Circumvention of PPS

6.5.9 - Circumvention of PPS (Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20) If you suspect, during review of a claim associated with a transfer or readmission, that a provider of Medicare services took an action with the intent of circumventing PPS (as described in §1886(f)(2) of the Act) and that action resulted in unnecessary admissions, premature discharges and readmissions, multiple readmissions, or other inappropriate medical or other practices with respect to beneficiaries or billing for services, you shall make a referral to your Unified Program Integrity Contractor (UPIC).