G2 News-At-A-Glance: Better Oversight of Zone Program Integrity Contractors Could Improve Benefits of the Program

Zone Program Integrity Contractors (ZPICs) saved the Medicare program $250 million in 2012, but because of a lack of information provided to the Centers for Medicare and Medicaid Services (CMS), the agency cannot determine if more savings could have been achieved by ZPICS, according to a Government Accountability Office (GAO) report issued in October. CMS paid ZPICs $108 million in 2012, which was spent primarily on fraud case development. The missing information concerns the timeliness of ZPICs’ actions. The report questions if ZPICs could save more money by reducing the time it takes between identifying a suspect provider and taking actions to stop that provider from receiving potentially fraudulent Medicare payments; however, that information is not included in ZPIC reports to CMS about its activities. Generally ZPICs received good ratings in annual reviews, with five of six eligible for incentive rewards. The report recommends that CMS begin collecting and analyzing data on the timeliness of ZPIC actions and develop performance measures based on the data. The measures would be designed to more closely link ZPIC work to Medicare program integrity performance measures and goals. The report (GAO-14-111) is available on the GAO Web site at www.gao.gov.