Zone Program Integrity Contractors (zpics), Zone Program Integrity Contractors (zpics)



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Zone Program Integrity Contractors (ZPICs),


ZPICs were called Program Safeguard Contractors (PSCs)

  • ZPICs were called Program Safeguard Contractors (PSCs)

  • 7 Zones:

    • Texas, Colorado and Oklahoma are in Zone 4
    • Health Integrity is the ZPIC for Zone 4
  • Contractor paid fixed rate ($84,928.432.00), but may receive bonus for quality

  • CMS paid over one half of a billion on ZPIC contracts



ZPIC reviews the following programs:

  • ZPIC reviews the following programs:

    • Medicare Part A—Hospitals, Home Health, and Hospice
    • Medicare Part B—Fee-For-Service, Office Visits, X-Rays, Blood Tests, Ambulance Services, etc.
    • Durable Medical Equipment (DME)
    • Medicare Medicaid Data Match Project—Partnership between state Medicaid agencies, CMS, and law enforcement officials to identify improper Medicare and Medicaid billing and utilization patterns


ZPIC tasks:



Examples of ZPIC abuses against providers:

  • Examples of ZPIC abuses against providers:

    • Deficient ZPIC Auditor Qualifications
    • Restrictions on Presence of Attorney or Corporate Officer
      • Audits are scheduled unannounced and auditors insist on employee interviews without allowing attorneys or corporate officer time to get to facility to monitor employee interviews




















Review usually starts based on data with CMS

  • Review usually starts based on data with CMS

  • Can arrive on very short notice (1 hour or less)

  • Unlimited number of records can be reviewed

  • Can put provider on 100% payment review




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