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Zone Program Integrity Contractors (ZPICs) are federal contractors that work under the direction of the Centers for Medicare and Medicaid Services (CMS) to uncover fraudulent billings under Medicare. ZPICs have broad authority to conduct audits of Medicare-participating healthcare providers; and, following audits, ZPICs can directly impose sanctions and/or refer providers to CMS or the U.S. Department of Justice for further enforcement action.
Technically, ZPICs are tasked with identifying both overpayments and underpayments. Their “integrity” function is intended to ensure that both CMS and the providers that bill Medicare achieve fair outcomes. However, as “fee for service” contractors working with CMS, ZPICs are only financially incentivized to identify overpayments and seek recoupments, and this means that ZPIC audits usually only focus on determining whether these contractors can lodge accusations of fraud.