Elizabeth E. Hogue, Esq.
The Centers for Medicare and Medicaid Services (CMS) are now conducting ZPIC audits. ZPIC’s are conducted by Zone Program Integrity Contractors. Unlike RAC audits that target identification of overpayment and CERT audits that attempt to pinpoint improper payments, ZPIC audits focus on fraud in the Medicare Program. This means that ZPIC contractors can audit the integrity of all Medicare claims, both pre- and post-payment.
CMS has established seven ZPIC zones. Contracts have been awarded in three zones thus far, as follows:
Zone 5 – AdvanceMed: Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia
Zone 7 – SafeGuard Services: Florida, Puerto Rico, and the Virgin Islands
Zone 4 – Health Integrity: Texas, Colorado, New Mexico, and Oklahoma
ZPIC contractors are currently especially active in Zone 4.