Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.4.4

Providers on Zone Restrictions

Last amended: 2026Year: 2026Length: 144 wordsOfficial source
4.8.4.4 – Providers on Zone Restrictions (Rev. 13821; Issued:06-09-26; Effective: 02-26-26; Implementation: 02-26-26) To maintain the integrity of the investigation, UPICs generally, unless otherwise advised, do not respond to provider and supplier inquiries when the provider or supplier is placed on full zone restriction by law enforcement (LE). However, UPICs are encouraged to communicate with the LE contact in such situations to determine the best and appropriate course of action. For partial zone restrictions, UPICs may conduct certain investigative activities in accordance with directives by LE; however, communication and responses to inquiries regarding the case or status by the provider or supplier should not be conducted unless otherwise directed by LE. All communication between the UPICs/I-MEDIC and a provider, supplier, or their authorized representative, including receipt of inquiry, coordination with CMS, and response to the inquirer, shall be documented in the appropriate UCM CSE(s).
Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.4.4: Providers on Zone Restrictions | Justis AI