US · guidance
CMS Pub. 100-08, ch. 4, § 4.4.3
Coordination and Referral to the UPIC
Throughout the monitoring of Home Health claims, the MAC shall coordinate with the
UPIC to determine if there is an open investigation concerning the HHA and appropriate
next steps. If there is an open investigation on the HHA, the MAC shall immediately
refer their findings to the UPIC and take no further action unless otherwise agreed upon.
A MAC may determine that an HHA’s misuse of NOAs and/or other conduct, such as an
HHA’s failure to respond to requests/queries during periods of increased monitoring,
CAPs, etc., warrants immediate referral to the appropriate UPIC. MACs and UPICs shall
coordinate in accordance with Pub 100-08, Medicare Program Integrity Manual, Chapter
4, Program Integrity and their Joint Operating Agreements.
History
(Rev. 11218; Issued: 01-27-2022; Effective: 02-28-2022; Implementation: 02-28- 2022)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c39c4f27737f3e9e550490bec94a3f43413932f324b688e56fda9227d5a4049f
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