Cases & Deals

Health care providers defend Medicare extrapolated audits of claims

Client(s) Health care provider

Jones Day is defending a hospice company against an alleged extrapolated overpayment calculated by a Zone Program Integrity Contractor (ZPIC) on behalf of the Centers for Medicare and Medicaid Services. The grounds for the ZPIC’s determination include alleged lack of medical necessity and documentation errors. The matter was initially separated and we were successful in obtaining a consolidation, which is an action the Centers for Medicare and Medicaid have historically rejected.