Payment Matters: RACs Bark, ZPICs Bite

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Please do not misunderstand. The Recovery Audit Contractors (RACs) are no teddy bears. However, more recently, the Zone Program Integrity Contractors (ZPICs) have been more active and causing more problems for Medicare providers and suppliers. There are several reasons why the ZPICs may be more worrisome than the RACs. Unlike the RACs, the ZPICs are tasked to identify Medicare fraud, waste, and abuse and may make referrals to other federal and state agencies. ZPICs may audit a statistical sample of post-payment claims and extrapolate the error rate to the full universe of claims to compute the overpayment amount...

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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