Foley & Lardner LLP partner Judith Waltz is quoted in the article, “CMS Seems to Tee Up More UPIC Reviews for Medicaid; Extrapolation Is Decided Early,” in the Report on Medicare Compliance, published by the Health Care Compliance Association.
Waltz, who is co-chair of Foley’s Health Care Practice, offered insight on the Centers for Medicare & Medicaid Services’ (CMS) profile raising of unified program integrity contractors (UPICs) with a recently issued Medicaid Transmittal.
“These revised provisions serve as a reminder of the aggressive role the feds are taking in Medicaid enforcement,” said Waltz. She identified serval items in the transmittal of note, including that UPICs will decide to extrapolate error rates on the front end, before an audit is completed, which Waltz finds troubling.
Waltz said the new language in the transmittal means UPICs will develop an extrapolation strategy early on. “This seems to be inconsistent with the approach that CMS takes in Medicare that you look at the error rate that you have identified after the audit and then assess whether extrapolation is appropriate,” she explained. “Here it seems that the UPIC decides up front whether they will use extrapolation. That may, theoretically, improve the design of the audits, as they should be looked at for statistically valid random samples, but likely means that extrapolation will be applied to any error rate.”
Waltz added that it may be time for providers to revisit extrapolation requirements in their state Medicaid programs and remember they may differ from Medicare’s. “Sometimes people can get a little lackadaisical and think if something works for Medicare it works for Medicaid as well, but Medicaid is a different world and it’s different in every state,” she concluded.
