Workload data used by CMS to oversee Zone Program Integrity Contractors has been inaccurate and inconsistent, and this has led to several ZPIC reporting errors and inconsistencies within information reports, according to a report from the Office of Inspector General (pdf).
ZPICs perform Medicare Parts A and B program integrity work in different geographical zones. In its study, the OIG looked at the ZPICs that cover zone 4 (Colorado, New Mexico, Oklahoma and Texas) and zone 7 (Florida, Puerto Rico and the Virgin Islands), and it collected and reviewed their workload data, case referrals and other administrative actions from Feb. 1, 2009, to Oct. 31, 2009.
The OIG found that the lack of uniformity in ZPICs' reporting of data hindered their abilities to gather relevant statistics and negatively affected their abilities to carry out their program integrity activities, according to the report. Consequently, the OIG made four recommendations for CMS to enhance the ZPICs' functionality:
• Clarify the workload definitions in the analysis system to ensure that ZPICs' workload statistics are accurate and that ZPICs report their data uniformly.
• Improve oversight of ZPICs by performing a timely review of data for each ZPIC and across ZPICs to detect any anomalies in workload reporting.
• Utilize and report ZPIC workload statistics in ZPIC evaluations.
• Ensure that ZPICs have access to all data necessary to effectively carry out their program integrity activities.
ZPICs perform Medicare Parts A and B program integrity work in different geographical zones. In its study, the OIG looked at the ZPICs that cover zone 4 (Colorado, New Mexico, Oklahoma and Texas) and zone 7 (Florida, Puerto Rico and the Virgin Islands), and it collected and reviewed their workload data, case referrals and other administrative actions from Feb. 1, 2009, to Oct. 31, 2009.
The OIG found that the lack of uniformity in ZPICs' reporting of data hindered their abilities to gather relevant statistics and negatively affected their abilities to carry out their program integrity activities, according to the report. Consequently, the OIG made four recommendations for CMS to enhance the ZPICs' functionality:
• Clarify the workload definitions in the analysis system to ensure that ZPICs' workload statistics are accurate and that ZPICs report their data uniformly.
• Improve oversight of ZPICs by performing a timely review of data for each ZPIC and across ZPICs to detect any anomalies in workload reporting.
• Utilize and report ZPIC workload statistics in ZPIC evaluations.
• Ensure that ZPICs have access to all data necessary to effectively carry out their program integrity activities.
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