The Zone Program Integrity Contractor (ZPIC) is an entity established in the United States by the

Centers for Medicare & Medicaid Services The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...

(CMS) to combat fraud, waste and abuse in the Medicare program.

Background

A Zone Program Integrity Contractor (ZPIC) is a company contracted by the CMS to assist in identifying and investigating abuse, fraud, or waste within the Medicare program. It was created as a result of the

Medicare Prescription Drug, Improvement, and Modernization Act The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health pro ...

of 2003, established seven zones throughout the United States to process Medicare claims, CMS created ZPICs to more effectively protect the Medicare program. ZPICs replaced Program Safeguard Contractors (PSC), which had been established by the Health Insurance Portability and Accountability Act of 1996.

References

Medicare and Medicaid (United States) {{med-org-stub