Coordination and Referral to the UPIC

4.4.3 - Coordination and Referral to the UPIC (Rev. 11218; Issued: 01-27-2022; Effective: 02-28-2022; Implementation: 02-28- 2022) 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.