1. Overview of ZPICs Curtis Watkins – Program Director
AdvanceMed Corporation
October 21, 2009
C S C. C O M

2. ZPIC: Zone Program Integrity Contractor
Replacing current Program Safeguard Contractors
Combined oversight of Medicare Parts A, B, DME, Home Health and Hospice
Potentially will combine oversight of Medicare Parts C and D
CMS will award 7 umbrella contracts with each containing 2 simultaneously awarded task orders
Task Order 1 is Medicare Parts A, B, DME, Home Health, and Hospice
Task Order 2 is Medicare/Medicaid Data Matching Projects
Future task orders will be awarded at CMS discretion for activities related to fraud, waste, and abuse detection and prevention

3. ZPIC Zone Alignment 6 3 1 2 1 2 - AdvanceMed 5 - AdvanceMed
Provide Task Order Org Chart.
5 - AdvanceMed
4 – Health Integrity, LLC 2
7 – SafeGuard Services LLC 1
Puerto Rico
U.S. Virgin Islands
*Other territories of Zone 1 include American Samoa, Northern Marianas Islands and Guam

4. ZPIC Zone 5 Awarded September 30, 2009
Transition period September 30 – December 15, 2009
Fully operational December 16, 2009 – November 30, 2014
10 states, including:
Alabama
Arkansas
Georgia
Louisiana
Mississippi
North Carolina
South Carolina
Tennessee
West Virginia
Virginia 4

5. ZPIC Zone 5 Offices located in: Nashville, Tennessee
Birmingham, Alabama
Little Rock, Arkansas
Baton Rouge, Louisiana
Raleigh, North Carolina
Baltimore, Maryland 5

6. ZPIC Statement of Work Highlights
Reactive and proactive identification of potential fraud, waste, and abuse
Data analysis
Evaluation of complaints
Referrals from law enforcement
Fraud alerts
Referrals from MACs and ACs
Support for law enforcement during investigation and prosecution of healthcare fraud cases
Medical review
Overpayment determination
Subject matter expert testimony
Fraud, waste, and abuse training for MAC and AC staff 6

7. Task Order 1 Medicare Parts A, B, DME, Home Health, and Hospice
Centralizes all Medicare fraud, waste, and abuse work under a single contractor
Transitions workload from 3 PSCs to 1 ZPIC in Tennessee
Focus is on cross-claims analysis and development of workload across multiple benefit types
AdvanceMed will house up to eight years of claims data for all benefit types for all beneficiaries and providers within the zone
Designates full-time Medical Director
Initial priorities will include:
Identity theft (beneficiary and provider)
Infusion therapy
DME
Benefits related to psychiatric services (A, B, Home Health, and Hospice)
CMS considering High Risk zones in Louisiana and North Carolina 7

8. Task Order 2 Medicare/Medicaid Data Matching Project
CMS plans to implement Medi-Medi projects in all 10 states in the zone
Medi-Medi combines all Medicare and Medicaid data for each state into a single data repository for proactive analysis
All Medicaid claim types, including children’s services and dental are included
All priorities are established by Steering Committee consisting of members from CMS, state Medicaid Program, OIG, FBI, US Attorney, DEA, IRS, and MFCU
Tennessee Medi-Medi project tentatively scheduled for implementation after September 1, 2010 8

9. ZPIC Facts
We are not reimbursed based on volume of referrals to law enforcement or value of overpayments determined or collected
ZPICs are administrative contractors with authority to:
Conduct prepay and/or postpay medical review
Conduct announced and/or unannounced onsite audits
Determine and refer actual or extrapolated overpayments for recoupment
Suspend provider payments, based on approval from CMS
Refer providers and beneficiaries to law enforcement
Conduct beneficiary interviews
Refer providers for exclusion from Medicare program
Providers are guaranteed appeal rights related to all overpayment determinations 9

10. AdvanceMed contact for ZPIC
Curtis Watkins
Deputy Zone Program Director/Benefit Integrity Manager