Resumption of Payment to a Provider - Continued

4.7.7.1.1 - Resumption of Payment to a Provider - Continued Surveillance After Detection of Fraud (Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21) After completion of the investigation and appropriate legal action, all determined overpayments are recouped by either direct refund or offset against payments being held in suspense. Once recoupment is completed, UPICs shall release any suspended monies that are not needed to recoup determined overpayments and, if applicable, penalties. UPICs shall monitor future claims and related actions of the provider for at least 6 months, to assure the propriety of future payments. In addition to internal screening of the claims, if previous experience or future billings warrant, they shall periodically interview a sampling of the provider's patients to verify that billed services were actually furnished. If, at the end of a 6-month period, there is no indication of a continuing aberrant pattern, UPICs shall discontinue the monitoring.