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

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

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

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

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

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

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

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

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

AdvanceMed contact for ZPIC Curtis Watkins Deputy Zone Program Director/Benefit Integrity Manager watkinsc@admedcorp.com