As a result of the multiple layers of reviews now facing health care organizations it is imperative that health care organizations, and the departments involved, understand the roles of Medicare and Medicaid Improper Payment review entities. The "Alphabet Soup" of entities are: CERT, MACs, MICs, MIG, MIP, PERM, PSCs, RACs, ZPICs, QIOs and the OIG. A clear understanding of the types of claims, how the claims are selected, the volume of claims, and purpose of the reviews will assist organizations in identifying the impact on them; and how to proactively ensure compliance across the regulatory enforcement initiatives. Hospitals must strive for accuracy in service, billing, and coding. Hospitals must support integrity efforts and understand the overlap by auditors.