Navigating a Unified Program Integrity Contractor (UPIC) Investigation

Toni Elhoms

Toni Elhoms

Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD10-CM/PCS Trainer is a nationally known speaker and recognized subject matter expert on medical coding, reimbursement, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC. She holds multiple credentials with the American Health Information Management Association...
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Pre-recorded
60 Mins
Toni Elhoms

Healthcare is one of the most regulated and complex industries that exist. The government contracts with various private companies (Unified Program Integrity Contractor aka UPICs) to conduct various functions including (not limited to): investigating potential fraud and abuse, performing medical reviews, performing data analysis, identifying outliers and areas that require further investigation, suspending program payments, coordinating efforts with other UPICs, making referrals to law enforcement, etc. UPICs work on behalf of CMS to perform program integrity functions like detecting fraud, waste, and abuse (FWA) through sophisticated data mining and analysis. They operate as an extension of the government and have unique authority to suspend payments immediately. When a UPIC gets involved, things have clearly escalated!

This webinar will  discuss the various pathways involved in a UPIC investigation, primary objectives of the investigation, strategies for building a successful response, the importance of a qualified team, best practice tips, and so much more.

Webinar Objectives


This webinar will cover the role and functions of Unified Program Integrity Contractor (UPICs), highlight the objectives of a UPIC investigation, the various pathways the investigation can take, how to assemble a competent and qualified defence team, discuss best practices, and so much more!

Webinar Agenda


  • Understand the governing authorities involved in investigating healthcare compliance
  • Recall the UPIC investigation process
  • Recognize current UPIC trends and UPIC audit targets in healthcare compliance
  • Recall strategies for building a successful response during a UPIC investigation 
  • Understand the appropriate steps to take when undergoing a UPIC investigation

Webinar Highlights


  • Outline the governing authorities involved in investigating healthcare compliance
  • Review the various pathways involved in UPIC investigations
  • Discuss the current UPIC audit targets 
  • Deconstruct current UPIC trends in healthcare compliance
  • Discuss statistically valid sampling protocols
  • Review total universe of claims protocols 
  • Discuss the process of error rate extrapolation employed by UPICs
  • Discuss proactive compliance best practice tips

Who Should Attend


  • Medical Coding Specialists
  • Medical Billing Specialists
  • Medical Auditing Specialists
  • Private Practice Physicians
  • Managed Care Professionals
  • Operations Leadership
  • Practice Administrators
  • Office Managers
  • Compliance Officers/Committees  
To access this webinar, kindly reach out to our customer support team at support@complianceducator.com.

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