PRACTICE MANAGEMENT


ZPICs Newest Medicare audit program increases physician scrutiny


Thomas A. Clark, MD, left, a Brownsville phlebologist, and his attorney, Mark Chouteau, JD, are appealing a determination by the Zone Program Integrity Contractor (ZPIC) audit program. Following a ZPIC investigation, TrailBlazer informed Dr. Clark last year that he owes $800,000 for noncompliance with Medicare local coverage determination criteria.


“They didn’t find any evidence of fraud, but they wanted close to $1 million.”


BY CRYSTAL CONDE


Brownsville phlebologist Thomas A. Clark, MD, had never


heard of Zone Program Integrity Contractors (ZPICs) until two years ago. Today, he wishes he weren’t so familiar with the audit program. Dr. Clark has practiced in the Rio Grande Valley and participated in Medicare since 1978. In 2003, he started what he thought would be a part-time phlebology practice. He worked as a cardiac and general surgeon until 2005, then transitioned


September 2011 TEXAS MEDICINE 21


JIM LINCOLN


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