This seems to be happening more and more often lately. Investigators and auditors working for Medicare's four Zone Program Integrity Contractors cite an error of care — or documentation of care — and demand repayment from a healthcare provider. Upon appeal, the payment is restored because the ZPIC employee misunderstood a pertinent rule, or mistakenly applied a hospital or physician rule to a home health claim, or completely made up a rule that never existed.
We wondered what it might be about the ZPIC working environment — training, salary, vacations, and management-employee relations — that would lead to such frequent errors. So we turned to the place where employees themselves could answer that question, online review sites.
This may not be entirely fair. Unhappy customers and employees tend to complain and happy customers and employees tend to keep quiet. Nevertheless, the way ZPIC employees talk about their employer and working environment reveals quite a lot about the skills and mental preparedness they bring to the task of examining your claims.
For your enlightenment, we compiled the following representative sample of comments from current and former employees of some of CMS's Zone Program Integrity Contractors. All comments are posted and available to the public, edited here only for clarity (apparently, grammar is not a ZPIC job requirement).
To improve efficiency and coordination of federal data analysis and audit/investigation work within each region, CMS is developing a Unified Program Integrity Contractor (UPIC) strategy. Under this strategy, Medicare and Medicaid program integrity audit and investigation work at the federal level will be consolidated into a single contractor within a defined multi-state area, which will complement audit and investigation efforts by states. This contractor will conduct Medicare, Medicaid, and Medi-Medi investigations and audits within designated geographic jurisdictions. In July 2013, CMS released a Request for Information and conducted an Industry Day targeted at gathering information from the vendor community on possible requirements for combining Medicare and Medicaid program integrity functions.
As a result, UPICs will perform many of the functions currently contracted to ZPICs and MICs. For CMS integrity contractors, this consolidation will result in more data and knowledge about healthcare claims and payments. For the provider community, this will mean increased and improved surveillance as well as the potential for more government scrutiny of claims payments by federal healthcare programs.
CMS awarded UPIC’s first task order to AdvanceMed for services in the contract vehicle’s Jurisdiction 1 area that encompasses Minnesota, Wisconsin, Illinois, Indiana, Michigan, Ohio, Kentucky, Iowa, Missouri, Nebraska and Kansas.
Further details on the GSA web site.
Utter laziness from upper management. CMS, our client, has no idea what they want. Too many changes to keep track. Everyone walks on pins and needles because management can't be trusted. Stay away, especially now that AdvancedMed has won the UPIC. Apply there. SGS is a dead zone now. People dropping like flies.
Safeguard Services ... has great benefits such as healthcare, sick leave and vacation. You are doing a great service for the Medicare Trust Fund and protecting everyone's future. It looks good on your resume. But that is it!
They DO NOT TRAIN you to do the job and expect you to read all the work instructions they've created, so they can tell you, "if you don't understand, read the work instructions!" Their so-called training is a one week session in which everything that would take you about one year to learn well, is read to you like a 5 year old! This is the only training they give you ... before giving you investigations.
CMS, the contractor, sets up extremely strict time frames and metrics for investigators to meet. They are nearly impossible to meet and extremely difficult to remember when you are new. Then, they blame you for not meeting the metrics, when they never gave you in depth training. If you must take a day off, they tell you, "CMS doesn't care if you were out." They expect you to come back and work over 40 hours a week just to catch up when you return, otherwise you get written up for not meeting the metrics!!!! I've been here for 4 years and seen so many innocent people be put on "improvement" plans and then quit, due to how difficult they make it for you during this 30-day plan they place you on.
Management from President down is unaccountable for anything; always point fingers at us investigators. They provide no training and unreasonable caseloads, and cause a stressful environment.
Work load is crazy and insane. It's a system that setting you up for failure. There is no such thing as work/life balance here.
Pros: Some team members are excellent, too bad they rarely remain with the company more than three years.
Cons: Client (CMS) constantly changing priorities and working requirements. Lack of focused direction from client. High turnover rate.
Advice to Management: Pay more attention to education, training and experience and less attention to who you would like to go to lunch with.
Pros: There are a few good employees that make the place less than horrific.
Cons: The company relies on winning a contract from CMS, so it is very stressful around the award time because you are not sure if they will give the contract to another company. Management only cares about making CMS happy and makes unreasonable deadlines to try and appease them; then they let everything go to Hell once CMS is off their backs. Nobody is held accountable for their lack of initiative and for the crap work they are doing. Everyone is miserable there. One year, we lost 20 people.
Advice to Management: Find other jobs so someone else can come in and actually care about the company and it's people.
Pros: The mission of the company is a noble one – fight fraud and abuse and protect the Medicare trust fund.
Cons: CMS has ADD. In recent years it has granted and pulled contracts from companies multiple times. SGS was on a Corrective Action Plan (CAP) from CMS and just recently got off of it. The work has been reduced to a dull, paper shuffling, bean counter, production oriented job, from what was once an interesting, sometimes exciting, thoughtful career.
This company has added only management positions in the last 2-3 years, promoting those managers from staff and then not back-filling staff. Then, when the parent company, HPE, has a Work Force Reduction (WFR), be prepared for SGS to do that as well, even when more staff is needed. We have had situations where an employee was placed on WFR, the same day a new employee was starting their first day!
Most managers employ fear-based tactics to harass, bully, micromanage, and threaten employees. Most staff work plenty of unpaid, unrewarded hours week after week. I am now an ex-employee and I can tell you that the negative reviews here are very much true.
Advice to Management: Not worth the time to tell. There has been much prior advice given and I can assure you none of it was heard.
