Question

Which entity provides benefit integrity investigations based on billing abnormalities identified by data analysis or allegations of fraud and abuse, as well as conducts reviews that will allow them to compare billing of Medicare claims to Medicaid claims known as the "Medi-Medi" program that helps to identify fraudulent activity between the two programs?

A. Medi-Medi Audit Contractors (MACs)
B. Recovery Audit Contractors (RACs)
C. Medicaid Integrity Contractors (MICs)
D. Zone Program Integrity Contractors (ZPICs)

Answer 1

Zone Program Integrity Contractors (ZPICs) are the entity that investigates billing abnormalities and fraud allegations in the Medicare and Medicaid programs, including running the 'Medi-Medi' program to identify fraudulent activity.

Step-by-step explanation:

The entity responsible for conducting benefit integrity investigations based on billing abnormalities and allegations of fraud and abuse in the context of Medicare and Medicaid, as well as carrying out the 'Medi-Medi' program, is known as the Zone Program Integrity Contractors (ZPICs). ZPICs are tasked with preventing and combating fraud, waste, and abuse within the Medicare and Medicaid programs. By conducting data analysis and comparative billing reviews, they help safeguard these essential healthcare programs from fraudulent activities.