Recent Medicare ZPIC Audits Target Skilled Nursing Facilities For Prepayment Review

Zone Program Integrity Contractors (“ZPICs”) have essentially taken over the role formerly held by Program Safeguard Contractors to perform program integrity functions under Medicare, focusing on the detection and prevention of fraud, waste, and abuse. As part of the implementation of the Medicare Modernization Act for contracting reform, the Centers for Medicare & Medicaid Services (“CMS”) established seven program integrity zones for the ZPIC program based on the Medicare Administrative Contractor (“MAC”) jurisdictions.1 Each ZPIC is responsible for the early detection of suspected fraud, waste, and abuse in its own zone and may take several actions, including identifying potential overpayments to be referred to the MAC for recoupment.

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