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Unified Program Integrity Contractors (UPIC)

By:  InstaCode Institute
Published:  February 15th, 2016

There are numerous Medicare & Medicaid review programs which have been created to step the problems of improper payments, fraud and abuse within these federal programs. CMS is currently working with Integrity Management Services to consolidate and simplify. The resulting Unified Program Integrity Contractors (UPIC) aims to coordinate audits, investigations, and data analyses. Additionally, the official stated intent is to also lower the burden on providers who are trying to meet all the requests of different auditing agencies.

According to the CMS' "Comprehensive Medicaid Integrity Plan for Fiscal Years 2014 - 2018" report (emphasis added):

"... CMS is developing a Unified Program Integrity Contractor (UPIC) strategy. Under this strategy, Medicare and Medicaid program integrity audit and investigation work at the federal level will be consolidated into a single contractor within a defined multi-state area, which will complement audit and investigation efforts by states. This contractor will conduct Medicare, Medicaid, and Medi-Medi investigations and audits within designated geographic jurisdictions. In July 2013, CMS released a Request for Information and conducted an Industry Day targeted at gathering information from the vendor community on possible requirements for combining Medicare and Medicaid program integrity functions. CMS expects to implement the UPIC strategy beginning with initial contract awards in FY 2015 with additional transitions to occur in subsequent fiscal years."

With the expansion of Medicaid as a result of the Affordable Care Act (Obamacare), ensuring minimal fraud and abuse is necessary to control program costs. Contracts are currently being awarded and this new program is now underway.


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