TPE vs SMRC vs UPIC
TPE is the MAC's Targeted Probe and Educate program. SMRC is the Supplemental Medical Review Contractor. UPIC is the Unified Program Integrity Contractor — the fraud-focused arm. Each has different goals and stakes.
Last reviewed May 24, 2026
Side by side
TPE (Targeted Probe and Educate)
MAC program that selects providers with high error rates or unusual billing patterns, reviews 20–40 claims per round, and offers one-on-one education between rounds.
Medicare Program Integrity Manual Ch. 3- Up to three rounds.
- Education between rounds is the named goal — not enforcement.
- Persistent failure can lead to 100% prepayment review or referral.
SMRC / UPIC
SMRC — Supplemental Medical Review Contractor performs nationwide medical review projects assigned by CMS. UPIC — Unified Program Integrity Contractor performs Medicare and Medicaid fraud, waste, and abuse investigations.
Medicare Program Integrity Manual Ch. 3, 4- SMRC: CMS-directed topical reviews. No education component.
- UPIC: fraud-focused. May involve law enforcement referral.
- Both can issue ADRs and refer overpayments.
When to use TPE (Targeted Probe and Educate)
- MAC letter referencing TPE and a sample of 20–40 claims — engage with the education offer between rounds.
When to use SMRC / UPIC
- Letter from SMRC or UPIC referencing a specific topic or fraud indicator — engage counsel; the stakes are higher.
Common mistakes
- Treating TPE as enforcement and getting adversarial — the program is education-first.
- Treating UPIC as a standard audit — it is fraud-focused, and counsel involvement is warranted from day one.
Sources
- CMS — Targeted Probe and Educatehttps://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/medical-review/targeted-probe-and-educate-tpe
- CMS — Supplemental Medical Review Contractorhttps://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/medical-review/smrc
- CMS — Unified Program Integrity Contractorshttps://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/upic
Related
Track contractor letters in the SRA readiness check
Open sra studio →D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
This comparison is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at CMS, HHS, OCR, eCFR, NIST, and the relevant payer or state regulator. Last reviewed May 24, 2026.