tci ED Coding & Reimbursement Alert - 2012 Issue 4

ZPIC Functions

The primary goal of ZPICs is to investigate instances of suspected fraud, waste, and abuse. ZPICs develop investigations early, and in a timely manner, take immediate action to ensure that Medicare Trust Fund monies are not inappropriately paid. They also identify any improper payments that are to be recouped by the MAC. Actions that ZPICs take to detect and deter fraud, waste, and abuse in the Medicare Program include: Investigating potential fraud and abuse for CMS administrative action or referral to law enforcement; Conducting investigations in accordance with the priorities established by CPI's Fraud Prevention System; Performing medical review...

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