- Dr. Nick Oberheiden, managing partner of The Oberheiden Law Group, PLLC, announced today the appointment of its attorney Matthew Lawhon to serve as head of the firm’s ZPIC audit group.
“ Zone Program Integrity Contractor’s , or ZPICs, are private entities contracted by CMS [the Centers for Medicare and Medicaid Services] to protect the integrity of the Medicare Trust,” explains Dr. Nick Oberheiden. “We increasingly see that the federal government is using ZPIC audits as the entry level tool to initiate and prepare larger civil or even criminal healthcare fraud investigations,” adds Mike Elliott, a former U.S. prosecutor with the Department of Justice and now a senior healthcare fraud defense attorney at the Oberheiden Law Group, PLLC.
Matthew Lawhon is no stranger to ZPIC audits. Prior to joining the Oberheiden Law Group, Mr. Lawhon served as a long-time federal healthcare fraud investigator. Among many other functions, Mr. Lawhon held senior positions with TriCenturion, Trailblazer Health Enterprises, and the Medicaid Fraud Control Unit (MFCU). In that capacity, Mr. Lawhon conducted ZPIC investigations and audits and worked closely with state and federal law enforcement.
Matthew Lawhon has firsthand knowledge of how ZPIC audits can become delicate enforcement tools. Matthew Lawhon explains: “The primary goal of ZPIC audits is to identify cases of suspected fraud, waste and abuse, and to take prosecutorial action to ensure that the Medicare Trust Fund monies are not inappropriately used. ZPICs are authorized by CMS to conduct data analysis, perform beneficiary/complainant interviews, site verifications, request medical records from the provider, conduct on-site visits of the provider, and implement auto-denial edits. During their on-site visits, it is not uncommon for ZPIC investigative and audit staff to conduct interviews of provider staff. As a result of their investigative/audit functions, ZPICs can lead to payment suspensions, prepayment denial of payment requests, post-payment collection of overpayments, or referral to law enforcement for consideration and initiation of criminal or civil prosecution, civil monetary penalties (CMP), or other administrative sanctions. Therefore, caution is in order and it is good practice to have experienced attorneys help with ZPIC audits to avoid complications.”
Oberheiden Law Group partner Mike Elliott is the former Chief Coordinator for Criminal Healthcare Fraud and the former Head of the Medicare Fraud Strike Force in the Northern District of Texas. During his tenure with the Department of Justice, Mr. Elliott oversaw, authorized, and prosecuted hundreds of healthcare investigations, including numerous ZPIC audits. From this experience, Mr. Elliott understands the close relationship between ZPIC auditors and government lawyers and he is able to share his valuable insights with his clients at the Oberheiden Law Group.
Oberheiden Law Group attorney Mindy M. Sauter is also a former Team Leader of the Medicare Fraud Strike Force and a former Assistant United States Attorney. Ms. Sauter has extensive experience with ZPIC audits, both as a government prosecutor and a defense attorney, which she utilizes to anticipate government strategies in healthcare matters on behalf of her clients.
The Oberheiden Law Group consists of former Medicare fraud prosecutors and law enforcement personnel that have specific experience with hundreds if not thousands of ZPIC audits. The attorneys’ combined experience of decades in charge of Medicare and Medicaid investigations helps clients of the Oberheiden Law Group PLLC to better understand what government lawyers are looking for when reviewing healthcare data and ZPIC information.
If you are interested to find out more about ZPIC audits, you should visit the Firm’s website at federal-lawyer.com or call Dr. Nick Oberheiden directly at 214.469.9009.
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