OIG investigation raises conflict of interest concerns in ZPIC program

Regulators need to be more aggressive in identifying conflicts of interest among Medicare's fraud-fighting Zone Program Integrity Contractors (ZPICs), a new government report recommends.

The Centers for Medicare & Medicaid Services requires potential Medicare antifraud contractors to disclose possible conflicts of interest and strategies for mitigating them. But when officials from the Department of Health and Human Services Office of Inspector General reviewed these disclosures, they identified 1,919 business and contractual relationships as possible conflicts and 16 as actual conflicts, according to the report. In their review, OIG investigators looked at information from 18 offerors (companies that put in proposals for contracts) and 85 subcontractors within CMS.

These conflicts have the potential to undermine the impartiality of ZPICs and compromise CMS's efforts to protect Medicare, according to the OIG.

The report recommended that CMS create a formal written policy outlining how conflict-of-interest information provided by offerors should be reviewed by CMS staff, as well as devise a standardized form for reporting conflicts.

ZPICs, which have recently stepped up antifraud audits on nursing homes, are facing increasing scrutiny by lawmakers, and were one of the focuses of the American Health Care Association/ National Center for Assisted Living' s Congressional Briefing held this week in Washington, D.C.

Critics of ZPICs charge that they are abusing their authority and engaging in “stealth policymaking.”

Click here to read the OIG's report.