Home Health & Hospice Week

The first Zone Program Integrity Contractors (ZPICs) will be coming online shortly. Zone 7 ZPIC SafeGuard Services (SGS), which covers Florida, Puerto Rico, and the U.S. Virgin Islands, will be fully operational Feb. 1, says the contractor based in Miramar, Fla.

ZPICs "will eventually be responsible for ensuring the integrity of all Medicare claims under Parts A and B (hospital, skilled nursing, home health provider, and durable medical equipment), Part C (Medicare Advantage health plans), Part D (prescription drug plans), and Medi-Medi (Medicare-Medicaid) data matches," SGS says on its Web site. SafeGuard is a subsidiary of Herndon, Va.-based EDS.

ZPICs in seven zones will gradually take over program integrity functions from Program Safeguard Contractors (PSCs), the Centers for Medicare & Medicaid Services notes in Dec. 19 CR 6170 (Transmittal No. 278).

"The implementation of the ZPIC will streamline program integrity functions, allowing a single entity to address health care fraud and abuse across all claim types," SGS notes in the National Government Services January bulletin for providers. The ZPIC will combat fraud and abuse in home health, hospice,durable medical equipment, and other types of Part A and Part B claims.

The other ZPIC contract awarded so far has gone to Health Integrity, a subsidiary of Quality Health Strategies Inc., formerly known as the Delmarva Foundation for Medical Care. Health Integrity will cover Texas, Colorado, Oklahoma, and New Mexico, it says on its Web site. HI hasn't announced a start date.

More names: ZPICs will be free to use subcontractors, which could mean more unfamiliar names. "SGS will continue its partnership with IntegiGuard LLC as its subcontractor to perform medical record reviews, financial reviews, and education activities as it did as the incumbent PSC," the new ZPIC says in the NGS article. "To further optimize its operations, SGS will engage the services of several other subcontractors with specialized experience for various portions of the ZPIC work as well as engage a subcontractor to ensure operational standards are met."

Targets: The "new program integrity contractors ... will look at billing trends and patterns across Medicare," CMS noted when announcing the contracts in October. "They will focus on companies and individuals whose billings for Medicare services are higher than the majority of providers and suppliers in the community."