Long-Term Care

ZPICs crack down on Medicare fraud and abuse

PPS Alert for Long-Term Care, September 1, 2009

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You may not have heard of Zone Program Integrity Contractors (ZPIC), but they will soon be responsible for fighting fraud and abuse in the Medicare program.

“One reason SNFs are largely unaware of the ZPIC transition is because CMS is months behind schedule in awarding contracts and implementing the program,” says William Mahon, consultant at Mahon Consulting Group in Great Falls, VA, and past president and CEO of the National Healthcare Anti-Fraud Association.

The first ZPICs awarded took on the work of two existing Medicare fraud and abuse auditors, Program Safeguard Contractors (PSC) and Medicare Drug Integrity Contractors (MEDIC), February 1. However, CMS has not released dates for the remaining ZPIC transitions.

Despite delayed implementation efforts, SNFs should understand how these new contractors expand the scope of fraud prevention and detection efforts and prepare for increased scrutiny of relationships between Medicare providers.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to PPS Alert for Long-Term Care.

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