Alphabet Soup: RACs, MICs, MFCUs, CERTs, ZPICs, PERMs and Their Respective Look Back Periods

Worth a re-blog. Audits concerning Medicaid eligibility is coming tomorrow!!


I have a dental client, who was subject to a post payment review by Public Consulting Group (PCG). During the audit, PCG reviewed claims that were 5 years old.  In communication with the state, I pointed out that PCG surpassed its allowable look back period of 3 years.  To which the Assistant Attorney General (AG) said, “This was not a RAC audit.”  I said, “Huh. Then what type of audit is it? MIC? ZPIC? CERT?” Because the audit has to be one of the known acronyms, otherwise, where is PCG’s authority to conduct the audit?

There has to be a federal and state regulation applicable to every audit.  If there is not, the audit is not allowable.

So, with the state claiming that this post payment review is not a RAC audit, I looked into what it could be.

In order to address health care fraud, waste, and abuse…

View original post 953 more words

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on November 17, 2015, in Medicaid. Bookmark the permalink. 5 Comments.

  1. I’d say “unbelievable” —but we have learned to expect the Spanish Inquisition. LF On Tue, Nov 17, 2015 at 11:59 AM medicaidlaw-nc wrote:

    > kemanuel posted: “Worth a re-blog. Audits concerning Medicaid eligibility > is coming tomorrow!!”

  1. Pingback: Health Care Integration: A Glimpse Into My Crystal Ball | medicaidlaw-nc

  2. Pingback: Medicare Audits – TPE Audits Are Here, But For How Long? | medicaidlaw-nc

  3. Pingback: How Does OIG Target Provider Types for Audits and Who Needs to Worry? | medicaidlaw-nc

  4. Pingback: Premature Recoupment of Medicare or Medicaid Funds Can Feel Like Getting Mauled by Dodgeballs: But Is It Constitutional? | medicaidlaw-nc

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: