To oversee the integrity of all Medicare-related claims of providers, the Centers for Medicare & Medicaid Services (CMS) has established seven zones across the nation and hires Zone Program Integrity Contractors (ZPICs) to audit providers and suppliers to identify cases of suspected fraud in each zone.

Health Integrity serves as a subcontractor to AdvanceMed – the Zone 2 ZPIC encompassing Alaska, Arizona, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming.

As the ZPIC for this region, our team plays a key role in protecting the following Zone 2 Medicare services from fraud, waste, and abuse:

  • Medicare Part A Hospitals, Home Health, and Hospice
  • Medicare Part B Fee-For-Service, Office Visits, X-Rays, Blood Tests, Ambulance Services, etc.
  • Durable Medical Equipment (DME)
  • Medicare Medicaid Data Match Project—This partnership between Medicare and Medicaid enhances collaboration among state Medicaid agencies, CMS, and law enforcement officials to identify improper billing and utilization patterns throughout Alaska, Arizona, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming..

Our work in these efforts includes:

  1. Performing Data Analysis and Data Mining
  2. Supporting Law Enforcement through Requests for Information