Which item is not listed as a ZPIC priority?

• A. Routine administrative adjustments
• B. Patient abuse or harm
• C. Multi-state fraud
• D. High dollar amounts of potential overpayment

Answer: (A)

ZPIC priorities are driven by clear signals of improper payments, focusing on fraud, waste, and abuse that indicate real risk or loss. The strongest targets are instances that show a pattern across time or locations and involve significant financial impact or direct harm to patients. Patient abuse or harm clearly signals a risk to individuals and often points to abusive practices that need immediate attention. Multi-state fraud reveals a coordinated scheme spanning more than one state, which is precisely the kind of cross-jurisdictional risk ZPICs look for. And high-dollar amounts of potential overpayment highlight substantial financial risk and the need to recover or prevent large losses.

Routine administrative adjustments, on the other hand, are typically normal, non-fraud-related corrections or clerical fixes within billing and claims processing. They don’t, by themselves, indicate a pattern of fraud, waste, or abuse, so they are not prioritized for ZPIC investigations.