Medicare Drug Integrity Contractor (MEDIC)
ID: 250474JType: Sources Sought
Overview

Buyer

HEALTH AND HUMAN SERVICES, DEPARTMENT OFCENTERS FOR MEDICARE AND MEDICAID SERVICESOFC OF ACQUISITION AND GRANTS MGMTBALTIMORE, MD, 21244, USA

NAICS

All Other Professional, Scientific, and Technical Services (541990)

PSC

SUPPORT- PROFESSIONAL: OTHER (R499)

Set Aside

Total Small Business Set-Aside (FAR 19.5) (SBA)

Original Source

https://sam.gov/opp/a0cd6111c3a946f0a97b03fbbbb252cc/view
Timeline
    Description

    The Department of Health and Human Services, specifically the Centers for Medicare and Medicaid Services (CMS), is seeking small businesses to support the Medicare Drug Integrity Contractor (MEDIC) initiative aimed at overseeing the Medicare Part D program. The primary objective of this procurement is to detect, deter, and prevent fraud, waste, and abuse (FWA) through comprehensive data analysis, audits of Medicare Advantage Prescription Drug (MA-PD) plans, and outreach and education efforts directed at stakeholders. This contract is crucial for maintaining the integrity of healthcare services under the Medicare program, ensuring the protection of the Medicare Trust Fund through effective oversight and innovative strategies. Interested small businesses are encouraged to respond to the Sources Sought Notice by demonstrating their capabilities in relevant areas, with inquiries directed to Charlene Barnes at Charlene.Barnes1@cms.hhs.gov or Jennifer Kuhn at jennifer.kuhn@cms.hhs.gov.

    Files
    Title
    Posted
    MEDIC SOW 12.12.24_DRAFT SOW.docx
    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.
    MEDIC SSN_FINAL.docx
    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.
    Lifecycle
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    Medicare Drug Integrity Contractor (MEDIC)
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