CMS Pub. 100-08, ch. 4, § 4.6

All leads and any new subjects that the UPIC determines warrant further investigation

shall be vetted through CMS for approval before advancing to an investigation. The

UPIC shall vet all applicable National Provider Identifiers (NPIs) and Provider

Identifiers associated with the provider or supplier’s tax identification number when

initially vetting the lead with CMS. The UPIC shall submit the lead on each subject to

CMS via UCM within two (2) business days of the UPIC determining that the lead

should be transitioned into an investigation.

For the submission to CMS, the UPIC shall submit subjects to the UCM queue for CMS

vetting, ensuring that each subject includes: NPI and the provider/supplier name.

The UPIC shall only open investigations into leads that have been approved by CMS.

Once CMS approves the lead, the subject will be marked with the vetting determination

date and determination type in UCM. If CMS instructs the UPIC to close the lead without

further action, the UPIC shall do so within two (2) business days. These subjects will be

marked with the HHS/OIG Vetting Determination Date in UCM with a red system ‘chip’.

If the screening results in a new investigation or becomes part of an existing

investigation, that screening information shall be included in the investigation file. If,

during a UPIC investigation, it is determined that additional subject(s) should be

incorporated into the ongoing investigation, the UPIC shall vet each additional subject

with CMS, using the approved CMS process described above, before implementing any

investigative actions related to the additional subject(s). For any new investigations, the

UPIC shall complete the appropriate updates in the UCM within seven (7) calendar days.