Part C Program Integrity Contractor (CPIC)
ID: 250475JType: 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/fa1f7fede53f40d28e44b8693b41c100/view
Timeline
    Description

    The Department of Health and Human Services, specifically the Centers for Medicare and Medicaid Services (CMS), is seeking qualified small businesses to support the Part C Program Integrity Contractor (CPIC) initiative aimed at combating fraud, waste, and abuse (FWA) in the Medicare Part C program. The CPIC will be responsible for conducting data analysis, audits, outreach, and education, while coordinating with CMS and other governmental entities to ensure the integrity of the Medicare Trust Fund. This opportunity is critical for enhancing program integrity and compliance monitoring within Medicare operations. Interested small businesses must submit their capability statements by January 21, 2025, and can direct inquiries to Charlene Barnes at Charlene.Barnes1@cms.hhs.gov or Jennifer Kuhn at jennifer.kuhn@cms.hhs.gov.

    Files
    Title
    Posted
    CPIC SOW 12.12.24_DRAFT SOW.docx
    The Part C Program Integrity Contractor (CPIC) is charged with detecting, deterring, and preventing fraud, waste, and abuse (FWA) in the Medicare Part C program. This document outlines the scope of work, responsibilities, and operational guidelines for the CPIC, emphasizing coordination with the Centers for Medicare & Medicaid Services (CMS) and other governmental entities. Key tasks include conducting audits of Medicare Advantage Organizations (MAOs), providing outreach and education, and analyzing data for compliance monitoring. Records management and retention protocols are critical, with requirements for maintaining files for ten years and ensuring proper disposal post-retention. The CPIC must also generate various reports, including Plan Sponsor Alerts and Peer Activity Reports, to aid in educating plan sponsors about FWA risks. Ongoing communication with stakeholders, responding to information requests, and engaging in training sessions are vital components of the CPIC's operation. Overall, the CPIC plays a pivotal role in safeguarding the Medicare Trust Fund by aggressively overseeing program integrity efforts and fostering collaboration among various stakeholders, thereby ensuring compliance with regulatory standards and enhancing the efficacy of Medicare operations.
    CPIC SSN_FINAL.docx
    The Centers for Medicare & Medicaid Services (CMS) issued a Sources Sought Notice (SSN) for potential small businesses to support the Part C Program Integrity Contractor (CPIC) aimed at combating fraud, waste, and abuse (FWA) in Medicare Part C. This initiative focuses primarily on data analysis, audits, outreach, and collaboration with Medicare Advantage Organizations (MAOs). Contractors should have relevant experience in analyzing Medicare Part C data, conducting healthcare audits, developing outreach materials, and identifying program vulnerabilities. Responses must detail the contractor's capabilities and include pertinent business information. This notice does not constitute a request for proposals (RFP) or obligate CMS to award a contract but serves as market research to fine-tune procurement strategies. Interested small businesses must submit capability statements by January 21, 2025, adhering to specific guidelines, while ensuring no proprietary information is included to avoid issues under the Freedom of Information Act (FOIA). This SSN underscores CMS's commitment to safeguarding the Medicare Trust Fund and enhancing program integrity through effective vendor partnerships.
    Lifecycle
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    Part C Program Integrity Contractor (CPIC)
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