Zone Program Integrity Contractor audits, or ZPIC audits are conducted in the field of healthcare providers. The ZPIC audits were established by the Centers for Medicare and Medicaid Services to assess fraudulent Medicare and Medicaid claims and other illegal actions in the healthcare sectors.
The ZPIC audits are carried out by a private contractor responsible for investigating and identifying fraud. These audits are initiated when the contractor receives complaints or referrals. The contractors might also conduct a data analysis if a suspicious pattern seems to appear in a healthcare provider's functioning.
ZPIC audits are an excellent tool for the Government to collect information regarding various establishments. Once a healthcare provider has submitted their documents to the ZPIC, the Government might not take any further actions for several months or even years. The company must stay alert and work with a reputed attorney familiar with ZPIC audit cases since the establishment stands a risk of losing their license.
The healthcare providers who most commonly experience ZPIC audits include hospice companies, ambulance services, chiropractic services, private practices, etc. The ZPIC is not under any obligation to send a notice before the start of an investigation. They can appear without warning and demand various documents and records. Check out here to know more about zpic audits.