Legal
CMS May Overhaul Unified Program Integrity Contractor Structure
In a client alert, McDermott Will & Schulte reports that CMS may be preparing a significant overhaul of its Unified Program Integrity Contractor (UPIC) program, the contractors responsible for investigating Medicare and Medicaid fraud, waste, and abuse. The firm suggests CMS could take a more direct role in managing program integrity functions currently delegated to UPICs, though specifics of the anticipated changes are still emerging. Providers and health plans subject to UPIC audits and investigations would be affected by any restructuring of oversight authority or investigative processes. The firm does not specify an effective date, indicating the change is still in a preparatory or anticipated stage.
Why it mattersProviders and Medicaid managed care plans facing UPIC audits should watch for changes to investigative authority and procedures that could alter how fraud, waste, and abuse cases are initiated and resolved.