What is the focus of ZPIC’s audits?

The focus of ZPIC’s (Zone Program Integrity Contractors) audits is primarily on identifying and addressing fraud incidents within their designated service areas. ZPICs are specialized contractors that work with the Centers for Medicare & Medicaid Services (CMS) to investigate and mitigate fraudulent activities related to Medicare and Medicaid services.

Their primary goal is to protect the integrity of these programs by conducting audits and employing various investigative techniques to detect, prevent, and deter fraud. This includes reviewing claims, analyzing billing patterns, and closely examining provider practices to uncover any fraudulent behavior that may harm the program or patients.

The other options do not accurately reflect the mission of ZPICs. While they might audit a variety of healthcare providers, their audits are specifically aimed at fraud rather than being indiscriminate or solely focused on larger entities or consumer complaints. Walking through these activities, you can see how ZPICs fulfill their role in compliance and protecting program integrity.