1|Page
AHFI (ACCREDITED HEALTH CARE FRAUD
INVESTIGATOR) EXAMINATION ACTUAL VERIFIED
EXAM COMPLETE QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR||NEWEST
EXAM!!
There are 5 Medicare Contractors for reviewing - Answer-
Medicare Administrative Contractors (MACs)
Zone Program Integrity Contractors (ZPICs)/ Program
Safeguard Contractors (PSCs)
Supplemental Medical Review Contractor (SMRC)
Comprehensive Error Rate Testing (CERT) Contractors
Medicare FFS Recovery Auditors
Medicare Administrative Contractors (MACs) - Answer-
Process claims submitted by physicians, hospitals, and
other health care professionals, and submit payment to
those providers according to Medicare rules and
,2|Page
regulations (includes identifying and correcting
underpayments and overpayments)
Zone Program Integrity Contractors (ZPICs)/Program
Safeguard Contractors (PSCs) - Answer-Perform
investigations that are unique and tailored to the specific
circumstances and occur only in situations where there is
potential fraud and take appropriate corrective actions.
Supplemental Medical Review Contrator (SMRC) -
Answer-Conduct nationwide medical review as directed by
CMS (includes identifying underpayments and
overpayments)
Comprehensive Error Rate Testing (CERT) Contractors -
Answer-Collect documentation and perform reviews on a
statistically valid random sample of Medicare FFS (fee for
service) claims to produce an annual improper payment
rate.
Medicare FFS Recovery Auditors - Answer-Review claims
to identify potential underpayments and overpayments in
Medicare FFS, as part of the Recovery Audit Program
,3|Page
ZPICS (MLN article) - Answer-The Health Insurance
Portability and Accountability Act (HIPAA) of 1996
established the Medicare Integrity Program (MIP). It was
established to strengthen CMS' ability to detect and deter
potential fraud, waste and abuse in the Medicare program.
Zones were created based on the MAC jurisdictions. New
entities entitled Zone Program Integrity Contractors
(ZPICs) were created to perform program integrity
functions in these zones for Medicare Parts A, B,
DMEPOS, Home Health and Hospice
**Medicare Part C and D program integrity efforts are
handled separately by one national contractor known as
the Medicare Drug Integrity Contractor (MEDIC). Health
Integrity, LLC is the current MEDIC)
ZPICs and MEDIC work under the direction of the Center
for Program Integrity (CPI) in CMS
ZPIC Zones - Answer-Zone 1 (Safeguard Services - SGS):
California, Hawaii, Nevada, American Samoa, Guam, and
the Mariana Islands
, 4|Page
Zone 2 (AdvanceMed): Washington, Oregon, Idaho, Utah,
Arizona, Wyoming, Montana, North Dakota, South Dakota,
Nebraska, Kansas, Iowa, Missouri, Alaska
Zone 3 (Cahaba): Minnesota, Wisconsin, Illinois, Indiana,
Michigan, Ohio, Kentucky
Zone 4 (Health Integrity): Colorado, New Mexico, Texas,
and Oklahoma
Zone 5 (AdvanceMed): Arkansas, Louisiana, Mississippi,
Tennessee, Alabama, Georgia, North Carolina, South
Carolina, Virginia, West Virginia
Zone 6 (Under Protest): Pennsylvania, New York,
Delaware, Maryland, D.C., New Jersey, Massachusetts,
New Hampshire, Vermont, Maine, Rhode Island,
Connecticut
Zone 7 (Safeguard Services (SGS): Florida, Puerto Rico,
Virgin Islands
AHFI (ACCREDITED HEALTH CARE FRAUD
INVESTIGATOR) EXAMINATION ACTUAL VERIFIED
EXAM COMPLETE QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR||NEWEST
EXAM!!
There are 5 Medicare Contractors for reviewing - Answer-
Medicare Administrative Contractors (MACs)
Zone Program Integrity Contractors (ZPICs)/ Program
Safeguard Contractors (PSCs)
Supplemental Medical Review Contractor (SMRC)
Comprehensive Error Rate Testing (CERT) Contractors
Medicare FFS Recovery Auditors
Medicare Administrative Contractors (MACs) - Answer-
Process claims submitted by physicians, hospitals, and
other health care professionals, and submit payment to
those providers according to Medicare rules and
,2|Page
regulations (includes identifying and correcting
underpayments and overpayments)
Zone Program Integrity Contractors (ZPICs)/Program
Safeguard Contractors (PSCs) - Answer-Perform
investigations that are unique and tailored to the specific
circumstances and occur only in situations where there is
potential fraud and take appropriate corrective actions.
Supplemental Medical Review Contrator (SMRC) -
Answer-Conduct nationwide medical review as directed by
CMS (includes identifying underpayments and
overpayments)
Comprehensive Error Rate Testing (CERT) Contractors -
Answer-Collect documentation and perform reviews on a
statistically valid random sample of Medicare FFS (fee for
service) claims to produce an annual improper payment
rate.
Medicare FFS Recovery Auditors - Answer-Review claims
to identify potential underpayments and overpayments in
Medicare FFS, as part of the Recovery Audit Program
,3|Page
ZPICS (MLN article) - Answer-The Health Insurance
Portability and Accountability Act (HIPAA) of 1996
established the Medicare Integrity Program (MIP). It was
established to strengthen CMS' ability to detect and deter
potential fraud, waste and abuse in the Medicare program.
Zones were created based on the MAC jurisdictions. New
entities entitled Zone Program Integrity Contractors
(ZPICs) were created to perform program integrity
functions in these zones for Medicare Parts A, B,
DMEPOS, Home Health and Hospice
**Medicare Part C and D program integrity efforts are
handled separately by one national contractor known as
the Medicare Drug Integrity Contractor (MEDIC). Health
Integrity, LLC is the current MEDIC)
ZPICs and MEDIC work under the direction of the Center
for Program Integrity (CPI) in CMS
ZPIC Zones - Answer-Zone 1 (Safeguard Services - SGS):
California, Hawaii, Nevada, American Samoa, Guam, and
the Mariana Islands
, 4|Page
Zone 2 (AdvanceMed): Washington, Oregon, Idaho, Utah,
Arizona, Wyoming, Montana, North Dakota, South Dakota,
Nebraska, Kansas, Iowa, Missouri, Alaska
Zone 3 (Cahaba): Minnesota, Wisconsin, Illinois, Indiana,
Michigan, Ohio, Kentucky
Zone 4 (Health Integrity): Colorado, New Mexico, Texas,
and Oklahoma
Zone 5 (AdvanceMed): Arkansas, Louisiana, Mississippi,
Tennessee, Alabama, Georgia, North Carolina, South
Carolina, Virginia, West Virginia
Zone 6 (Under Protest): Pennsylvania, New York,
Delaware, Maryland, D.C., New Jersey, Massachusetts,
New Hampshire, Vermont, Maine, Rhode Island,
Connecticut
Zone 7 (Safeguard Services (SGS): Florida, Puerto Rico,
Virgin Islands
