Kelly Simonelli

Using PEPPER to Strengthen Medicare Compliance Across Healthcare Settings: A Practical Roadmap for Providers

The return of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides healthcare organizations with a valuable opportunity to identify potential billing, coding, utilization, and compliance risks before they become larger concerns. To help providers and healthcare professionals make the most of this resource, LW Consulting, Inc. (LWCI) has released a new whitepaper, Using PEPPER to Strengthen Medicare Compliance Across Healthcare Settings. The whitepaper explores how PEPPER data can be used to identify outliers,…

Why Reviewing the Open Payment Database Matters: A $46 Million Lesson

On August 10, 2026, the U.S. Department of Justice (DOJ) announced a pharmaceutical company that agreed to pay over $46 million to resolve criminal and civil allegations involving kickback schemes. What is a Kickback? The Centers for Medicare & Medicaid Services (CMS) defines a kickback as “the soliciting, offering, paying, or receiving of remuneration—in cash or in kind—to induce or in return for patient referrals, or for the generation of business involving any goods or…

UPIC Denials and the Inevitable Business Decision: Appeal or Pay? A Cautionary Tale

The following is based on a true story. Warning: This is not a bedtime story! Content may induce sleeplessness or even nightmares. The Initial UPIC Audit A busy wound care practice receives a Unified Program Integrity Contractor (UPIC) medical record request covering a small number of patients with multiple dates of service. The practice responds, producing the requested records and supporting documentation. A few months later, the decision arrives: 100% denial. While certainly not the…