HIPAA established the Medicare Integrity Program (MIP). MIP was established to strengthen the Centers for Medicare & Medicaid Services’ (CMS’) ability to detect and deter potential fraud, waste, and abuse in the Medicare program. As part of this program, CMS created new entities, Program Safeguard Contractors (PSCs), to perform program integrity functions. Seven program integrity zones were created based on the newly-established MAC jurisdictions. New entities entitled Zone Program Integrity Contractors (ZPICs) were created to perform program integrity functions in these zones for Medicare Parts A, B, Durable Medical Equipment Prosthetics, Orthotics, and Supplies, Home Health and Hospice and Medicare-Medicaid data matching.
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.