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Is the UPIC Fraud Prevention System Broken?

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Manage episode 502480215 series 2288292
Content provided by RACmonitor. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by RACmonitor or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.

The Unified Program Integrity Contractors (UPICs) are household names in healthcare compliance.

But their track record tells a troubling story, according to senior healthcare analyst Frank Cohen. These Medicare fraud enforcement contractors are using controversial extrapolation techniques that providers successfully challenge over 60 percent of the time on appeal.

Cohen, who will be the special guest during the next live edition of Monitor Mondays, said he will examine how the 2016 consolidation created five regional enforcement powerhouses, along with why their statistical methodologies are devastating practices based on flawed assumptions. Cohen intends to show how misaligned incentives are creating systematic accuracy problems, while revealing why the current UPIC system might be fundamentally broken, despite everyone agreeing that fraud prevention matters.

The weekly broadcast will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

  continue reading

Chapters

1. Is the UPIC Fraud Prevention System Broken? (00:00:00)

2. Ronald Hirsch, MD (00:01:09)

3. Knicole Emanuel, Esq (00:05:21)

4. RACmontior Commercial (00:10:51)

5. David Glaser, Esq (00:11:36)

6. RACmontior Commercial (00:17:11)

7. Matthew Albright (00:18:10)

8. Frank Cohen (00:23:30)

9. Q&A With David Glaser (00:27:57)

10. Closing (00:29:31)

368 episodes

Artwork
iconShare
 
Manage episode 502480215 series 2288292
Content provided by RACmonitor. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by RACmonitor or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.

The Unified Program Integrity Contractors (UPICs) are household names in healthcare compliance.

But their track record tells a troubling story, according to senior healthcare analyst Frank Cohen. These Medicare fraud enforcement contractors are using controversial extrapolation techniques that providers successfully challenge over 60 percent of the time on appeal.

Cohen, who will be the special guest during the next live edition of Monitor Mondays, said he will examine how the 2016 consolidation created five regional enforcement powerhouses, along with why their statistical methodologies are devastating practices based on flawed assumptions. Cohen intends to show how misaligned incentives are creating systematic accuracy problems, while revealing why the current UPIC system might be fundamentally broken, despite everyone agreeing that fraud prevention matters.

The weekly broadcast will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

  continue reading

Chapters

1. Is the UPIC Fraud Prevention System Broken? (00:00:00)

2. Ronald Hirsch, MD (00:01:09)

3. Knicole Emanuel, Esq (00:05:21)

4. RACmontior Commercial (00:10:51)

5. David Glaser, Esq (00:11:36)

6. RACmontior Commercial (00:17:11)

7. Matthew Albright (00:18:10)

8. Frank Cohen (00:23:30)

9. Q&A With David Glaser (00:27:57)

10. Closing (00:29:31)

368 episodes

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