Preparing for ZPIC Audits
Medicare fraud and abuse prevention and detection efforts are about to get tougher because of the new Zone Program Integrity Contractors (ZPIC). According to CMS, ZPICs were developed to fix flaws in the current Medicare program integrity system, which protects the Medicare program by preventing and detecting fraud and abuse. VGM’s Mark Higley has compiled an excellent document to understand the program titled “ZONE PROGRAM INTEGRITY CONTRACTORS AND AUDITS - Preparing for an Audit, How to Respond to a Review & FAQs”.
Summary: In conjunction with CMS' audit, oversight, and anti-fraud, waste, and abuse efforts, contracts are being awarded to independent vendors called “zone program integrity contractors”, or ZPICs. The ZPIC contractors will audit providers and suppliers of Part A, Part B, Part C, the Medicare prescription drug benefit (Part D), durable medical equipment, prosthetics, and orthotics supplier (DMEPOS), home health and hospice, and Medicaid services.