The Medicare Drug Integrity Contractor (MEDIC) is tasked with managing fraud, waste, and abuse (FWA) activities related to Medicare Part D. The contractor will provide comprehensive services, including data analysis, audits of Medicare Advantage Prescription Drug (MA-PD) plans, and collaboration with the Centers for Medicare & Medicaid Services (CMS) and law enforcement. Key functions encompass conducting program integrity audits, generating reports, and managing communication through alerts and notifications tailored to plan sponsors.
The MEDIC must adhere to strict regulations concerning record retention, ensuring all documentation is maintained for a minimum of ten years, particularly concerning program integrity documentation. The performance also requires sophisticated file management and compliance with statutory guidelines, underscoring the protection of personal health information.
The MEDIC's operational framework facilitates a structured approach to detecting FWA, leveraging advanced analytics and collaboration with various stakeholders, including ongoing engagement during transitions between contractors. The overarching goal is to safeguard the Medicare Trust Fund through ongoing oversight, innovative data analyses, and robust education and outreach initiatives. This contract ultimately reflects the federal government's commitment to maintaining the integrity of healthcare services delivered under the Medicare program.
The Centers for Medicare & Medicaid Services (CMS) issued a Sources Sought Notice (SSN) to gauge the capabilities of small businesses for potential contract support in its Medicare Drug Integrity Contractor (MEDIC) services. The focus is on detecting, deterring, and preventing fraud, waste, and abuse (FWA) in Medicare Part D through comprehensive data analysis, auditing Medicare Advantage Prescription Drug (MA-PD) plans and stand-alone Prescription Drug Plan Sponsors (PDPs), as well as outreach and education to relevant stakeholders. Interested small businesses must demonstrate their capacity in specified areas, including healthcare data analysis and audit experience, while providing distinct business information. Responses should comply with submission guidelines and are not considered formal bids or solicitations. Moreover, the notice outlines confidentiality stipulations regarding proprietary information and compliance with the Freedom of Information Act (FOIA). This initiative aims to refine CMS's procurement strategy for MEDIC services, integral to safeguarding the Medicare Trust Fund and ensuring efficient oversight in healthcare programs.