UPIC Audits Target Medicare and Medicaid Provider Billing Compliance
Unified Program Integrity Contractors (UPICs) are CMS-hired auditors that review healthcare provider medical and billing records to identify improper payments and pursue recoupments in Medicare and Medicaid programs. UPICs operate as part of CMS's broader program integrity enforcement infrastructure. The article provides a procedural overview for providers facing UPIC audits, covering response strategies and compliance steps. This guidance is relevant for any Medicaid managed care organization or provider subject to program integrity review.
Medicaid MCOs must understand UPIC audit processes because contracted providers facing recoupment actions may trigger network stability issues, encounter credentialing complications, or require MCO support in responding to federal program integrity investigations.
Managed Care · Finance
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