Preparing for ZPIC Audits



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.
 
  ZPICs will cover seven zones based on Medicare administrative contractors (MAC) jurisdictions. There are five “hot spot” zones: California, Florida, Illinois, New York and Texas. These “hot spots” align with Program Integrity field offices. There are two other zones covering states with limited incidence of fraud. The Contractors are organizations hired indirectly (or in connection with other CMS affiliated contractors) by CMS to perform a wide range of medical review, data analysis and Medicare evidence-based policy auditing activities. As of 1/2010, CMS has awarded only three of the seven ZPIC contracts  
    1. Health Integrity LLC for Zone 4 (Colorado, New Mexico, Oklahoma, and Texas)
    2. Advance Med for Zone 5 (Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia) —
    3. SafeGuard Services LLC for Zone 7 (Florida, Puerto Rico, and Virgin Islands. 
 
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