BC Advantage - 2018 Issue 1

The Truth about ZPICs: Why Oversight is Needed

ZPIC (Zone Program Integrity Contractors) letters are the ultimate stop and gulp in healthcare since they are typically focused on potential fraudulent matters. They are specifically charged by the Centers for Medicare and Medicaid Services (CMS) to data mine, identify, and investigate potentially fraudulent behavior.  However, they are required to comply with regulations and guidelines established by the Centers for Medicare and Medicaid Services (CMS) when it comes to making Additional Documentation Requests (ADRs) for pre-payment and post-payment reviews, initiation of Medicare Suspension of Payments (which can be a death knell for physician practices), and other areas for...

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