OIG Identifies Major Flaws in Contingency-Based Auditors Program

The Office of the Inspector General (OIG) has found problems with data provided to CMS by multiple Zone Program Integrity Contractors (ZPICs). ZPICs are contingency-based auditors tasked with recovering money for the Medicare program. In a report issued on Monday, the OIG said the data used by CMS to assess the performance of ZPICs were not accurate or uniform, resulting in reporting errors and inconsistencies.

OIG offered several recommendations to help CMS better assess ZPICs performance:

  1. Take steps to ensure accurate statistics and uniform reporting by ZPICs;
  2. Improve oversight of ZPICs by performing timely reviews of data to detect any anomalies in workload reporting;
  3. Utilize and report ZPIC statistics in ZPIC evaluations; and
  4. Ensure that ZPICs have all the data necessary to effectively carry out their program integrity activities.

Click here to read the OIG Report.

More information and resources are available on the NCMS Fraud and Abuse webpage at: https://www.compassionatecarenc.org/pages/fraud_abuse/fraud_abuse.html.


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