The OIG has released a Report that shows inaccuracies and a lack of uniformity in data used by the ZPICs (Zone Program Integrity Contractors) resulting from system issues in CMS ARTS, ZPIC reporting errors, ZPICs’ interpretations of workload definitions, and inconsistencies in requests for information reports. Inaccuracies and lack of uniformity prevented the OIG from making a conclusive assessment of the ZPICs’ activities. However, the OIG noted that “the issues we identified present a serious obstacle to CMS in effectivelyoverseeing ZPIC operations.” The OIG also noted that some of these issues date back to problems the OIG first identified ten years ago.
It is refreshing to learn that at least one part of the government understands the continuing difficulties providers face in determining whether they have a clear overpayment, which would trigger repayment obligations. It is essential that providers get their compliance efforts right and fully understand what, in many cases, are complicated rules that come into play in the determination of whether an overpayment exists.”