You might have heard of ZPIC, which stands for Zone Program Integrity Contractors. It covers different regions, or zones, of the United States. The Centers for Medicine and Medicaid Services, CMS for short, created ZPIC to investigate potential waste, abuse, and fraud of the Medicaid system.
There are four companies that currently handle ZPIC investigations. Most of them cover two zones each, even though some zones are not contiguous. Here is an overview of the agencies that provide ZPIC audit oversight, and the zones they are responsible for throughout the country.
Zones Covered by ZPIC
The areas covered by each zone mostly contain states bordering each other, though a few of them are not consistent. For instance, Zone 1 contains California, Nevada, and a few Pacific islands while Zone 2 covers the Pacific Northwest, Central America, and Alaska. Although you might normally think Alaska and the Pacific Northwest would include California and end up in the same zone, in this case, it isn’t.
Safeguard Services, LLC
Zones 1 and 7 fall under Safeguard Services, LLC. These zones include California, Nevada, Florida, Hawaii, and other US islands. California and Florida contain most of their offices with one of them in Puerto Rico. For those in California, however, this is the zone and the organization that is likely providing the audit oversight in your case.
NCI, Inc. covers the rest of the Pacific Northwest, Alaska, most of the central United States, and most of the south. They are one of the larger ZPICs with over 100 locations and 2000 employees and they perform more roles than auditing. NCI specializes in cybersecurity and other technological fields to assist in civilian and government protection. NCI’s headquarters is currently in Reston, Virginia.
Cahaba Safeguard Administrators
Cahaba Safeguard Administrators oversees Zones 3 and 6, which covers the northern United States and the northeastern seaboard states even though the company is based out of Alabama. CSA has been around for 70 years in total and started as an insurance company before becoming a Medicare contractor 35 years ago. CSA has spent the last 15 years as a ZPIC with its specialization in statistical analysis to give auditors all the data they need for their investigations.
Health Integrity, LLC
Health Integrity, LLC, based in Maryland, protects the interests of Zone 4. This zone is by far the smallest in scope, protecting Colorado, New Mexico, Oklahoma, and Texas. Texas is renowned worldwide for their medical prowess, so they have their work cut out for them. Health Integrity, LLC includes a staff made up of experts who have a wide range of specializations and experience.
Experienced ZPIC Audit Attorneys at Oberheiden, P.C.
A ZPIC audit can be overwhelming and scary. However, you don’t have to panic. Our attorneys have the experience and skill your company needs to successfully navigate a ZPIC audit. If you are being audited or need help with an appeal, contact the attorneys at Oberheiden, P.C. at (888) 727-5159 or complete our online contact form today.
Not all attorneys of Oberheiden, P.C. are licensed in California and nothing contained in here is meant to constitute the unauthorized practice of law.