When I joined SafeGuard Services 5-6 years ago, it was fun, exciting. I felt like I was contributing, making a difference in controlling fraud and waste in our Medicare system. Two years ago a new management team took control of SGS and I have never been so confused as to my daily function. The rules change on a daily basis. We have such a large turnover in employees.
Protecting the Medicare System could be a worthy cause but, OMG - it is a horrible place to work. There are about 6 managers in the Miramar office and each one is mean spirited, abusive and all around not decent human beings. If you like being insulted, intimidated and bullied while working in daily fear under unnecessary, manager-imposed stress, then this is the place for you. The managers will do whatever it takes to keep their own jobs, even throw you under a bus in a heartbeat.
Advice to Management: Quit!
Pros: Entering salary is not too bad. The SMEs in all areas are very friendly and willing to help. Some flexibility with work hours and bonuses. If you are self-motivated, you can develop great skills and make wonderful contacts to help in future employment.
Cons: Management is useless. They have been in their positions for decades and haven't had new ideas for most of those. They also are unwilling to fight for their employees in salary negotiations with Medicare or HP or to assert themselves generally with Medicare. Raises are virtually non-existent. There is almost no mobility within the organization. With management staff being so few in number and so entrenched there is no opportunity for advancement.
Advice to Management: Retire and allow others with more experience and new ideas to drive the company forward.
Benefits were great. The other investigators were professional and worked long hours for little or no recognition. Just a job.
Worst job I ever had. Worst management. Worst company policies. Micromanagement like I have never seen before. Management by intimidation. High turnover.
Advice to Management:
Wouldn't take any advice when I was there. No need to start giving advice now. Not willing to consider other views. No teamwork.
Great benefits, including plenty of PTO and unlimited sick days. My colleagues were among the nicest people I've ever met.
Low morale, high stress environment, constantly being threatened with losing the contract and being unemployed. Lack of communication, no real organization, caseload not spread evenly throughout investigators. If you can close cases fast you're gonna be expected to hold a high caseload to make up for the slackers in the office. Micro managing to the extreme due to the stress.
Advice to Management: You have great employees but you are losing them left and right because you don't appreciate them and they're all afraid of losing their jobs any day. Focus on the bigger picture and stop gigging the investigators for petty mistakes.
Nature of the work, ability to work from home once a week, unlimited sick time, but strictly monitored.
No raises, no training, upper management does not have managerial skills, favoritism, employees being harassed and disrespected. Lack of respect for employees from managerial staff. No open door policy. Bonus structure is extremely based on favoritism. Employee feedback is never requested but when required by company policy, it is ignored. Human Resources is non-existent. Legitimate complaints to HR or upper management by coworkers against manager wrongs results in no changes and the complainer will usually be let go.
Advice to Management:
Improve employee morale, provide raises, invest in training employees. Communicate with and support employees. Invest in working phones, faster network, etc. Hardworking employees who do their job are pushed out and weak employees that do nothing are left alone. If you notice that employees are quitting left and right, do something to stop it.
Parent company Hewlett Packard has decent benefits.
Misguided, incompetent management. Managers have little leadership skills, no compassion, no understanding and have never had to work investigations under the same unreasonable expectations they have imposed on investigators in the current environment. Everything is blamed on the customer/client. Employees feel harassed and intimidated by management.
Advice to Management:
"Because that's what the customer expects" is not good enough anymore. Your high turnover rate should be telling you something is not right. Managers need to be leaders not task masters.
Large salary discrepancies for veteran and newly hired employees doing the same work. Few, irregular, and low raises and bonuses, mostly going to the same individuals year after year. Management is acutely aware of these issues and year after year refuses to correct these unethical practices. Managers rely on fear-based management style. Constant fear of losing Federal contract, no control over work, no decision making ability. High stress, tight time-lines, human error is not tolerated, constant fear of job loss over minor errors. Management is top heavy with multiple layers and overlapping roles. High turnover of staff due to dissatisfaction.
Freedom to pursue your own work with relatively little supervision. Being actively involved with Medicare and Medicaid fraud detection is a positive experience professionally and personally. CEO seems to have his heart in the right place and wants to make SGS a quality work environment but middle management and the recent purchase by HP make it an impossible task.
Management is all but useless. Never worked for a more poorly managed company in three decades of work. They do not supervise or manage employees.
Since HP bought EDS, the SGS parent company, salaries have been cut and frozen. No incentive to stay. Even no salary increase if you get promoted from staff to manager! Bonuses seem to be used mostly to compensate for lack of salary increases rather as a reward for quality work.
Advice to Management:
Lower to middle managers need training on how to manage staff and projects.
You get a paycheck. I met a few friends in 5 plus years. The hours of operation were nice. You got free coffee. You were off for the major holidays.
WOW...were do I start? First and foremost, "management", if I must refer to them as management, must have gotten their degrees from a box of Cracker Jacks! "Management" personnel are VERY UNPROFESSIONAL!!!!!! A lot of back stabbing, inconsistencies, poor judgment, and lack of physically being at the office. There are some managers that work 5 hours away, some 3,000 miles away, and get to work from the comfort of their homes. How can you manage anything from home? Management would not accept any ideas from employees. It is their way or the highway! There are a lot of cliques and if you are not part of the right clique, you fear for your job. This is definitely a Good Ol' Boys place of employment! Some employees could do as they please and others could not! Very unfair, stressful, hostile work environment. A lot of GREAT people have left this place either on their own or were fired because of not being in the clique! Always walking on egg shells!
Advice to Management:
Get rid of all of them that have been causing the most problems and start fresh. The CEO is a horrible person and is out to get everyone that she can!
DO NOT...I REPEAT...DO NOT APPLY for a job here.
This has been a representative sampling of comments posted on GlassDoor.com
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org